Ebook Point of care - Ultrasound: Part 2
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Ebook Point of care - Ultrasound: Part 2
KidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2y suspicious mass detected by point-of-care ultrasound warrants further investigation and expert consultation.•A bladder ultrasound exam should accompany every renal ultrasound exam. A distended bladder due to bladder outlet obstruction is a common cause of hydronephrosis.BackgroundRenal ultrasound Ebook Point of care - Ultrasound: Part 2provides a fast, radiation-free. and cost-effective alternative to computed tomography (CT) for the initial workup of low-risk patients who present wiEbook Point of care - Ultrasound: Part 2
th acute symptoms ranging from undifferentiated abdominal pain to painless hematuria.1 Ultrasound is the imaging modality of choice for investigating KidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2etect and grade hydronephrosis in the context of obstructive uropathy/ directly visualize large obstructing calculi,3 and characterize renal cysts or solid masses.4 Renal ultrasound can be incorporated into the assessment of any patient with undifferentiated Hank or abdominal pain. When clinical sus Ebook Point of care - Ultrasound: Part 2picion for renal calculus is high, the presence of hydronephrosis on the side of pain can be considered as de facto evidence of obstructive uropalhy.Ebook Point of care - Ultrasound: Part 2
Sensitivity of ultrasound for detecting a calcified stone can be improved with the addition of a single plain film of the abdomen (kidneys, ureter, anKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2 calculus.7 When stone disease is clinically less likely or an alternate pathologysuch as abdominal aortic aneurysm, gallbladder disease, ovarian torsion, or ectopic pregnancy is being considered, the absence of hydronephrosis effectively guides investigations elsewhere.Normal AnatomyKidneys are ret Ebook Point of care - Ultrasound: Part 2roperitoneal organs that lie in an oblique longitudinal plane with the inferior pole of each kidney more anterior and lateral compared to its superiorEbook Point of care - Ultrasound: Part 2
pole (Figure 20.1). Therefore, rhe transducer must be positioned obliquely to image the kidney along its long axis. The left kidney is located more sKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2o interference by bowel and stomach gas anteriorly, and the right kidney is often visualized through the acoustic window provided by the liver. The right kidney is slightly larger than the left kidney, but both kidneys are normally within 2 cm of each other in any dimension. Normal kidneys are 9-12 Ebook Point of care - Ultrasound: Part 2cm long. 4-6 cm wide, and 2.5 3.5 cm thick.Kidneys are divided into two distinct anatomic parts: renal parenchyma and renal sinus (Figure 20.2). RenalEbook Point of care - Ultrasound: Part 2
parenchyma is further subdivided into renal cortex and medulla. The medulla consists of cone-shaped medullary pyramids. Renal parenchyma surrounds154KidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2ein, and proximal ureter enter the renal sinus. Prominent fatty deposits within the renal sinus give it a hyperechoic appearance and distinguish it from the hypoechoic, grainy renal parenchyma. This difference in echogenicity is known as the sonographic double density of the kidney.4-8Image Acquisit Ebook Point of care - Ultrasound: Part 2ionA low-frequency transducer with deep penetration. cither phased-array or curvilinear type, is used to image the kidneys, rhe narrower beam width ofEbook Point of care - Ultrasound: Part 2
a phased-array transducer is ideal for imaging between the ribs, but the wider beam width of a curvilinear transducer allows visualization of the entKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2ne image to compare with the affected side. To image the right kidney, place the patient in a supine position with the transducer in a coronal plane in the midaxil-lary to anterior axillary line al the level of the xiphoid process. Center rhe kidney on the screen and rotate the transducer 15-30 degr Ebook Point of care - Ultrasound: Part 2ees counterclockwise to aim the transducer marker slightly posteriorly to capture a true long-axis view of the right the kidney. While holding the traEbook Point of care - Ultrasound: Part 2
nsducer in the same location on the skin surface, tilt or fan the transducer anteriorly and posteriorly to assess the entire kidney from its most anteKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2. Tilt or fan the transducer superiorly and inferiorly to assess the superior and inferior poles of the kidney. Figure 20.3 illustrates transducer positions to obtain long-and short-axis views of the kidney.The left kidney is more posterior and superior than the right kidney. Placing the patient in Ebook Point of care - Ultrasound: Part 2a right lateral decubitus position facilitates visualization of the left kidney and reduces interference from the ribs and bowel gas. Requesting the pEbook Point of care - Ultrasound: Part 2
atient to hold his breath in maximal inspiration will shift the kidney caudally to further reduce interference from rib shadows. Identify the left kidKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2 marker posteriorly to acquire a true long-axis view (Figure 20.4). Transverse or short-axis views arc obtained by rotating the transducer 90 degrees counterclockwise from the long axis (Figure 20.5). ’KSagittal and transverse views of the bladder should be obtained for a complete evaluation of the Ebook Point of care - Ultrasound: Part 2urinary system (see Chapter 21. Bladder).Image InterpretationPerinephric fat and Gero la's fascia appear as a hypercchoic stripe around the kidneys, aEbook Point of care - Ultrasound: Part 2
nd the fibrous capsule gives each kidney a hyper-echoic outline. Normally, the renal cortex has a homogeneous appearance on ultrasound20-KIDNEYS155FigKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2hypoechoic or anechoic triangular prominences in a semicircular arrangement around the sinus. As a result, the renal medulla is significantly less echogenic compared to the surrounding cortex.rhe renal sinus normally appears hyper-echoic due to fat content, and in rhe absence of urinary tract obstru Ebook Point of care - Ultrasound: Part 2ction, the sinus appears homogenously hyperechoic with small anechoic pockets of urine. The ureter is usually obscured by bowel gas but may be visibleEbook Point of care - Ultrasound: Part 2
with ultrasound when dilated. When distended, theureter appears as a tubular structure extending inferiorly from the renal pelvis.4-8Pathologic FindiKidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•Any Ebook Point of care - Ultrasound: Part 2ction and indicates hydronephrosis. The severity of hydronephrosis is classified as mild, moderate, or severe (Figure 20.6)9 and may correlate with the size of the1564-ABDOMEN AND PELVIS Ebook Point of care - Ultrasound: Part 2KidneysBehzad HassaniKEY POINTS•ỉhc primary indication to perform a point of care ultrasound exam of the kidney is to evaluate for hydronephrosis.•AnyGọi ngay
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