Hello all! This week’s VOTW is brought to you by myself!
Hospital course
A 10 year old female presented with severe abdominal pain after hitting her abdomen on a metal pole. The patient was hypotensive and her abdomen was diffusely tender with guarding. A bedside FAST exam was done.
In this RUQ view, we can see free fluid located adjacent to the liver tip. See the attached clip to see this in real-time!
In this LUQ view, we can see free fluid between the diaphragm and the spleen. The diaphragm is highlighted with the dotted white line. Also note the abnormal spleen architecture; the spleen appears to have varying echo intensity with irregular borders and a hypoechoic rim. See the attached clip to see this in real-time!
In this sagittal view of the bladder, we can see free fluid between the bowel and bladder. See the attached clip to see this in real-time!
In this transverse view of the bladder, we can see free fluid above the bladder. See the attached clip to see this in real-time!
Without a doubt this was a positive FAST!
Case Conclusion
The patient was quickly stabilized with IV fluids and pRBC transfusion. CT imaging showed a grade 3 splenic laceration and confirmed moderate amount of hemorrhage in the abdomen and pelvis. The patient was admitted to the PICU for observation.
FAST exam & Splenic laceration
· With every FAST exam it is extremely important to follow the liver until you have a good view of the liver tip, as fluid will likely collect there first.
· Remember, free fluid fills potential spaces between structures, so will have characteristically sharp edges! Free fluid will NOT have smooth edges and walls like physiologic structures do.
· In the LUQ view, any disruption of normal spleen architecture / echotexture could indicate a splenic injury. These include splenic lacerations, hematomas, and rupture.
Happy scanning!
Sono team
Resources to review:
· https://www.thepocusatlas.com/trauma-atlas
· https://www.acep.org/sonoguide/basic/fast
· https://www.ultrasoundcases.info/cases/abdomen-and-retroperitoneum/spleen/trauma-of-the-spleen/