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US of Blunt Abdominal Trauma: Importance of Free Pelvic Fluid in Women of Reproductive Age¹

¹ From the Departments of Radiology (C.B.S., G.C., M.A.B., E.J.B.), Surgery (N.P., D.B.H.), and Family and Preventive Medicine (R.D.), UCSD Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8756. From the 1998 RSNA scientific assembly. Received April 14, 2000; revision requested June 6; revision received June 30; accepted August 8. R.D. supported in part by National Institutes of Health grant M01 RR00827. Address correspondence to C.B.S. (e-mail: csirlin@ucsd.edu).

PURPOSE: To assess the importance of free fluid and to determine the accuracy of screening ultrasonography (US) in female patients of reproductive age with trauma.

MATERIALS AND METHODS: US was performed in 1,047 patients, aged 10–60 years, to evaluate blunt trauma. Patients were retrospectively assigned to groups on the basis of presence and location of intraperitoneal free fluid. Injury and surgical injury rates were assessed by comparing US results with computed tomographic, repeat US, cystographic, peritoneal lavage, surgical, and/or autopsy findings in 144 patients and with final clinical outcome in 903. US scans were positive if fluid was outside the cul-de-sac or if suspicious parenchymal abnormalities were present.

RESULTS: In 939 patients, no fluid was seen: Eight had injuries; three were surgical. In 56, anechoic fluid was isolated to the cul-de-sac: Two had injuries; one was surgical. In 26, fluid was isolated to the upper abdomen: Fifteen had injuries; five were surgical. In 22, fluid involved the pelvis and abdomen: Nineteen had injuries; 14 were surgical. In four, questionable fluid was isolated to the supravesical space. Patients with fluid in the cul-de-sac had similar injury and surgical injury rates as those with no fluid but had lower rates than those of patients with fluid elsewhere (P < .02 to P < .001). US screening had 89% sensitivity, 98% specificity, 97% accuracy, a 61% positive predictive value, and a 99% negative predictive value.

CONCLUSION: In female patients of reproductive age with trauma, free fluid isolated to the cul-de-sac is likely physiologic; clinical follow-up should suffice. Patients with fluid elsewhere usually have clinically important injury and require further evaluation.

Index terms: Abdomen, injuries, 70.41 • Abdomen, US, 70.1298 • Kidney, injuries, 81.41 • Liver, injuries, 761.41 • Pelvic organs, US, 761.1298, 775.1298 • Peritoneum, fluid, 791.41 • Spleen, injuries, 775.41

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