Young lady presented with history of assault and abdominal pain with difficulty to pass urine.
Liver, spleen, pancreas, kidneys, urinary bladder are normal with no features of contusions. No free fluid in the abdomen or pelvis. Corresponding to sites of clinical pain and tenderness, were focal areas of hyperechogenicities within the anterior abdominal wall fat correlating with contusions of the abdominal wall. They were associated with probe tenderness.
Careful examination of sites of tenderness using high frequency linear probes will help elicit subtle injuries confined to the abdominal wall that presents as localized abdominal pain. Alteration of normal fat echoes replaced by high echogenicities or even distortion of normal fat architecture gives a clue.