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1. Abdominal wall hematoma
The patient was diagnosed with an abdominal wall hematoma. The following figures demonstrate the hematoma in CT (Figure 2) and still image of the ultrasound (Figure 3).
Figure 2. Transverse CT scan view of the pelvis demonstrating abdominal wall hematoma (H).
Figure 3. Transverse bedside ultrasound still image of the pelvis with abdominal wall hematoma (H) and clot (C).
Both are labeled with H-Hematoma. Clot is demonstrated with C on the ultrasound. Note the improved resolution of ultrasound in demonstrating the texture of the clot. The patient was resuscitated with fluid and blood, the heparin was discontinued, and the shock resolved.
Hematomas with fresh blood are typically hypoechoic. However, clotted blood may have the appearance of stranding, or organized clots. In larger cavities, bleeding may demonstrate a hematocrit sign due to layering red blood cells after time (1). The hematocrit sign is a gradient of increased, gravity dependent echogenicity seen with layering blood after a hemorrhage within a body cavity.
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