Presentation
Acute right lower quadrant pain, vomiting. Palpable solid lesion in this area.
Patient Data
CT of the abdomen demonstrates lobulated hyperdense structure within the sheath of right rectus abdominis muscle with no obvious enhancement.
Other organs are unremarkable.
Also, there is a prosthetic mitral valve.
Mitral valve prosthesis (red arrow). Rectus sheath non-enhanced mass (yellow arrows).
Case Discussion
This patient has anamnesis of mitral valve replacement and she takes warfarin (anticoagulant) as life-long supportive therapy. But last 2 months she didn't check INR (International normalized ratio - lab test that times the clotting of blood, ideally it should be performed every 4 weeks ).
So, this rectus sheath mass is hematoma as a complication of warfarin therapy.