Test Yourself

Case 2

HISTORY

Blunt trauma to the upper abdomen

ULTRASOUND FINDINGS

There is free fluid seen in the RUQ view (Morrison's pouch). There is no fluid seen in the LUQ. There was no fluid seen in the pelvis (not shown). The spleen has an irregular wedge shaped, hypoechoic area.

DISCUSSION

The distribution of free fluid does not necessarily indicate the site of injury. Usually, it depends more on how the patient has been positioned - if they have been standing, it may all be in the pelvis, for example. In this case, although the fluid is all in the right upper quadrant, the injury is on the left.

Although solid organ injury may occasionally be seen on EFAST scanning, remember it is not sensitive for this (therefore, do not rule out injury on the basis of a normal scan). EFAST is very accurate for the correct question (= "is there significant fluid in the peritoneal cavity?"), but not for the wrong question (= "is there any abdominal injury?").

SUBMITTED BY

Adrian Goudie


RUQ view

RUQ view

There is fluid in Morrison's pouch
RUQ view LUQ view Spleen Spleen