Sudden onset of abdominal mass

The patient was a 58-year-old man with a tobacco habit of 20 cigarettes/day, ischemic cardiomyopathy and chronic obstructive pulmonary disease. He came to the Emergency Department due to the sudden appearance of a mass in the right abdomen after a fit of coughing. He was admitted with BP 125/75 mmHg and 102 bpm, and we observed a large mass in the right flank and hypochondrium during physical examination. The lab work showed hemoglobin 13.3 mg/dL and hematocrit 37.29%. A simple abdominal radiograph showed no alterations. Meanwhile, computed tomography of the abdomen with intravenous contrast revealed a large hematoma of the right rectus abdominis muscle sheath measuring 20 cm×14cm×70 cm with signs of active bleeding (Figs. 1 and 2).

Fig. 1

Fig. 2