AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
Ascites: Ultrasound Guidance or Blind Paracentesis? CMAJ. Percutaneous Management of Malignant Fluid Collections. The Serum-Ascites Albumin Gradient is Superior to the Exudate-Transudate Concept in the Differential Diagnosis of Ascites. Runyon B, Montano A, Akriviadis E, Antillon M, Irving M, McHutchison J. The Role of Imaging in Patients with Ascites. Visualization of the Lateral Edge of the Liver in Ascites. Physiological: small amount of pelvic fluid may be normal in young femalesĬholeperitoneum: biloma/bile leak, e.g. Partially imaging-guided: an appropriate site is marked on the abdominal wall using ultrasound but the puncture is blindĬonsider other causes of intraperitoneal fluid: It can be performed with a variety of techniques depending on the institution and the availability of imaging resources 8: Interventional techniques for management include serial paracentesis (ascitic tap), transjugular intrahepatic portosystemic shunt (TIPS) or peritoneovenous shunting 8,9.Īscitic taps are the most common and thought to be the most effective treatment for symptomatic ascites 9. Medical management includes a modified diet (restricting sodium) and the use of medications such as diuretics 7,9. features of heart failure, features of cirrhosis, peritoneal catheter in situ, etc). Of course, other intra- or extra-abdominal CT features may give further evidence to the origin of the ascites (e.g. Hemoperitoneum density is higher still (~45 HU) Transudative ascites density should be approximate to that of water (-10 to +10 HU) The CT density of intraperitoneal fluid may give a clue to the underlying etiology: Septations suggest an inflammatory or neoplastic cause and may be called a loculated ascitesĬT is most sensitive to small amounts of fluid in the peritoneum which collects preferentially in the dependent regions, such as Morison pouch and the pelvis. May detect smaller volumes especially if they are adjacent to the diaphragm or anterior margin of the liver 3. Assessment of fluid type:Įxudative, hemorrhagic or neoplastic ascites contains floating debris Increased separation of small bowel loopsĭog ear sign: represents fluid in pelvic peritoneal recess 10 Medial displacement of bowel and solid viscera (away from the properitoneal fat stripe) Poor definition of the soft tissue shadows, such as the psoas muscles, liver and spleen Plain radiograph findings of ascites include:ĭiffusely increased density of the abdomen Most commonly: breast, ovarian, endometrial, gastrointestinal and pancreatic 7ĭetection of intraperitoneal fluid on a plain radiograph requires at least 500 mL to be present. Malignancy (~10% of refractory ascites) 7,9 continuous ambulatory peritoneal dialysis (CAPD) More recently, the concept of the serum-ascites albumin gradient has been shown to be more accurate in the classification of the causes of ascites 5. For the purposes of simplicity, however, we maintain the former classification.Ĭolors of ascitic fluid may suggest the following conditions:īloody: traumatic tap, hepatocellular carcinoma, peritoneal carcinomatosisĬloudy or turbid: spontaneous bacterial peritonitis, pancreatitisĬlear or straw color: cirrhosis, congestive cardiac failure 13ĭark brown: biliary perforation or leak 14 Transudate: thin, low protein count and low specific gravityĮxudate: high protein count and high specific gravity Patients with a large volume of ascites can present with abdominal distension (which may be painful), nausea, vomiting, dyspnea, and peripheral edema 7,9.Īscitic fluid is traditionally characterized as either: It has been pointed out that the term free fluid would seem not to include small amounts of loculated fluid, as 'free' and 'loculated' are antonymic 11,12. Occasionally, the term "trace ascites" might be employed. When only a small amount of fluid is present, which might be physiological, radiologists tend to use the term "free peritoneal fluid" or just "free fluid" instead. However, it is noted that physiologically there is 50-75 mL of fluid in the abdominal cavity. The amount has not been defined formally. Ascites (plural is the same word) tends to be reserved for relatively sizable amounts of peritoneal fluid.
0 Comments
Read More
Leave a Reply. |