Ascites

  • Etiology:
    — simple ascites due to hydrops fetalis, liver failure
    — complicated ascites due to bowel perforation, biliary tree laceration, lymphatic system laceration, intraperitoneal hemorrhage, urinary tract obstruction
  • AXR: centralization of bowel loops
  • US: simple ascites is clear, complicated ascites is echogenic
  • DDX: abscess
  • Complications: can become septated or infected
  • Clinical: if large can cause respiratory distress

Cases of Ascites

CXR of Pentalogy of Cantrell
CXR and AXR shows the cardiac margin to be absent below the level of the diaphragm. The left lung is hyperlucent compared to the right. There is a paucity of bowel gas within the abdomen and centralization of bowel loops
AXR of chylous ascites in child abuse
CXR AP (left) shows the lungs to be poorly expanded and clear but there are dense areas of callus along the lateral aspect of the right 3rd-5th ribs. Centralization of the loops of bowel were also incidentally noted and confirmed on a subsequent AXR AP (right).