Navya did an EFAST on a young male who had come off his bike. He had L loin pain and haematuria. He was haemodynamically stable.
These are the initial LUQ view
LUQ view showing a sliver of anechoic FF around the inferior surface of the spleen
LUQ view showing mostly anechoic FF with small hyper echoic areas ?free gas ?bowel. Renal capsule is hyeprechoic ?haematoma
Another LUQ view shows L kidney seems large with disrupted parenchyma. There is a hyper echoic area anterior to the kidney which could be haematoma.
Pelvic view showed hyper echoic debris within the bladder (likely haematoma)
The patient went to CT before further US images could be obtained. But the clear diagnosis was a likely high grade renal laceration. CT confirmed an isolated grade 4 renal laceration.
These are the US images following return from CT.
Dedicated L renal longitudinal view showing hyperechoic haematoma surrounding the kidney.
LIF view showing intraperitoneal haematoma overlying the ileopsoas muscle
Blood has different US appearances depending on its stage of organisation. This is important to remember when looking at an EFAST: especially for trauma patients who have had a prolonged retrieval time.
Fresh blood: anechoic
Early clot formation: anechoic with hyperechoic strands
Haematoma: hyperechoic: solid
Late: organisation and resorption: complex cystic areas, may develop a hyperechoic rim.
OTHER EFAST IMAGES WITH HAEMATOMA
LUQ view showing splenic lacerarion, anechoic FF and haematoma (annotated below)
LUQ in patient with L kidney laceration. Clip shows inferior haematoma and early clot in leinorenal recess (annotated below)
LUQ view showing haematoma anterior to spleen.
LUQ view with large amount FF of mixed echogenicity. Inferior echogenic debris likely represents sedimenting blood.
Note: other things may look hyperechoic or caused mixed echogenicity to the haemoperitoneum in trauma.
free gas (bright white (hyper echoic) with posterior dirty shadowing (reverberation artefact): settle non dependent)
bowel contents (mixed echogenicity, may have free gas)
fat (hyper echoic, tends to cover the contours of the organ: see below)