Image Interpretation: There is disruption of the normal echotexture of the left rectus abdominis muscle with a focal deep hypoechoic defect, consistent with a partial thickness muscle tear with associated intramuscular hematoma contained within the muscle sheath. The hyperechoic peritoneal line is visualized deep to the abdominal wall musculature and appears intact. The right rectus abdominis muscle demonstrates normal echotexture and architecture for comparison.
Teaching Pearl: Clinical suspicion for rectus abdominis tear may be guided by injury mechanism, especially sudden eccentric contraction or bracing of the abdominal wall. Ultrasound can confirm focal disruption of rectus muscle echotexture, identify intramuscular hematoma, and show whether the rectus sheath and deep peritoneal line remain intact.
An important point to remember is to avoid overcalling a musculoskeletal injury when abdominal pain is severe, progressive, atraumatic, or associated with systemic or intra-abdominal symptoms. Ultrasound is excellent for confirming abdominal wall injury, but clinical red flags still require broader evaluation.
References:
1. Manske RC, Wolfe C, Page P, Voight M. Diagnostic musculoskeletal ultrasound in the evaluation of the rectus abdominis. Int J Sports Phys Ther. 2025;20(10):1557-1563. doi:10.26603/001c.144822
2. Connell D, Ali K, Javid M, Bell P, Batt M, Kemp S. Sonography and MRI of rectus abdominis muscle strain in elite tennis players. AJR Am J Roentgenol. 2006;187(6):1457-1461. doi:10.2214/AJR.04.1929
3. Copley M, Johnson SC. Abdominal wall muscle injuries in athletes. Curr Phys Med Rehabil Rep. 2023;11(2):235-241. doi:10.1007/s40141-023-00402-w