Case Study: A Motor Vehicle Accident

Ready to put your skills to the test? See if you can identify the area of free fluid in this POCUS case study.

A 22-year-old female was involved in a motor vehicle accident.

The patient was rushed to the emergency department. On arrival an eFAST examination was performed. The view below was obtained in the left upper quadrant.

 

What is the arrow pointing to? 

A. Free fluid in the peritoneal cavity 
B. Free fluid in the left costophrenic angle 
C. Pericardial effusion 

 

 

The arrow is pointing to free fluid in the left costophrenic angle.

Explanation 

The image shows the left upper quadrant view with the arrow pointing to the left costophrenic angle. There is evidence of anechoic (black) fluid in that region which is a positive finding. There is a shadow in the region of the spleen and the entire spleen and the region under the left hemidiaphragm is not well seen. Obtain additional views to make sure that there is no fluid/blood under the left hemidiaphragm. 

 

 

References

  1. https://www.pocus101.com/efast-ultrasound-exam-made-easy-step-by-step-guide/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801666/
  3. http://dx.doi.org/10.1136/bcr-2012-007336