This ultrasound performed yesterday by Dr. MC nicely demonstrates a left sided plural effusion.
When determining if a pleural effusion or intraadominal fluid is present in the left upper quadrent, always remember to identify the diaphram. It will often be difficult to find on the left side but you must always take the time to find it. Have the patient take a deep breath and hold it if your view is made difficult due to rib shadowing. As opposed to fluid in the right upper quadrent, which often collects between the liver and the kidney in morrison’s pouch, fluid on the left side will more often collect between the spleen and the diaphram. If you only look between the spleen and the kidney, you will likely miss the fluid you are searching for.
In the video, the pleural effusion is quite easy to see as well as the inferior portion of the lung moving within it. But if you look closely just under the diaphram, there is a questionable “hypoechoic” or black stripe between the spleen and the diaphram. While performing the ultrasound, we wondered whether this could be intraabdominal fluid.
We then performed a right upper quadrent ultrasound and indeed found some fluid around the medial edge of the liver, concluding that this patient had a small amount ascites as well.
These ultrasounds show how easy it could be to miss a small amount of intraabdominal fluid, so especially in the setting of trauma, make sure that you spend the time to really “fan” (keep the probe at the same spot and move it anterior and posterior) through Morrison’s pouch on the right and look under the diaphram on the left.
Great job ultrasounding this week.
