Focused Assessment With Sonography for Trauma Examination: Reexamining the Importance of the Left Upper Quadrant View.

ABSTRACT

OBJECTIVES: The purpose of this study was to determine the frequency and predominant location of isolated free fluid in the left upper quadrant (LUQ) on focused assessment with sonography for trauma (FAST) examinations of adult patients with trauma presenting to the emergency department. METHODS: We conducted a retrospective review of adult patients with positive FAST results for free fluid in the abdomen at 2 academic emergency departments. Eligible FAST examinations were reviewed for the presence of fluid in the LUQ and exact location of free fluid within the LUQ. RESULTS: A total of 100 FAST examinations with free fluid in the abdomen that met inclusion criteria were identified during the study period. Overall 32 of 100 (32%; 95% confidence interval [CI], 23.5%-41.6%) of patients with positive FAST results were found to have free fluid in the LUQ. Only 6 of 100 (6%; 95% CI, 2.5%-11.9%) patients with positive FAST results had free fluid isolated to the LUQ. Of these 6 patients with isolated LUQ free fluid, none had free fluid isolated to the splenorenal fossa alone; 1 had free fluid isolated to the subphrenic space (above the spleen/below the diaphragm); and 4 had free fluid visible only in the left paracolic gutter/inferior to the spleen. Twenty-seven of 32 patients (84%; 95% CI, 69.1%-93.8%) with free fluid anywhere in the LUQ were also found to have fluid in the left paracolic gutter. CONCLUSIONS: Free fluid isolated to the LUQ occurs in a clinically significant number of adult patients with trauma and positive FAST results. Isolated fluid accumulation was often seen within the left paracolic gutter.