Figure 225 normal subxiphoid view figure 226 a large

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Figure 2.25 Normal subxiphoid view. Figure 2.26 A large pocket of free fluid seen around the liver edge. Figure 2.27 A stripe of fluid is seen in Morison’s pouch. Diaphragm and Gerota’s fascia well visualized as hyperechoic bright lines. 42 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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Figure 2.28 Fluid is seen at the spleen tip and in the subdiaphragmatic space, stressing the importance of these views. Figure 2.30 Fluid around tip of liver and heterogeneous material outside Gerota’s fascia in the free fluid pocket suggests clot. Figure 2.29 Fluid in Morison’s pouch. Diagnostic ultrasound 43 Focused assessment with sonography in trauma (FAST)
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Figure 2.32 This is an unusual image in that the fracture of the spleen can be well visualized. In any case, large amounts of free fluid around the spleen are seen. Courtesy of Emergency Ultrasound Division, St. Luke’s–Roosevelt Hospital Center, New York, NY. Figure 2.31 Fluid stripe in Morison’s pouch. The heterogeneous echogenic material at the inferior pole of the kidney suggests clot. Figure 2.33 These images show how important it is to use the diaphragm as a landmark to identify whether fluid is intrathoracic or intraperitoneal. ( A ) Fluid collecting above the spleen in the subphrenic space below the bright diaphragm before filling the splenorenal recess. ( B ) Fluid above the bright hyperechoic diaphragm indicates that this is a pleural effusion. 44 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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(A) (B) Figure 2.35 ( A ) Fluid is seen behind the uterus and tracking above the fundus. ( B ) Fluid can be seen outside the bladder wall and tracking into the rectovesicular space. Figure 2.34 There is free fluid between the spleen and the left hemidiaphragm. Diagnostic ultrasound 45 Focused assessment with sonography in trauma (FAST)
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Figure 2.36 Bowel loops floating in free fluid in the pelvis. Figure 2.37 Free fluid in the pelvis surrounding the bladder. Figure 2.38 Fluid (*) is seen here both anteriorly and posteriorly separating the pericardium (bright white line) from myocardium. The right ventricle is also bowed inward, which is concerning for tamponade physiology (see Chapter 3 ). Courtesy of Emergency Ultrasound Division, St. Luke’s–Roosevelt Hospital Center, New York, NY. 46 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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Extended FAST or eFAST In the normal right upper quadrant and left upper quadrant views of the FAST exam, the diaphragm acts as a strong reflector of ultrasound beams. Therefore, if you remember the description of the mirror image from Chapter 1 , the diaphragm reflects the normal splenic or liver tissue, so an additional “mirror image” is present above the diaphragm ( Figure 2.40 ). The ability of the eFAST to rapidly and accurately diagnose traumatic hemothoraces has been well documented [ 22 , 23 ]. If there is fluid in either the right or the left chest, the mirror image is lost above the diaphragm and black fluid is seen instead ( Figure 2.41 ). In addition, the vertebral shadow that is visible
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