Free Fluid in Pelvis?

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canigetawhatwhat

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3rd Year Resident Here.

Free Fluid in the Pelvis is my one of my least favorite CT hedge by our lovely Radiology team.

My question is.....what do yall do with it?

My program:
In a female, we dont care about it. Unless it's a trauma, than if they have any semblance of a tender abdomen, our trauma service admits them.
In a male, it draws a little more attention. We usually dont care but I have it seen it (aka my attending) has my admitted for it before in the right clinical picture.

Curious what yall do.

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3rd Year Resident Here.

Free Fluid in the Pelvis is my one of my least favorite CT hedge by our lovely Radiology team.

My question is.....what do yall do with it?

My program:
In a female, we dont care about it. Unless it's a trauma, than if they have any semblance of a tender abdomen, our trauma service admits them.
In a male, it draws a little more attention. We usually dont care but I have it seen it (aka my attending) has my admitted for it before in the right clinical picture.

Curious what yall do.

That's what I've seen in my residency program as well, with not a lot of variation that I can remember off the bat. Our radiologists tend to report the free fluid more than I'd like as well. Other good ones include the over-called mastoiditis on CT heads (which as far as I know is a clinical diagnosis).

Did you ever follow up on the male admitted for free fluid? Without a good story, legitimate physical exam findings, and in an otherwise healthy patient, I can't imagine I'd admit.
 
3rd Year Resident Here.

Free Fluid in the Pelvis is my one of my least favorite CT hedge by our lovely Radiology team.

My question is.....what do yall do with it?

My program:
In a female, we dont care about it. Unless it's a trauma, than if they have any semblance of a tender abdomen, our trauma service admits them.
In a male, it draws a little more attention. We usually dont care but I have it seen it (aka my attending) has my admitted for it before in the right clinical picture.

Curious what yall do.

Kill someone by ignoring it in the setting of a small bowel perforation disguised by the antibiotics being used for open fractures.
 
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depends on the context and why you got the scan to begin with.
Would have a low threshold to obs for serial exams.

If it was in someone who I thought had nothing to begin with, I'd just send home with return precautions and a good chart.
In those cases, I probably never should have gotten the scan to begin with, but I probably scan too many people.
 
Yes, a sad painful one. Technically not at fault, but still feel bad. About 5 weeks into residency.

Sounds like this was in the setting of major blunt trauma, in which case you've got to take it seriously since CT is relatively insensitive for hollow organ trauma--consult trauma surgery for Obs vs diagnostic lap. Def do not blow this off if they have a +seatbelt sign.

Absent an otherwise concerning evaluation, I'd probably blow this off in a medical patient. Although very common and usually physiologic in a female, consider PID.

Old people I'd admit for Obs.

Middle aged women I'd refer to obgyn given the possibility of ovarian cancer (CYA)
 
Sounds like this was in the setting of major blunt trauma, in which case you've got to take it seriously since CT is relatively insensitive for hollow organ trauma--consult trauma surgery for Obs vs diagnostic lap. Def do not blow this off if they have a +seatbelt sign.

I was trauma surgery in my case. A diagnostic lap would have been a good idea. Observing him in this country would have also been a good idea. Like I said, long, painful story.
 
Pelvic free fluid is normal in small volumes in reproductive aged women. Otherwise, it's abnormal but exceptionally nonspecific. Radiology can't always give you your diagnosis on a silver platter.

3rd Year Resident Here.

Free Fluid in the Pelvis is my one of my least favorite CT hedge by our lovely Radiology team.

My question is.....what do yall do with it?

My program:
In a female, we dont care about it. Unless it's a trauma, than if they have any semblance of a tender abdomen, our trauma service admits them.
In a male, it draws a little more attention. We usually dont care but I have it seen it (aka my attending) has my admitted for it before in the right clinical picture.

Curious what yall do.
 
I'd suggest clinical correlation.


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