Not So FAST: Pearls and Pitfalls of the Left Upper Quadrant Window during the Focused Assessment with Sonography in Trauma

The Focused Assessment with Sonography in Trauma (FAST) exam has for decades been used to screen for free peritoneal and pericardial fluid in blunt trauma. Although the exam was originally developed for blunt trauma, anesthesiologists have also demonstrated its utility in narrowing the differential diagnosis of intra- or postoperative hypotension.¹  Further, proficiency with the FAST exam’s abdominal views was recently identified by the American Board of Anesthesiology (Raleigh, North Carolina) as a core competency for anesthesiologists.² 

Anesthesiologists should therefore become familiar with the FAST exam’s pearls and pitfalls, especially the challenging left upper quadrant (LUQ) view.^1,3  The view is obtained by placing a low-frequency transducer along the left flank in the body’s coronal plane (Supplemental Digital Content 1, https://links.lww.com/ALN/D594). Perhaps because the simpler right upper quadrant view screens for fluid between the liver and kidney (Supplemental Digital Content 2, https://links.lww.com/ALN/D595), novice sonographers tend...