Abdominal pain and swelling

doi:10.1136/bmj.b2870

Published 5 August 2009, doi:10.1136/bmj.b2870
Cite this as: BMJ 2009;339:b2870

Endgames

Case report

Abdominal pain and swelling

Saeed Mirsadraee, specialist registrar in radiology, David Kessel, consultant radiologist

¹ Radiology Academy, Leeds General Infirmary, Leeds LS1 3EX

niloogan@yahoo.co.uk

The first 150 words of the full text of this article appear below.

A 78 year old woman presented with a sudden onset tender palpablelump just to the right of the midline in the infraumbilicalregion. The patient was taking warfarin for previous prostheticheart valve surgery. No history of trauma was present. An ultrasoundexamination showed a cystic mass with echogenic sediment inthe rectus abdominis muscle. Two days later, the patient’sabdominal pain increased, her abdomen became distended, andshe became hypotensive with a blood pressure of 75/45 mm Hgdespite fluid resuscitation. Blood tests showed a drop in haemoglobinconcentration—from 100 g/l to 70 g/l—and an increasein serum creatinine—from normal (45-90 µmol/l) to230 µmol/l over the two day period. The patient had aninternational normalised ratio (INR) of 7.