Peritoneum, noncardiac chest, and invasive procedures
abnormal collection of serous fluid in the peritoneal cavity.
a large triangular area devoid of peritoneal covering located between the two layers of the coronary ligament.
the removal of a small piece of living tissue for microscopic analysis.
left coronary ligament suspends the left lobe of the liver from the diaphragm; right coronary ligament serves as a barrier between the subphrenic space and Morison pouch.
an accumulation of chyle and emulsified fats in the peritoneal cavity; most commonly associated with an abdominal neoplasm.
tendinous structure extending downward from the diaphragm to the vertebral column.
an accumulation of fluid, pus, or serum in the peritoneal cavity; most commonly associated with inflammation or trauma.
a thin needle and gentle suction is used to obtain tissue samples for pathological testing.
a double-fold of peritoneum attached at the greater curvature of the stomach and superior portion of the duodenum; covers the transverse colon and small intestines.
the presence of extravasated blood in the peritoneal cavity.
an accumulation of blood and fluid in the pleural cavity.
a portion of peritoneum extending from the portal fissure of the liver to the diaphragm; encloses the lower end of the esophagus.
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 congenital thin-walled cyst located between the leaves of the mesentery; most commonly located in the small-bowel mesentery.
a cannula or catheter is passed into the abdominal cavity to allow outflow of fluid into a collecting device for diagnostic or therapeutic purposes.
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.
a needle is inserted through the chest wall and pleural cavity to aspirate fluid for diagnostic or therapeutic purposes.
an accumulation of a fluid in the peritoneal cavity containing small protein cells; most commonly associated with cirrhosis or congestive heart failure.
Peritoneal spaces
Lesser sac (omental bursa)
• 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.
Morison pouch (hepatorenal pouch)
Pelvic spaces
• 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.
Subphrenic spaces
• 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).
Anatomy of the pleura
• 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.
Technique
Preparation
Examination technique and image optimization
• 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
• Laboratory values will vary with individual cases.
• Decreased hematocrit is suspicious for internal bleeding.
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FLUID COLLECTION | ETIOLOGY | CLINICAL FINDINGS | SONOGRAPHIC FINDINGS | DIFFERENTIAL CONSIDERATIONS |
Abscess | Infection | Abdominal painFeverLeukocytosisFatigueNausea/vomiting |