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Blunt Abdominal Injury in the Pregnant Patient: Detection with US¹

¹ From the Division of Emergency Medicine (J.R.R.) and Department of Radiology (E.L.O., M.A.G., J.P.M.), University of California, Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817; and School of Medicine, Georgetown University, Washington DC (M.V.R.). Received October 17, 2003; revision requested January 12, 2004; revision received February 20; accepted March 26. Address correspondence to J.R.R. (e-mail: jrrichards@ucdavis.edu).

View larger version (96K): [in a new window]   Figure 1a. Images in 20-year-old woman in the first trimester of pregnancy who was involved in a high-speed motor vehicle crash that resulted in splenic laceration that was managed without intervention. (a) Longitudinal US image of pelvis shows free fluid (arrow) in cul-de-sac and an intrauterine (U) pregnancy. A Foley catheter (F) is present within the bladder. (b) Transverse helical CT scan of abdomen shows laceration (arrow) in posterior aspect of spleen but no substantial free fluid. (c) Transverse CT scan of pelvis shows an enlarged uterus (U) with gestational sac and free fluid (arrow) in the cul-de-sac.

View larger version (114K): [in a new window]   Figure 1b. Images in 20-year-old woman in the first trimester of pregnancy who was involved in a high-speed motor vehicle crash that resulted in splenic laceration that was managed without intervention. (a) Longitudinal US image of pelvis shows free fluid (arrow) in cul-de-sac and an intrauterine (U) pregnancy. A Foley catheter (F) is present within the bladder. (b) Transverse helical CT scan of abdomen shows laceration (arrow) in posterior aspect of spleen but no substantial free fluid. (c) Transverse CT scan of pelvis shows an enlarged uterus (U) with gestational sac and free fluid (arrow) in the cul-de-sac.

View larger version (94K): [in a new window]   Figure 1c. Images in 20-year-old woman in the first trimester of pregnancy who was involved in a high-speed motor vehicle crash that resulted in splenic laceration that was managed without intervention. (a) Longitudinal US image of pelvis shows free fluid (arrow) in cul-de-sac and an intrauterine (U) pregnancy. A Foley catheter (F) is present within the bladder. (b) Transverse helical CT scan of abdomen shows laceration (arrow) in posterior aspect of spleen but no substantial free fluid. (c) Transverse CT scan of pelvis shows an enlarged uterus (U) with gestational sac and free fluid (arrow) in the cul-de-sac.

View larger version (89K): [in a new window]   Figure 2a. Images in 30-year-old woman in the first trimester of pregnancy who was involved in a rollover automobile crash. After the initial US examination, she was taken directly to the operating room for repair of colon and liver lacerations. (a) Longitudinal US image of hepatorenal fossa shows free fluid (arrow). (b) Longitudinal US image of lower left paracolic gutter reveals free fluid (FF). (c) Transverse US image of pelvis shows free fluid anterior (FF) and posterior (arrow) to the uterus (U).

View larger version (84K): [in a new window]   Figure 2a. Images in 30-year-old woman in the first trimester of pregnancy who was involved in a rollover automobile crash. After the initial US examination, she was taken directly to the operating room for repair of colon and liver lacerations. (a) Longitudinal US image of hepatorenal fossa shows free fluid (arrow). (b) Longitudinal US image of lower left paracolic gutter reveals free fluid (FF). (c) Transverse US image of pelvis shows free fluid anterior (FF) and posterior (arrow) to the uterus (U).

View larger version (93K): [in a new window]   Figure 2c. Images in 30-year-old woman in the first trimester of pregnancy who was involved in a rollover automobile crash. After the initial US examination, she was taken directly to the operating room for repair of colon and liver lacerations. (a) Longitudinal US image of hepatorenal fossa shows free fluid (arrow). (b) Longitudinal US image of lower left paracolic gutter reveals free fluid (FF). (c) Transverse US image of pelvis shows free fluid anterior (FF) and posterior (arrow) to the uterus (U).

View larger version (88K): [in a new window]   Figure 3a. Images in 22-year-old woman in the first trimester of pregnancy who had sustained blunt abdominal trauma and subsequent splenic laceration in a motor vehicle collision. After US was performed, the patient was taken immediately to the operating room for laparotomy. (a) Longitudinal US image of left upper quadrant reveals perisplenic free fluid (arrow) and abnormal-appearing splenic parenchyma (S). (b) Longitudinal US image of pelvis shows free fluid (FF) superior to the bladder (BL) and gravid uterus (U).

View larger version (98K): [in a new window]   Figure 3b. Images in 22-year-old woman in the first trimester of pregnancy who had sustained blunt abdominal trauma and subsequent splenic laceration in a motor vehicle collision. After US was performed, the patient was taken immediately to the operating room for laparotomy. (a) Longitudinal US image of left upper quadrant reveals perisplenic free fluid (arrow) and abnormal-appearing splenic parenchyma (S). (b) Longitudinal US image of pelvis shows free fluid (FF) superior to the bladder (BL) and gravid uterus (U).

View larger version (89K): [in a new window]   Figure 4a. Images in 17-year-old adolescent who was less than 1 month pregnant and who had sustained blunt abdominal trauma in a domestic assault. She had a small left hemothorax but no intraabdominal injury. (a) Longitudinal US image of pelvis shows trace amount of free fluid (FF) posterior to the uterus (U). The gestational sac is not visualized. (b) Incidental longitudinal US image of left upper quadrant reveals small hemothorax (PLEURAL) above left diaphragm and spleen (S). (c) Transverse CT scan of pelvis confirms presence of the free fluid (arrow) seen at US.

View larger version (79K): [in a new window]   Figure 4b. Images in 17-year-old adolescent who was less than 1 month pregnant and who had sustained blunt abdominal trauma in a domestic assault. She had a small left hemothorax but no intraabdominal injury. (a) Longitudinal US image of pelvis shows trace amount of free fluid (FF) posterior to the uterus (U). The gestational sac is not visualized. (b) Incidental longitudinal US image of left upper quadrant reveals small hemothorax (PLEURAL) above left diaphragm and spleen (S). (c) Transverse CT scan of pelvis confirms presence of the free fluid (arrow) seen at US.

View larger version (98K): [in a new window]   Figure 4c. Images in 17-year-old adolescent who was less than 1 month pregnant and who had sustained blunt abdominal trauma in a domestic assault. She had a small left hemothorax but no intraabdominal injury. (a) Longitudinal US image of pelvis shows trace amount of free fluid (FF) posterior to the uterus (U). The gestational sac is not visualized. (b) Incidental longitudinal US image of left upper quadrant reveals small hemothorax (PLEURAL) above left diaphragm and spleen (S). (c) Transverse CT scan of pelvis confirms presence of the free fluid (arrow) seen at US.