Trauma and COVID-Induced Severe Rhabdomyolysis

The novel coronavirus COVID-19 has been implicated in a number of extra-pulmonary manifestations including rhabdomyolysis. It is hypothesized to be secondary to direct muscle damage from the virus. The usual treatment of rhabdomyolysis is resuscitation with aggressive fluid management to prevent acute renal failure. However, the combination of blunt thoracic trauma and COVID pneumonia has posed additional challenges for critical care management. A 68-year-old male presented to our institution after being found down for an unknown duration of time. He was diagnosed symptomatic COVID pneumonia. His traumatic injuries included 4 rib fractures, a rectus sheath hematoma, and rhabdomyolysis with a creatinine kinase (CK) level of 16,716 U/L. He was initially treated with steroids, prone positioning, and aggressive fluid administration. Despite treatment his CK level peaked at 146,328 U/L. Here we present the case of trauma and COVID-induced rhabdomyolysis with an extremely elevated CK level.

Fatal rectus sheath hematoma: a rare autopsy phenomenon

Background Rectus sheath hematoma is a condition where blood is accumulated within the sheath of the rectus abdominis muscle. It is caused by the rupture of either the superior or inferior epigastric artery or from a direct tear of the rectus muscle itself. This condition is usually self-limiting and most of the time, the hematoma is small, non-expanding and can be reabsorbed spontaneously over time. However, certain underlying pathology may lead to the expansion of the hematoma or even a recurrence, and without any medical treatment or intervention, this condition can even be fatal. Due to its rarity, only a few published cases of fatality associated with rectus sheath hematoma are reported worldwide. Case presentation We present a case of non-traumatic fatal rectus sheath hematoma in the presence of underlying lung infection. The deceased complained of abdominal pain 2 days prior to death with a history of prolonged cough. The autopsy revealed the presence of a hematoma within the rectus sheath of the left lower quadrant of the abdomen extending down into the left pelvis and a multitude of small yellow-tan firm lesions scattered throughout the parenchyma of the right lung, suggestive of a lung infection which was later confirmed histologically. Conclusions The case serves to increase awareness of fatal rectus sheath hematoma as a cause of death given its rarity in forensic medicine practice. The importance of a thorough post-mortem examination is the key to noticing the fatal hematoma since its enclosed location within the rectus sheath may be obscured to the eye of an inexperienced prosector.

Rupture of the left rectus abdominis muscle due to COVID-19 related cough

Throughout the coronavirus disease 2019 pandemic, patients using oral anticoagulants for mechanical valve replacement and/or another clinical-pathological condition might have faced various clinical scenarios. Rectus sheath hematoma is one of the acute abdominal pain syndromes. This study presented a patient with developed anticoagulation-induced rectus sheath hematoma after mitral valve replacement.