IntroductionThe focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation.MethodsWe analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency physicians at a Level I trauma center from January 2012 – June 2013. Ultrasound fellowship-trained faculty with three emergency medicine residents reviewed all FAST exams. We excluded studies if they were incomplete, of poor image quality, or with incorrect medical record information. Positive studies were assessed for FF localization, comparing the traditional abdominal views and on a sub-quadrant basis: right upper quadrant (RUQ)1 - hepato-diaphragmatic; RUQ2 - Morison’s pouch; RUQ3 - caudal liver edge and superior paracolic gutter; left upper quadrant (LUQ)1 - splenic-diaphragmatic; LUQ2 - spleno-renal; LUQ3 – around inferior pole of kidney; suprapubic area (SP)1 - bilateral to bladder; SP2 - posterior to bladder; SP3 – posterior to uterus (females). FAST results were confirmed by chart review of computed tomography results or operative findings.ResultsOf the included 1,008 scans, 48 (4.8%) were positive. The RUQ was the most positive view with 32/48 (66.7%) positive. In the RUQ sub-quadrant analysis, the most positive view was the RUQ3 with 30/32 (93.8%) positive.ConclusionThe RUQ is most sensitive for FF assessment, with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ.
Cysticercosis is an emerging disease in the United States. Neurocysticercosis may rarely cause disease within the spinal cord, but the occurrence of such pathology can produce debilitating symptoms for patients. We present the second report in the literature of intramedullary spinal neurocysticercosis presenting with a Brown-Sequard syndrome.
Pleural effusions are a common finding in emergency departments, with cytologic analysis traditionally required for definitive diagnosis. This article describes a classic sonographic appearance of tuberculous pleural effusion.
CitationLindquist B, Perera P, Chao A, Lobo V, Gharahbaghian L. Hemorrhagic contents within uterine sac mimicking intrauterine pregnancy on point-of-care ultrasound: A case report of a ruptured ectopic pregnancy [Video].
Case ReportPage 11
ABSTRACTWe present a case of a female patient who presented to the emergency department (ED) with lower abdominal pain and was found to have a ruptured ectopic pregnancy with hemorrhagic uterine contents mimicking a fetal pole on bedside transabdominal point-of-care ultrasound (POCUS). The case reinforces the importance of accurately interpreting the transabdominal pelvic POCUS for potential mimics of an intrauterine pregnancy. In addition, the case also emphasizes the performance of an abdominal ultrasound for free fluid assessment in the right and left upper quadrants to evaluate for free fluid in patients with concerns for a ruptured ectopic pregnancy.
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