27 yoF presented to the ED with acute onset abdominal pain and distention. An ultrasound was performed that showed intraperitoneal fluid. Free fluid was identified at the liver tip and in the pouch of Douglas (video 1).
As a reminder, the pouch of Douglas is the potential space between the uterus and rectum (seen in the suprapubic view).
Video 1 shows something called the “TIE fighter sign,” where large amounts of free fluid fill the pouch of Douglas, posterior to the uterus. The uterus and ovarian ligaments are suspended between the pouch of Douglas and the bladder. This sonographic sign is based on the fact that the appearance of the uterus and ovarian ligaments looks like the “Twin Ion Engine” fighter from the Star Wars movies (Image 1).
While the free fluid was initially presumed to be from a ruptured ovarian cyst, the patient remains admitted to workup this ascites of unknown etiology
Happy scanning!
Ariella Cohen
M.D. Emergency Medicine
Maimonides Medical Center