Emergency Radiology

, Volume 3, Issue 3, pp 113–117 | Cite as

Interpreting the trauma ultrasound: Observations in 62 positive cases

  • Kimberley Lentz McKenney
  • Mark G. McKenney
  • Diego B. Nuñez
  • Lauren McDowell
  • Larry Martin
Original Article


The purpose of this study was to review all positive trauma abdominal ultrasound examinations, to determine a standard imaging protocol that would provide rapid patient evaluation, and to assess the ability of ultrasound to predict the need for emergent laparotomy.

All 62 positive examinations obtained over a 17-month period were reviewed. Nine anatomic sites were evaluated for free intraperitoneal fluid, recording the location and depth. A scoring system was devised to reflect the amount of fluid. Results were correlated with the need for laparotomy.

Free fluid was found in all nine areas; however, four areas (the right subphrenic, subhepatic, and perisplenic areas and the pelvis) were diagnostic when a positive examination resulted from fluid found in only one site. Eighteen parenchymal injuries were identified during sonography. To help determine the need for laparotomy, a simple scoring system was developed. Patients with a score of >2 were found to have a significantly higher incidence of requiring an operation (P<0.001).

We conclude that trauma ultrasonography should consist of imaging the right subphrenic, subhepatic, and perisplenic areas and the pelvis. Use of a scoring system can help determine the need for an operation

Key Words

Trauma ultrasound Free intraperitoneal fluid Blunt abdominal trauma 


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  1. 1.
    Powell DC, Bivins BA, Bell RM. Diagnostic peritoneal lavage. Surg Gynecol Obstet 1982;155:257–63.PubMedGoogle Scholar
  2. 2.
    Soderstrom CA, DuPriest RW, Cowley RA. Pitfalls of peritoneal lavage in blunt abdominal trauma. Surg Gynecol Obstet 1980; 151:513–8.PubMedGoogle Scholar
  3. 3.
    Engrav HM, Benjamin CI, Strate RG et al. Diagnostic peritoneal lavage in blunt abdominal trauma. J Trauma 1975;15:854–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Thal ER, Meyer DM. The evaluation of blunt trauma: computed tomography scan, lavage, or sonography. In: Cleveland M, Wolferth S, editors. Advances in trauma. Vol. 3 Chicago: Mosby-Year Book, 1988;201–28.Google Scholar
  5. 5.
    Cox EF. Blunt abdominal trauma: a 5 year analysis of 870 patients requiring celiotomy. Ann Surg 1984;199:467–74.PubMedGoogle Scholar
  6. 6.
    Hubbaard SG, Bivins BA, Sachatell CR et al Diagnostic errors with peritoneal lavage in patients with pelvic fractures. Arch Surg 1979;114:244–6.Google Scholar
  7. 7.
    Kusminsky RE, Rogers JS, Rushden RO, et al. The value of sequential peritoneal profile in blunt abdominal trauma. Am Surg 1984;50:248–53.PubMedGoogle Scholar
  8. 8.
    Tiling, T, Bouillon B, Shmid A et al Ultrasound in blunt trauma. In: Border JF, Allgoewer M, Hansen ST et al. editors Blunt multiple trauma, New York: Marcel Dekker, 1990;415–33.Google Scholar
  9. 9.
    McKenney M, Lentz K, Nunez D, et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt abdominal trauma. J Trauma 1994;37:439–41.PubMedGoogle Scholar
  10. 10.
    Gruessner R, Mentges, B, Duber C, et al. Sonography vs. peritoneal lavage in blunt abdominal trauma. J Trauma 1989;29:242–4.PubMedGoogle Scholar
  11. 11.
    Kimura A, Otsulca T. Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study. J Trauma 1991;30:20–3.Google Scholar
  12. 12.
    Hoffman R, Nevlich M, Muggia-Sullum M, et al. Blunt abdominal trauma in multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma 1992;32:452–8.Google Scholar
  13. 13.
    Sarkisian AE, Khondkavian RA, Amirbekian NM, et al. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma 1991; 31:247–50.PubMedGoogle Scholar
  14. 14.
    Tso P, Rodriguez A, Cooper C, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma 1992; 33:39–44.PubMedGoogle Scholar
  15. 15.
    Nerlich ML, Hoffman R. Ultrasonography in the diagnosis of abdominal trauma. In: Maull KI, editor. Advances in trauma and critical care. Vol. 6. Chicago: Mosby-Year Book, 1991;31–52.Google Scholar
  16. 16.
    Paivansalo M, Myllyla V, Siniluoto T, et al. Imaging of splenic rupture. Acta Chir Scand 1986;152:733–7.PubMedGoogle Scholar
  17. 17.
    Cooperberg PL, Li DBK, Sauerbrei EE. Abdominal and peripheral applications of real time ultrasound. Radiol Clin North Am 1980;18:59–77.PubMedGoogle Scholar
  18. 18.
    Huang M, Ming L, Jer-Kan W, et al. Ultrasonography for the evaluation of hemoperitoneum during resuscitation: a simple scoring system. J Trauma 1994;36:173–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Farnell MB, Spinur MP, Thompson E, et al. Nonoperative management of blunt hepatic trauma in adults. Surgery 1988;104:748–55.PubMedGoogle Scholar
  20. 20.
    Longo WE, Baker CC, McMillen MA, et al. Nonoperative management of adult blunt splenic trauma. Ann Surg 1989;210:626–9.PubMedGoogle Scholar

Copyright information

© American Society of Emergency Radiology 1996

Authors and Affiliations

  • Kimberley Lentz McKenney
    • 1
    • 2
  • Mark G. McKenney
    • 3
    • 4
  • Diego B. Nuñez
    • 1
    • 2
    • 4
  • Lauren McDowell
    • 4
  • Larry Martin
    • 3
    • 4
  1. 1.Department of RadiologyJackson Memorial HospitalMiami
  2. 2.Department of SurgeryJackson Memorial HospitalMiami
  3. 3.Department of RadiologyJackson Memorial HospitalMiami
  4. 4.University of Miami School of Medicine and Ryder Trauma CenterJackson Memorial HospitalMiami

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