Ultrasound for Detection of Ascites and for Guidance of the Paracentesis Procedure: Technique and Review of the Literature

Abstract

Objective: To review the use of ultrasound (US) for the detection of free intraperitoneal fluid (ascites) and for the procedural guidance of the paracentesis procedure. Methods: Two clinical vignettes are presented to review the pertinent diagnostic, management and safety considerations associated with paracentesis. First, US techniques used for the identification of ascites and in the quantification of fluid pockets amenable to aspiration will be discussed. Next, the actual steps required for the performance of US-guided paracentesis will be covered. A review and analysis of the most current literature regarding US and paracentesis then follows. Conclusion: Current literature favors US-guided paracentesis over the traditional blind technique with a significant reduction in both the rate of unsuccessful aspiration of fluid and in the bleeding complications related to this procedure. Use of US for both the diagnostic and therapeutic management of ascites should be advocated as an essential skill for physicians and other health care providers caring for these patients.

Recommendations on the Use of Ultrasound Guidance for Adult Abdominal Paracentesis: A Position Statement of the Society of Hospital Medicine

“…Identification of abdominal wall blood vessels is most commonly performed with a high-frequency transducer using color flow Doppler ultrasound. 10,[13][14][15] A low-frequency transducer capable of color flow Doppler ultrasound may be utilized in patients with a thick abdominal wall.…”

“…[5][6][7][8][9][10] The most common serious complication of paracentesis is bleeding, although puncture of the bowel and other abdominal organs has also been observed. Over the past few decades, ultrasound has been increasingly used with paracentesis due to the ability of ultrasound to improve detection of ascites 11,12 and to avoid blood vessels 10,[13][14][15] and bowels. 16 Three-quarters of all paracenteses are currently performed by interventional radiologists.…”

Portal Vein Thrombosis and Gut Microbiota: Understanding the Burden

“…Ascites was graded on a scale of 0 (absence) to 3 (massive) according to amount of liquid : 1-mild ,<600 cc, 2-moderate 600-1500cc and 3-severe (massive) >1500-2000cc [17]. Esophageal varices were graded on a scale of 0 (absence) to 3 (large) according to Paquet classification [18].…”

Usefulness of ultrasound imaging in overhydrated nephropathic patients

“…Because of these limitations studies on IVC ultrasound to estimate volume status in dialysis patients have yielded conflicting results [5][6][7]. IVC ultrasound is certainly useful in assessing volume status, but its results should be put in the wider frame of all available clinical and ultrasound data, particularly about cardiac function-otherwise IVC diameters alone can be misleading.The second observation is about the statement that a study of the peritoneum in search of edema can also be performed with a high-frequency probe: it is certainly possible to identify superficial free fluid in this way, but only a low frequency probe has enough wavelength to scan deep regions of the abdomen and pelvis in search of free fluid [8]. Scanning with a linear probe risks to be insensitive, and the regular abdominal probe remains the preferred choice.…”

“…The second observation is about the statement that a study of the peritoneum in search of edema can also be performed with a high-frequency probe: it is certainly possible to identify superficial free fluid in this way, but only a low frequency probe has enough wavelength to scan deep regions of the abdomen and pelvis in search of free fluid [8]. Scanning with a linear probe risks to be insensitive, and the regular abdominal probe remains the preferred choice.…”