We had an interesting the case the other day.

A young female was triaged to ambulatory care with pelvic pain and urinary retention after a soccer team mate ran headlong into her lower abdomen during the game. When we saw her she had been able to pass urine. The urine dipstick was NAD and negative for pregnancy.

Her abdomen was soft, with no guarding, but tender to deep palpation in the suprapubic region. 

So what to do? She has had blunt trauma to the abdomen. Should she have a CT? She doesn't have peritonitis so she's unlikely to have a perforation, but could she have a small mesenteric bleed or something from the impact??

She's young... would you CT her?

Well, we have US, so that's what we did. 

LUQ

RUQ

Pelvis Trans

Is there Free fluid?

Now where in the pelvis is the FF? Number 1, 2 or 3 in the video below?

The long view of the pelvis revealed the cause of the free fluid. See the clip below

The ovary is identified by the features of an oval shaped hypoechoic structure with peripheral follicles. This ovary has a large central cyst with internal septations. We assumed that the cyst had ruptured with the trauma. Given it was after hours and the trauma, we went on to do a CT which confirmed this. 

In a pregnant female, this could have been a ruptured ectopic.  

An ovarian cyst >5cm in a pre-menopausal female and >3cm in a post menopausal female should be followed up with US.