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