CHAPTER 18 abnormal collection of serous fluid in the peritoneal cavity. the removal of a small piece of living tissue for microscopic analysis. tendinous structure extending downward from the diaphragm to the vertebral column. a thin needle and gentle suction is used to obtain tissue samples for pathological testing. the presence of extravasated blood in the peritoneal cavity. an accumulation of blood and fluid in the pleural cavity. the presence of numerous small fluid spaces in the peritoneal cavity. a collection of lymph from injured lymph vessels. a double layer of peritoneum suspending the intestine from the posterior abdominal wall. a serous membrane containing lymphatics, vessels, fat, and nerves. a thin space located between the two layers of pleura. an accumulation of fluid within the pleural cavity. a pouch formed by the inferior portion of the parietal peritoneum. an extension of the peritoneum surrounding one or more organs adjacent to the stomach. • Located anterior to the pancreas and posterior to the stomach. • Located between the diaphragm and transverse colon. • Communicates with the subhepatic space through the foramen of Winslow. • Retrovesical pouch is located posterior to the urinary bladder and anterior to the rectum. • Retrouterine pouch is located posterior to the uterus and anterior to the rectum. Also called posterior cul de sac or pouch of Douglas. • Vesicouterine pouch is located anterior to the uterus and posterior to the urinary bladder. Also called anterior cul de sac. • Prevesical or retropubic space is located anterior to the urinary bladder and posterior to the symphysis pubis. Also known as space of Retzius. • Divided into the left and right subphrenic spaces by the falciform ligament. • Left subphrenic space is located inferior to the diaphragm and superior to the spleen. • Left subphrenic space includes spaces between the left diaphragm, left lobe of the liver, stomach, and spleen. • Right subphrenic space is located inferior to the diaphragm and superior to the liver. • Right subphrenic space extends over several rib spaces to the right coronary ligament (bare area). • A delicate serous membrane composed of a visceral and parietal layer. • Visceral pleura covers the lung and has a low sensitivity to pain. • Parietal pleura lines the chest wall and has a high sensitivity to pain. • Pleural cavity is a thin space between the two layers of the pleura. • Pleural fluid lubricates the pleural surfaces. • Use the highest-frequency abdominal transducer possible to obtain optimal resolution for penetration depth. • Focal zone(s) at or below the place of interest. • Sufficient imaging depth to visualize structures immediately posterior to the region of interest. • Harmonic imaging or decreasing system compression (dynamic range) can be used to reduce artifactual echoes within anechoic structures. • Spatial compounding can be used to improve visualization of structures posterior to a highly attenuating structure. • Use a systemic approach to evaluate and document the entire abdominal and pelvic cavities. • Use an intercostal approach for noncardiac imaging of the chest. • Increase in transducer pressure may be necessary in abdominal examinations. • Patients are typically examined in a supine position when evaluating the peritoneal cavity. • Patients are typically examined in a sitting position when evaluating the thoracic cavity. • Oblique, decubitus, or erect positions may also be used. • Documentation and measurement of any abnormality in two scanning planes with and without color Doppler should be included. • Laboratory values will vary with individual cases. • Decreased hematocrit is suspicious for internal bleeding.
Peritoneum, noncardiac chest, and invasive procedures
Peritoneal spaces
Lesser sac (omental bursa)
Morison pouch (hepatorenal pouch)
Pelvic spaces
Subphrenic spaces
Anatomy of the pleura
Technique
Preparation
Examination technique and image optimization
Laboratory values
FLUID COLLECTION
ETIOLOGY
CLINICAL FINDINGS
SONOGRAPHIC FINDINGS
DIFFERENTIAL CONSIDERATIONS
Abscess
Infection
Abdominal pain
Fever
Leukocytosis
Fatigue
Nausea/vomiting
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