title: Spontaneous rectus sheath hematoma: two variant cases.
abstract: We present two variant cases of spontaneous rectus sheath hematoma (SRSH). A 71-year-old woman presented with ST elevation myocardial infarction and was found to have multivessel coronary artery disease. She was treated with aspirin, clopidogrel, eptifibatide, and heparin. Heparin was continued while preoperative workup for coronary artery bypass grafting was done. She developed a large 20x10 cm actively bleeding SRSH while on heparin. It was surgically evacuated. The second case represents an atypical cause of SRSH. A 64-year-old woman with Wegener's Granulomatosis presented with anemia and abdominal pain. Abdominal CT showed a large 22 cm SRSH without active bleeding that was treated conservatively. Both patients did well on follow-up. The incidence of SRSH is likely to increase in the coming years with the increasing use of antithrombotic agents for many disease processes. Clinicians should be aware of typical and atypical presentations of SRSH and its variant management options.
authors.affiliation: Department of Internal Medicine at East Tennessee State University in Johnson City, Tennessee.
authors.forename: Kamesh
authors.initials: K
authors.lastname: Sivagnanam
authors.affiliation: Department of Internal Medicine at East Tennessee State University in Johnson City, Tennessee.
authors.forename: Vatsal
authors.initials: V
authors.lastname: Ladia
authors.affiliation: Department of Cardiology at East Tennessee State University in Johnson City, Tennessee.
authors.forename: Vedang
authors.initials: V
authors.lastname: Bhavsar
authors.affiliation: Department of Internal Medicine at East Tennessee State University in Johnson City, Tennessee.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Summers
authors.affiliation: Department of Cardiac Rehabilitation and Prevention at East Tennessee State University in Johnson City, Tennessee.
authors.forename: Timir
authors.initials: T
authors.lastname: Paul
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D000368:Aged; D000740:Anemia / Q000000981:diagnostic imaging / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000000981:diagnostic imaging / Q000628:therapy; D006406:Hematoma / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants