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Abdominal Distension

A 58-year-old male presented to the outpatient clinic with complaint of abdominal distension for 1 year. There was no history of abdominal pain, nausea, vomiting, fever, or trauma. The patient was an alcoholic and drank alcohol every day for the past 25 years. Patient did not appear to be in distress. Vital signs were within […]

A 58-year-old male presented to the outpatient clinic with complaint of abdominal distension for 1 year. There was no history of abdominal pain, nausea, vomiting, fever, or trauma. The patient was an alcoholic and drank alcohol every day for the past 25 years. Patient did not appear to be in distress. Vital signs were within normal range. The following images were obtained while performing an abdominal scan.

Images courtesy of UltrasoundCases.info owned by SonoSkills

 

What is the most accurate diagnosis?

A. Hemoperitoneum
B. Acute acalculous cholecystitis
C. Liver cirrhosis with ascites

 

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Answer: 

Since, the patient has no history of trauma, the patient is a male and vitals are stable, so there is very low probability of it being hemoperitoneum. The gallbladder wall appears thickened and edematous, and it is an expected finding with ascites. There is no history suggestive of acute cholecystitis. The liver appears small and shrunken with an irregular surface and heterogeneous echotexture. Patients with cirrhosis often present with ascites. 60-70% of patients with liver cirrhosis have a history of chronic excessive alcohol consumption. Some patients may have no history of alcohol consumption in cases with non-alcoholic steatohepatitis. Viral hepatitis may be the etiology in about 10% of patients. Always correlate clinically.

Reference

https://www.scirp.org/pdf/IJCM_2014111116284061.pdf

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