A patient with blunt abdominal trauma undergoes a FAST examination. Which of the following findings in Morrison's pouch represents a true positive and mandates urgent surgical evaluation?
- A Anechoic fluid stripe > 1 cm between liver and right kidney with hemodynamic instability ✓
- B Fluid stripe < 5 mm between liver and right kidney in a hemodynamically stable patient
- C Fluid in the subhepatic space in a patient who received 2L pre-hospital IV fluids
- D Collapsed inferior vena cava with no pericardial effusion
Explanation
In FAST examination, Morrison's pouch (hepatorenal space/right paracolic gutter) is the most dependent intraperitoneal space in the supine position and the first to accumulate blood. A fluid stripe > 1 cm in the setting of hemodynamic instability is a significant positive finding requiring emergent laparotomy without CT. Small fluid collections (< 5 mm) in stable patients may be further evaluated with CT. A collapsed IVC suggests hypovolemia but is not site-specific to intraperitoneal hemorrhage. The sensitivity of FAST for detecting hemoperitoneum improves with increasing fluid volume and operator experience.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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