54 y/o female was the unrestrained driver in a car vs tree at a high rate of speed. She is altered, but is moaning in pain, gets louder when you palpate her abdomen and chest. There is an abdominal and chest seatbelt sign noted. Vitals: 75/42 134 24 90% RA. What is the name of this finding and sign?
Answer: Spine Sign, Hemothorax
This eFAST exam demonstrates normal lung sliding bilaterally and a Morison’s Pouch view that is negative for peritoneal free fluid. Above the diaphragm, however, there is noted to be an anechoic fluid collection consistent with hemothorax.
- When the diagnosis of pleural effusion is in question, increase the scan depth and identify the spine. If a pleural effusion is present, the spine will be visible past the diaphragm. This is known as a positive spine sign.1,2
- Although this Morison’s Pouch view is negative for peritoneal free fluid, the caudal tip of the liver is not well visualized here, reducing this scan’s sensitivity for peritoneal free fluid. Fluid will first appear at this caudal hepatic tip.3,4
- Ahmed AA, Martin JA, Saul T, Lewiss RE. The thoracic spine sign in bedside ultrasound. Three cases report. Med Ultrason. 2014;16:(2)179-81. [pubmed]
- Lobo V, Weingrow D, Perera P, Williams SR, Gharahbaghian L. Thoracic ultrasonography. Crit Care Clin. 2014;30:(1)93-117, v-vi. [pubmed]
- Ma OJ, Kefer MP, Mateer JR, Thoma B. Evaluation of hemoperitoneum using a single- vs multiple-view ultrasonographic examination. Acad Emerg Med. 1995;2:(7)581-6. [pubmed]
- Wu TS. Ultrasound, an Issue of Critical Care Clinics. Elsevier; 2013. [google book]