So as a follow up to a recent post about intra-abdominal thrombolysis, here is a little pearl from a colleague and fellow ICU physician, Dr. Ian Ajmo.

The Ajmo sign refers to the visualization of injected contrast in a fluid cavity, used to confirm proper position of a drainage catheter in an effusion or ascites.

In the case of a separated effusion, it is often difficult to determine if the septations are truly divisive of the fluid, or just a network of membranes that remain communication and that a single catheter can drain. I have seen both cases with similar echo graphic appearance.

However, the Ajmo sign can be used to determine of the catheter is likely to drain the bulk of the collections, or if the use of thrombolytics should be considered:

In this case, we can see that the agitated saline fills only one of the cavities with little or no spillover into adjacent pockets of pleural fluid. This is a case where thrombolytics can be considered. Hence, this consideration can be done early using bedside ultrasound, rather than follow up CT scans (notoriously poor at seeing fine separations).

cheers!

Philippe