during ultrasound examination of acute abdomen, sometimes we see free fluid , can we know the type of fluid ,whether blood or not , using ultrasound only? if yes , what are the sonographic features of blood?
In most cases, it is difficult to judge the nature of the fluid in the abdominal cavity by the echoscopic picture. A change in the echoscopic picture may occur in the presence of blood clots in hemoperitoneum, especially if there are clinical and echosocopic signs of injury to the spleen or liver. The presence of fibrin in the ascitic fluid also changes the echoscopic picture. In many ways, this is influenced by a combination of factors: the experience of a specialist and his workload for a working shift, the class of the device, the conditions for preparing the patient. A fine needle puncture of the abdominal cavity under echoscopic control (a 5-10 ml syringe with an intramuscular needle) using the "free hand"technique will help to differentiate the nature of the fluid.
In these emergency cases, there is no time to be lost. Is the fluid serous or blood? . Sonar -guided aspiration will be the ideal solution especially in hemodynamically unstable patients.
Nature of the free fluid in abdominal and pelvic cavity is important indicator to draw a picture of the ongoing pathology. However, sensitivity and specifisty of such diagnostic tool are well-known. Evidence based practice supports other imaging modalities and procedures if the nature of free fluid has impact on clinical decision making.
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