Free Fluid in the Pelvis

This week's Image of the Week is brought to us Dr. Kyle Minor. While evaluating a 48 year-old woman with increasing lower extremity edema and abdominal swelling, Dr. Minor performed a bedside US showing the following image. 

 

This image shows free fluid around the uterus.

Probe placement for this image is just like that used to image the bladder in transverse plane.

Using the curvilinear probe, the transverse view is obtained with the probe indicator to the right of the patient. From this position, subtle fanning movements of the probe up towards the head and down to the feet permits visualization of abdomino-pelvic contents.

Looking back at the first image, the critical bedside finding is free fluid in the pelvis. This patient – with what turned out to be new onset ascites – has free fluid posterior to the uterus. This combined with the urine noted in the bladder (anterior to the uterus) shows what appears as a“floating” uterus.

To the Star Wars fans in the department, this may look similar to a Tie Fighter.

This patient was admitted for fluid overload, new onset ascites, and further management of idiopathic pulmonary arterial hypertension.