Ultrasound: Scrotal edema and abdominal distension
Posted on: March 18, 2013, by : Sonny Tat MD MPHby Priya Gopwani
A 3yo M presented with 2 weeks of worsening abdominal distention, scrotal and LE edema. He has a history of frequent vomiting x 2 years. He had been seen the week prior with mild abd pain and vomiting, and was found to have an albumin of about 2 with no proteinuria. He tolerated POs and was discharged home. Now, he re-presented with worsening abdominal distention and edema as above.
A bedside ultrasound was performed to evaluate for ascites (positive), pericardial effusion (negative) and pleural effusions (positive b/l). Below you can see clips of the lung ultrasound. Typically when you look at the level of the diaphragm, you should see the reflection of the liver/spleen above the diaphragm. The reflection should have a similar echogenicity to the organ itself. Here, you can see that you lose that reflection, and see dark fluid instead.
Additionally, in this video clip, you can see that the lung is collapsed and essentially floating in the effusion.
Lung ultrasound for pleural effusions can be obtained either in the eFAST (extended FAST), that includes looking above the diaphragm with the abdominal probe, or it can be obtained posteriorly using the linear probe. Using the linear probe provides higher resolution, and is how these video clips were obtained. The patient was admitted for further work up/management and diagnosed with a protein losing enteropathy. He is currently being treated and followed in GI clinic.