{"id":802,"date":"2017-09-18T18:45:16","date_gmt":"2017-09-18T18:45:16","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=802"},"modified":"2020-07-22T00:07:13","modified_gmt":"2020-07-22T00:07:13","slug":"case-6-not-your-average-syncope","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2017\/09\/18\/case-6-not-your-average-syncope\/","title":{"rendered":"Case # 6: Not Your Average Syncope"},"content":{"rendered":"
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A 25 year old female presents to the emergency department with acute abdominal pain and a syncopal episode. She notes a positive home urine pregnancy test 1 week ago. She appears mildly uncomfortable with a tender abdomen. A bedside ultrasound is performed, a clip is shown below.\u00a0What are the findings of the ultrasound clip and what is your diagnosis?<\/h3>\n

Vitals: T 98.7\u00a0HR\u00a0120 BP 95\/72\u00a0 RR 20\u00a0O2 98% on RA<\/h3>\n<\/div>\n<\/div>\n<\/div>\n
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Image courtesy of Elizabeth Owen, MD<\/p><\/div>\n<\/div>\n<\/div>\n

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Answer and Learning Point<\/h3>
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Answer<\/strong><\/p>\n

The ultrasound clip demonstrates a large amount of free fluid between the spleen and the diaphragm. There is also a sliver of echogenic material above the capsule of the spleen suggestive of clotted blood. Morison\u2019s pouch (not shown) was also noted to be significantly positive for free fluid. Given the patient\u2019s unstable vitals and the clinical history, this was concerning for a ruptured ectopic pregnancy. OB was consulted immediately and the patient was taken to the OR. The diagnosis of ruptured ectopic pregnancy was confirmed during laparotomy. The patient did well.<\/p>\n

While the FAST exam has traditionally been used in trauma, there has been increasing use to diagnose intra-abdominal bleeding as a source of hypotension in medical patients. Specifically with regards to ectopic pregnancy, data has suggested that positive free fluid in Morison\u2019s pouch is highly predictive of operative intervention with a positive likelihood ratio of 112 (Sens 50%, Spec 99.5) [1]. A retrospective study in 2001, looking at emergency medicine physician performed ultrasound, demonstrated that identifying patients with a suspected ectopic pregnancy and free fluid in Morison\u2019s pouch decreased the time to diagnosis and treatment [2].<\/p>\n

Learning Points<\/strong><\/p>\n