Ultrasound Case 008

Presentation

A 49 year old cyclist hit by a car complains of abdominal pain, worst in his left upper quadrant.

Right Upper Quadrant (RUQ)
View 2
Left Upper Quadrant (LUQ)
View 3
Pelvis

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: RUQ: There is a large amount of anechoic free fluid in the right upper quadrant. A small cortical right renal cyst is present.

Image 2: LUQ: The spleen and left kidney are clearly seen. There is no fluid in the lienorenal angle – between the spleen and kidney. There is heterogeneous echogenic and anechoic material adherent to the outer convex splenic border. This has the typical appearance of acute blood clot.

Image 3: Pelvis: There is a very small amount of free fluid seen in the longitudinal view of the pelvis.


CLINICAL CORRELATION

Splenic laceration and intra-abdominal free fluid.

When a patient is bleeding from a splenic injury and is kept supine it is not uncommon for minimal fluid to accumulate in the pelvis.

Acute blood in the left upper quadrant clots creating the heterogeneous material seen here layering the convex surface of the spleen. The more anechoic non-clotted blood typically collects in Morrison’s pouch in the right upper quadrant.

I compare this to blood in a clotting tube – clot forms creating a gelatinous solid mass and serum remains. The heterogeneous clot tends to stay at the site of bleeding and the anechoic more serum like component is seen in other regions of the abdomen.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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