Ultrasonography in ascites

Our plain-English summary of Ultrasonography in ascites, by H.C. Yeh, B.S. Wolf (Radiology, 1977).

The study

• Authors: H.C. Yeh, B.S. Wolf
• Journal: Radiology
• Published: 1977;124(3):783-90
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Ascites is usually not difficult to detect with ultrasonography because of its characteristic lack of echoes. However, minimal or lobulated collections of fluid or unusual distributions due to anatomical variations or associated pathological processes may create problems in diagnosis. Differentiation from an intraperitoneal abscess, hematoma, lymphocele, or cystic mass is of considerable clinical importance.

In plain English

This article described how ascites (fluid collecting in the abdomen) looked on ultrasound scans. The authors scanned 40 patients with possible ascites or related problems, including abdominal cancer, peritoneal mesothelioma, heart failure, pelvic abscess, pelvic lymphocele and a blood collection under the liver's capsule. They did not report how many patients had each condition. The article does not discuss asbestos. With patients lying on their backs, small amounts of fluid usually appeared in the flanks, more often on the right. Fluid between the liver and right kidney, or in the lesser sac, appeared only with marked ascites. In very thin, wasted patients, the small bowel and its mesentery sank in the fluid. One illustrated patient had pelvic fluid caused by a peritoneal mesothelioma, with the uterus surrounded by fluid. The authors noted that cysts, abscesses, hematomas and lymphoceles can mimic trapped fluid. They described scan features that can help tell ascites apart from cysts, liver hematomas and lymphoceles. They concluded that the distinction may have to rest on clinical features rather than the scan. They noted that a fluid-filled abdomen can make it hard to angle the probe into the pelvis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive imaging report (case series) of ultrasound appearances, with no statistical analysis
• Who was studied: 40 patients with possible ascites or related problems, including abdominal carcinoma or carcinomatosis, peritoneal mesothelioma, congestive heart failure, pelvic abscess, pelvic lymphocele and subcapsular hematoma of the liver. The departments of radiology were at Mount Sinai Hospital and Mount Sinai School of Medicine, New York. Study dates and the number of patients with each condition were not given.
• Exposure: No asbestos or other exposure was studied. The article concerns gray-scale and real-time ultrasound imaging of abdominal fluid.
• Main results:
  • In patients lying on their backs, minimal ascites usually showed as fluid in the flanks on one or both sides. It was more often on the right, at the superior end of the paracolic gutter.
  • Fluid between the liver and right kidney (Morison's pouch) and in the lesser sac was unusual and occurred only with marked ascites.
  • In markedly emaciated or cachectic patients, the entire small bowel and mesentery sank in the ascitic fluid.
  • In one illustrated patient, ascitic fluid in the pelvis was due to a peritoneal mesothelioma, and the uterus was surrounded by the fluid.
  • Localized collections such as fluid in a cyst, pus in an abscess, blood in a hematoma or lymph in a lymphocele may simulate loculated fluid.
  • A cyst was characteristically round or oval with smooth walls, whereas loculated ascites was surrounded by bowel loops or organs without a smooth, rounded shape.
  • A subcapsular hematoma of the liver could simulate ascites, but the blood was on one side only and did not cross the falciform ligament.
  • A pelvic lymphocele, being outside the peritoneum, could compress and push the bladder to one side, which is less likely with loculated ascites.
  • Adhesions or a 'frozen pelvis' were not necessarily caused by a malignant process.
• The authors' conclusion: The authors concluded that telling ascites apart from localized fluid collections may have to rest on clinical features rather than the ultrasound appearance. In many cases, they wrote, the clinical picture is decisive.
• Limitations the authors state:
  • The authors noted a limitation of the technique: a fluid-distended abdomen can make it difficult to angle the probe into the pelvis, so associated masses may be hard to show.

Topics

Medical terms in this study, explained in our Lexicon: Ascites.

Related studies

• Ultrasonography and computed tomography of peritoneal mesothelioma — H.C. Yeh, A.P. Chahinian (1980)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Improving the cytological diagnosis of high-grade serous carcinoma in ascites with a panel of complementary biomarkers in cell blocks — X. Zhang, L. Chen, et al. (2018)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Palliation of malignant ascites with a Tenckhoff catheter — D.A. Lomas, P.J. Wallis, et al. (1989)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)

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