FAST - Focused Assessment with Sonography for

Trauma

• FAST examines four areas for free

fluid:

– Perihepatic & hepato-renal space
– Perisplenic
– Pelvis
– Pericardium

The 4 FAST views

The 4 FAST views

Views for FAST U/S

• RUQ view is the most important view for FAST
• 80% of hemoperitoneum detected on

hepatorenal view alone

• If blood collects in the RUQ, the fluid settles

between the kidney and liver

Morrison’s Pouch

Liver

Morrison’s Pouch

Kidney

Normal Morrison’s pouch

Abnormal Morrison’s

LUQ view

• In this view, looking for blood between the

– Spleen and the kidney OR
– Spleen and the diaphragm

Abnormal LUQ

Pelvis view

• In this view, looking for blood in the

– Rectovesicular pouch (males)
– Rectouterine pouch aka pouch of Douglas (females)

Normal pelvis view

Abnormal pelvis view

Pericardial view

• In this view, looking for blood between the

pericardium and the heart

Normal pericardium

Abnormal pericardium

FAST vs DPL

FAST

DPL

Radiation

None

None

Rapid

++

+

Portable ++

+

Noninvasive Yes

No

Sensitive

Good

Excellent

Specificity

Good

Fair

Pericardial eval

Yes

No

 

                                                                             

Contrast-enhanced CT of abdomen shows linear low-attenuation defectcrossing the

posterior aspect of the left lobe of the liver representing a laceration

Liver laceration

Liver laceration

Liver hematoma

Ultrasound examination shows the laceration as a
relatively hypoechoic area (arrow) with a local anechoic
area (arrowhead) that represents a haematoma

Liver hematoma

Spleen laceration

Spleen laceration and

hemoperitoneum

Kidney trauma

Axial contrast-enhanced CT section through
the kidneys showing extravasation of contrast
(arrow) from the left kidney, due to traumatic
forniceal rupture

Kidney trauma

Axial contrast-enhanced CT section shows a
large haematoma surrounding the fractured
lower pole of the right kidney.

Urinary bladder rupture

          - requires prompt diagnosis so as to
avoid hyperkalemia, hypernatremia,
uremia, acidosis, and peritonitis;
          - can be extraperitoneal or
intraperitoneal (or both);
     

    - extraperitoneal

rupture:

- most often, the rupture is anterior and
extraperitoneal;
- in rare may result from laceration from
sharp bone spike;
- in many cases, may be treated non
operatively w/ suprapubic drainage;
         

- intraperitoneal rupture:

- occurs in about 15% of major pelvic
fractures;
- most often occurs from contussion to
lower abdomen or to the symphyseal
region;
- may occurs w/o associated pelvic ring
disruptions as the result of a seatbelt or
steering wheel injury;
- usually requires operative correction;