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Free fluid in the hepatorenal space and right paracolic gutter

Ultrasound images showing an anechoic collection, consistent with free fluid, in the perihepatic region, in the hepatorenal space (Morison pouch), extending toward the right paracolic gutter.

Topography
Abdomen / FAST-eFAST
Diagnosis/finding
Intraperitoneal free fluid
Source
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Case discussion

In a trauma or FAST protocol context, free fluid in these locations is highly suspicious for hemoperitoneum and requires urgent clinical correlation and management. Outside trauma, differential diagnoses include ascites related to portal hypertension, heart failure, hypoalbuminemia, inflammatory or infectious disease, and neoplastic causes. Clinical context is essential to determine the cause of the fluid.

How to report it

Free fluid (anechoic collection) in the perihepatic region, extending into the hepatorenal space (Morison pouch) and right paracolic gutter.

How to explain it to the patient

The ultrasound found free fluid in the abdomen, near the liver and right kidney. In emergency or trauma settings, this can be a sign of internal bleeding and needs urgent medical assessment. In other situations it may have other causes, and the treating physician will define the next steps.

Case captions

Free fluid in the hepatorenal spaceUltrasound cine showing free fluid in the hepatorenal space (Morison pouch), seen as an anechoic collection between the liver and the right kidney. In trauma, this is suspicious for hemoperitoneum; in other settings, correlate for ascites or other causes.
Left subphrenic and splenorenal spacesLeft upper quadrant FAST/eFAST window assessing the left subphrenic and splenorenal spaces, where small volumes of free fluid may be subtle. Scan broadly around the spleen to avoid missing small collections.
Pericardial effusion surveyCardiac FAST/eFAST window used to assess for pericardial fluid. Interpretation should correlate the cine appearance with the clinical context and, when possible, with multiple cardiac windows.
Right subphrenic spaceUltrasound cine of the right subphrenic space, one of the areas assessed during FAST/eFAST screening for free fluid.
No free fluid in the pelvisPelvic image from the systematic search for free fluid, showing no evident anechoic collection in the evaluated pelvic recess. Small volumes may still be limited by bladder filling, window quality, or incomplete assessment.
Right paracolic gutterUltrasound cine showing free fluid in the right paracolic gutter, appearing as an anechoic collection along the lateral right abdomen. In trauma, this supports intraperitoneal free fluid/hemoperitoneum.