Right Upper Quadrant (RUQ)

The RUQ is the area to scan first, as free fluid will often be seen in this area earlier than in other areas. In addition, this is probably the easiest area to scan and in which to gain confidence. Ensure the pleural recess is adequately seen.

Probe position

Ensure the pleural recess is adequately seen. Position the probe as shown in the diagram.

Normal scans: RUQ and right pleural recess

Abnormal scans

Fluid in Morison’s pouch and the pleural recess

Free fluid, both in Morison’s pouch and in the pleural recess, appears black. Visualising early collections of fluid is dependant on the patient having been supine for at least 20 minutes. A patient who is sitting upright, even by 10 or 15 degrees, will obviously pool fluid in the pelvis rather than in the upper recesses of the peritoneal cavity, and this can lead to errors. Always ensure that any patient who has been upright is positioned flat for at least 20 minutes, if a meaningful scan is to be carried out. Always ensure that the patient lies flat for 20 minutes.

Fluid in the RUQ

Fluid in the pleural cavity and peritoneal cavity on RUQ view