Role of US in the Diagnosis of Intraabdominal Catastrophes1
Kimberley L. McKenney, MD
1 From the Department of Radiology, Duke University Medical Center, Erwin Rd, Durham, NC 27710. From the Plenary Session, Friday Imaging Symposium: Acute Radiology—Where Minutes Count, at the 1998 RSNA scientific assembly. Received March 15, 1999; revision requested May 4 and received June 2; accepted June 8. Address reprint requests to the author.
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Figures 1, 2. (1) Intraperitoneal hemorrhage in the subhepatic space in a 20-year-old woman following a motor vehicle accident. Transverse US image demonstrates fluid in the subhepatic space (Morison pouch) (*). (2) Intraperitoneal hemorrhage in the pelvis of a 30-year-old woman following a motor vehicle accident. Longitudinal US image shows fluid in the pouch of Douglas. Bowel loops are outlined posteriorly (arrows).
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Figures 1, 2. (1) Intraperitoneal hemorrhage in the subhepatic space in a 20-year-old woman following a motor vehicle accident. Transverse US image demonstrates fluid in the subhepatic space (Morison pouch) (*). (2) Intraperitoneal hemorrhage in the pelvis of a 30-year-old woman following a motor vehicle accident. Longitudinal US image shows fluid in the pouch of Douglas. Bowel loops are outlined posteriorly (arrows).
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Figure 3a. Calculation of the hemoperitoneum score in a clinically unstable 45-year-old man with a large amount of free intraperitoneal fluid. The patient had been involved in a motor vehicle accident as a pedestrian. (a) Longitudinal US image of the pelvis reveals the largest collection of fluid, whose depth (9 cm) was determined by measuring the fluid from anterior to posterior. * = partially distended bladder. (b) Longitudinal US image of the Morison pouch shows only one additional site that demonstrated fluid. One point was added for this site, resulting in a hemoperitoneum score of 10 (9 + 1). (c) Transverse US image of the spleen shows heterogeneous parenchyma with loss of normal organ contour superiorly (arrows), a finding that is consistent with splenic rupture and perisplenic clot. Emergency splenectomy was performed.
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Figure 3b. Calculation of the hemoperitoneum score in a clinically unstable 45-year-old man with a large amount of free intraperitoneal fluid. The patient had been involved in a motor vehicle accident as a pedestrian. (a) Longitudinal US image of the pelvis reveals the largest collection of fluid, whose depth (9 cm) was determined by measuring the fluid from anterior to posterior. * = partially distended bladder. (b) Longitudinal US image of the Morison pouch shows only one additional site that demonstrated fluid. One point was added for this site, resulting in a hemoperitoneum score of 10 (9 + 1). (c) Transverse US image of the spleen shows heterogeneous parenchyma with loss of normal organ contour superiorly (arrows), a finding that is consistent with splenic rupture and perisplenic clot. Emergency splenectomy was performed.
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Figure 3c. Calculation of the hemoperitoneum score in a clinically unstable 45-year-old man with a large amount of free intraperitoneal fluid. The patient had been involved in a motor vehicle accident as a pedestrian. (a) Longitudinal US image of the pelvis reveals the largest collection of fluid, whose depth (9 cm) was determined by measuring the fluid from anterior to posterior. * = partially distended bladder. (b) Longitudinal US image of the Morison pouch shows only one additional site that demonstrated fluid. One point was added for this site, resulting in a hemoperitoneum score of 10 (9 + 1). (c) Transverse US image of the spleen shows heterogeneous parenchyma with loss of normal organ contour superiorly (arrows), a finding that is consistent with splenic rupture and perisplenic clot. Emergency splenectomy was performed.
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Figure 4a. Small fluid collection in an 18-year-old man who was clinically stable following a motor vehicle accident. (a) Longitudinal US image shows 1 cm of fluid adjacent to the spleen (the width of fluid is determined in small, curvilinear collections). No additional areas demonstrated fluid, resulting in a hemoperitoneum score of 1. (b) Longitudinal US image of the spleen obtained lateral to a shows a hyperechoic region (arrow), a finding that is consistent with parenchymal injury. (c) Helical CT scan helps confirm the splenic injury (arrows). The patient was successfully treated nonsurgically.
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Figure 4b. Small fluid collection in an 18-year-old man who was clinically stable following a motor vehicle accident. (a) Longitudinal US image shows 1 cm of fluid adjacent to the spleen (the width of fluid is determined in small, curvilinear collections). No additional areas demonstrated fluid, resulting in a hemoperitoneum score of 1. (b) Longitudinal US image of the spleen obtained lateral to a shows a hyperechoic region (arrow), a finding that is consistent with parenchymal injury. (c) Helical CT scan helps confirm the splenic injury (arrows). The patient was successfully treated nonsurgically.
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Figure 4c. Small fluid collection in an 18-year-old man who was clinically stable following a motor vehicle accident. (a) Longitudinal US image shows 1 cm of fluid adjacent to the spleen (the width of fluid is determined in small, curvilinear collections). No additional areas demonstrated fluid, resulting in a hemoperitoneum score of 1. (b) Longitudinal US image of the spleen obtained lateral to a shows a hyperechoic region (arrow), a finding that is consistent with parenchymal injury. (c) Helical CT scan helps confirm the splenic injury (arrows). The patient was successfully treated nonsurgically.
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Figure 5. Laceration of the liver in a 25-year-old man who had suffered a fall. Longitudinal US image of the right upper quadrant reveals a localized area of increased echogenicity in the liver (arrows), a finding that is compatible with a liver laceration.
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Figure 6a. Intraparenchymal hemorrhage in a 40-year-old man who sustained injuries in a motor vehicle accident. (a) Transverse US image of the liver reveals heterogeneous parenchyma with a central anechoic area (arrow). (b) Helical CT scan helps confirm the hepatic laceration and demonstrates an area of active contrast material extravasation (arrow). The diagnosis was confirmed at angiography, and the patient underwent successful embolization.
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Figure 6b. Intraparenchymal hemorrhage in a 40-year-old man who sustained injuries in a motor vehicle accident. (a) Transverse US image of the liver reveals heterogeneous parenchyma with a central anechoic area (arrow). (b) Helical CT scan helps confirm the hepatic laceration and demonstrates an area of active contrast material extravasation (arrow). The diagnosis was confirmed at angiography, and the patient underwent successful embolization.
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Figure 7a. Global parenchymal injury. (a) Transverse US image of the liver obtained in a 60-year-old woman following a motor vehicle accident reveals heterogeneous hepatic parenchyma involving the entire right lobe. Normal vascular structures cannot be identified. (b) Longitudinal US image of the spleen obtained in a 45-year-old man following a motor vehicle accident shows diffuse involvement with areas of both increased and decreased echogenicity. The contour of the spleen is irregular and poorly demarcated.
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Figure 7b. Global parenchymal injury. (a) Transverse US image of the liver obtained in a 60-year-old woman following a motor vehicle accident reveals heterogeneous hepatic parenchyma involving the entire right lobe. Normal vascular structures cannot be identified. (b) Longitudinal US image of the spleen obtained in a 45-year-old man following a motor vehicle accident shows diffuse involvement with areas of both increased and decreased echogenicity. The contour of the spleen is irregular and poorly demarcated.
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Figure 8a. Subcutaneous emphysema in a 40-year-old man with a left pneumothorax sustained in an altercation. (a) On a suboptimal longitudinal US image of the left upper quadrant, the spleen is not visualized. Open arrow indicates the diaphragm, solid arrows indicate the region of the spleen. (b) CT scan through the upper abdomen reveals a small splenic laceration with perisplenic fluid (solid arrow). Subcutaneous emphysema overlying the splenic region (open arrows) precluded adequate US evaluation.
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Figure 8b. Subcutaneous emphysema in a 40-year-old man with a left pneumothorax sustained in an altercation. (a) On a suboptimal longitudinal US image of the left upper quadrant, the spleen is not visualized. Open arrow indicates the diaphragm, solid arrows indicate the region of the spleen. (b) CT scan through the upper abdomen reveals a small splenic laceration with perisplenic fluid (solid arrow). Subcutaneous emphysema overlying the splenic region (open arrows) precluded adequate US evaluation.
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Figure 9a. Intraperitoneal clot in a 29-year-old woman who was involved in a motor vehicle accident. (a) Longitudinal US image reveals an isoechoic clot filling the cul de sac (arrows). (b) CT scan of the pelvis helps confirm the presence of a high-density clot posterior to the uterus (arrows). (c) Longitudinal US image of the left upper quadrant reveals a hyperechoic clot between the spleen and kidney (arrows). The splenic contour is poorly defined due to parenchymal injury.
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Figure 9b. Intraperitoneal clot in a 29-year-old woman who was involved in a motor vehicle accident. (a) Longitudinal US image reveals an isoechoic clot filling the cul de sac (arrows). (b) CT scan of the pelvis helps confirm the presence of a high-density clot posterior to the uterus (arrows). (c) Longitudinal US image of the left upper quadrant reveals a hyperechoic clot between the spleen and kidney (arrows). The splenic contour is poorly defined due to parenchymal injury.
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Figure 9c. Intraperitoneal clot in a 29-year-old woman who was involved in a motor vehicle accident. (a) Longitudinal US image reveals an isoechoic clot filling the cul de sac (arrows). (b) CT scan of the pelvis helps confirm the presence of a high-density clot posterior to the uterus (arrows). (c) Longitudinal US image of the left upper quadrant reveals a hyperechoic clot between the spleen and kidney (arrows). The splenic contour is poorly defined due to parenchymal injury.
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Copyright © 1999 by the Radiological Society of North America.
