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Sonographic detection of fluid in the cul-de-sac in children--a normal finding?
1Department of Radiology, Montreal Children's Hospital, Quebec.
Insights
A small amount of fluid in the cul-de-sac is normal in children. Larger amounts of incidental free pelvic fluid, however, require further investigation.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Abdominal Ultrasound
Background:
- Free intraperitoneal fluid in the cul-de-sac is occasionally detected during pediatric abdominal and pelvic ultrasounds.
- Understanding the significance of incidental fluid findings is crucial for accurate diagnosis and management.
Purpose of the Study:
- To determine the prevalence and significance of incidental fluid in the cul-de-sac in children.
- To differentiate normal fluid variations from potentially pathological findings.
Main Methods:
- Retrospective analysis of pediatric ultrasound examinations (n=65) of the abdomen and pelvis.
- Grading of fluid amount (minimal, moderate, abundant) and exclusion of expected or explained fluid collections.
- Follow-up examinations in a subset of patients.
Main Results:
- Incidental fluid in the cul-de-sac was found in 6.7% of pediatric ultrasounds.
- A small amount of fluid is considered normal in 1.5%–2% of children.
- Moderate incidental fluid showed no associated morbidity; however, large amounts were not considered normal.
Conclusions:
- Minimal cul-de-sac fluid can be a normal incidental finding in pediatric ultrasounds.
- Abundant free pelvic fluid, even when incidentally detected, warrants further clinical evaluation.
- Ultrasound findings should be interpreted in conjunction with clinical context.
Abstract:
Fluid in the cul-de-sac was found in 6.7% of ultrasound examinations of the abdomen and pelvis in children aged one day to 20 years. The amount was graded as minimal (+), moderate (++), or abundant ( ). Excluding teenage girls and those clinical situations in which free intraperitoneal fluid was expected (48 children) or could be explained by clinical circumstances (71 children), there remained a group of 65 children in whom no explanation of the usually minimal amount of fluid in the cul-de-sac could be found. A small amount of such fluid is a normal finding in 1.5% to 2% of children of both genders. Follow-up examinations in 16 patients found to have minimal incidental fluid in the pelvis showed repeat findings only in two; in the others no free fluid was demonstrated. A moderate amount of incidental free fluid was not associated with any morbidity: two of seven having a follow-up examination were normal. A large amount of free pelvic fluid, even when found incidentally, should not be considered as normal.