title: [Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants].
abstract: OBJECTIVE
  To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy.
  
  
  METHODS
  CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed.
  
  
  RESULTS
  All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted.
  
  
  CONCLUSIONS
  Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.
authors.affiliation: CHU Brabois.
authors.forename: A
authors.initials: A
authors.lastname: Blum
authors.forename: P
authors.initials: P
authors.lastname: Bui
authors.forename: H
authors.initials: H
authors.lastname: Boccaccini
authors.forename: L
authors.initials: L
authors.lastname: Bresler
authors.forename: M
authors.initials: M
authors.lastname: Claudon
authors.forename: P
authors.initials: P
authors.lastname: Boissel
authors.forename: D
authors.initials: D
authors.lastname: Régent
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017568:Rectus Abdominis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants
vernacular_title: Imagerie des formes graves de l'hématome des grands-droits sous anticoagulants.