Emergency Ultrasound Section Forum
General EUS Topics
FF in Morrison's and Specificity for Ruptured Ectopic
Posted on behalf of Drew from the listserv:
See abstract from 2007 article below.Of 242 patients with early pregancy, 28 ectopics, free fluid in 10 - 9 ectopics, one was a ruptured ovarian cyst.Would definitely get a pregnancy test - if so very likely (but not 100%) to be ruptured ectopic needing operative intervention.If negative, very likely to be ruptured ovarian cyst (which still may require operative intervention).Absence of FF does not r/o ectopic, but presence makes operative intervention much more likely to be required.
Chris MooreFree Fluid in Morison’s Pouch on BedsideUltrasound Predicts Need for OperativeIntervention in Suspected Ectopic PregnancyChris Moore, MD, William M. Todd, MD, Elizabeth O’Brien, MD, Henry Lin, MDAbstractBackground: Ectopic pregnancies are frequently present in women who present to the emergency departmentwith pregnancy and abdominal pain or bleeding, a subset of whom may require operative intervention.Objectives: To prospectively determine if emergency physician (EP)-performed transabdominal pelvicultrasonography (US) with determination of free abdominal fluid in the hepatorenal space predicted theneed for operative intervention.Methods: Patients who were suspected to have an ectopic pregnancy were prospectively enrolled overa ten-month period. An EP-performed bedside transabdominal pelvic US that included a view of thehepatorenal space (Morison’s pouch) for free fluid. The EP US was classified as intrauterine pregnancy(IUP) or no definitive IUP, with Morison’s pouch classified as positive or negative. The majority of patientshad a subsequent transvaginal pelvic US performed by the Department of Radiology. Patientswere followed up for radiology results, need for operative intervention, and ultimate outcome of thepregnancy.Results: There were 242 patients enrolled, with an average time to complete the EP US of 4 minutes and 27seconds. There were 28 ectopic pregnancies diagnosed (11.6%), of which 18 patients underwent operativeintervention. Free fluid in Morison’s pouch was identified in ten patients, nine of whom underwent operativeintervention, yielding a positive likelihood ratio of 112 (95% confidence interval = 15 to 831) forpatients with suspected ectopic pregnancy who required operative intervention.Conclusions: Free intraperitoneal fluid found in Morison’s pouch in patients with suspected ectopic pregnancymay be rapidly identified at the bedside by EP-performed US and predicts the need for operativeintervention.ACADEMIC EMERGENCY MEDICINE 2007 14:755-758