4. Free Fluid Evaluation with Pelvic Ultrasound

Abnormal Pelvic Free Fluid

There are several pathologic conditions (both pelvic and non-pelvic) associated with an abnormal buildup of free fluid in the pelvis. 

Here is a list of potential pelvic causes of abnormal amounts of free fluid in the Pouch of Douglas:

  • Endometriosis
  • Malignancy
  • Leiomyoma
  • Pelvic Inflammatory Disease
  • Ectopic Pregnancy
Transvaginal Ultrasound Free Fluid in Pouch of Douglas Sagittal View
Pelvic free fluid accumulation in Pouch of Douglas; Sagittal Transvaginal scan

When you do see a significant amount of free fluid in the Pouch of Douglas make sure to check the right upper quadrant (RUQ) in Morison’s Pouch and the left upper quadrant (LUQ) to evaluate for more free fluid. Remember, free fluid can also be due to non-pelvic causes such as liver cirrhosis (alcohol-related or viral), heart failure, renal failure, and trauma. Below are ultrasound images of abdominal free fluid in the left and right upper quadrants.

RUQ Free Fluid in Morison’s Pouch
Free Abdominal Fluid Left Upper Quadrant LUQ
LUQ Free Fluid

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