Sonography: Pelvic, Renal, etc

This is an example of a positive Pelvic view in a Sagittal orientation. You can see the Bladder and the Bladder wall with free fluid superior to the Bladder and you can actually see some lips of dal floating in the free fluid. That's indicative of significant free fluid.

Following the exam of the human Pelvis, we'd like to look at the heart. We place the probe in a Subxiphoid view, the indicator to the patient's right. We often have to flatten this probe out in order to get a view of the heart. If we're unable to get a view there we may try a Parasternal view with the indicator in this case towards the patient's right shoulder to see if we can get a view of the heart Parasternally. 

This is an image of the heart seen from a Subxiphoid view. You can see the Liver which is acting as a window; we're looking through that to the inferior Pericardium, right adjacent to the right ventricle. You can see the Pericardium, this is a negative view. There is no anechoic fluid around or no pericardial effusion.

This is an example of patient with a significant pericardial effusion. You can see that there is a black or anechoic area around the heart interior to the right ventricle that's surrounding the entire heart significant for pericardial effusion.

Couple of pitfalls, one thing to be aware of is to make sure that you're not looking encapsulated fluid. In this case we're actually looking at the Gallbladder in the right upper quadrant. You can tell that the fluid is not tracking acute angles and it's actually enclosed by the Gallbladder wall.

Similarly this is an enclosed fluid collection, actually a Renal Cyst associated with the Kidney. It's very round, does not track into acute angles. It's completely anechoic and thin walled consistent with a simple Renal Cyst.