# An Unexpected Cause of Shock in a Trauma Patient with Hemodynamic Instability: A Case Report

## TL;DR

A trauma patient with unstable vital signs was found to have abdominal fluid, but the real cause of her shock was a pulmonary embolism, not an abdominal injury.

## Contribution

This case highlights how eFAST findings can be misleading and emphasizes the importance of clinical correlation in trauma evaluation.

## Key findings

- A patient with free abdominal fluid on eFAST was found to have a high-risk pulmonary embolism as the cause of hemodynamic instability.
- The free fluid was due to a ruptured ovarian cyst and ascites, not an acute intra-abdominal injury.
- Emergency physicians should consider non-traumatic causes when interpreting eFAST results.

## Abstract

Traumatic injury is the leading cause of death in individuals under 45 years of age, and point-of-care ultrasound (POCUS) has become an essential component of the initial trauma evaluation. However, positive findings on the extended focused assessment with sonography in trauma (eFAST) may be misinterpreted as evidence of an acute surgical emergency, particularly in the context of blunt trauma, underscoring the need for careful clinical correlation.

We present a case in which a hemodynamically unstable patient had significant free abdominal fluid on eFAST after a fall from standing height. She was ultimately diagnosed with a high-risk pulmonary embolism as the cause of her hemodynamic instability, while the free abdominal fluid was identified as originating both from a ruptured ovarian cyst and from moderate-volume ascites.

The eFAST exam is a valuable tool in rapidly identifying intra-abdominal injuries following blunt trauma. However, the presence of free fluid on eFAST may result from causes other than acute intra-abdominal injury requiring surgical intervention. Therefore, emergency physicians should interpret positive findings with clinical judgment and consider the broader clinical context.