Confirmation of the diagnosis of obstructive uropathy in patients suspected of ureteral colic
Abdominal or flank pain
Hematuria
Groin pain
Acute urinary retention
Known or suspected acute renal failure
Laboratory evidence of renal failure
Oliguria or anuria
Painless hematuria or proteinuria
Suspected renal abscess
Infected urine with fever and abdominal or flank pain
Suspected or known abdominal trauma
CONTRAINDICATIONS
None
RISKS/CONSENT ISSUES
Allergy to the ultrasonography gel
LANDMARKS
The right kidney is usually located inferior and posterior to the liver
The left kidney is located inferior to the spleen
The bladder should be imaged in the suprapubic region
TECHNIQUE
A 3.5-MHz probe is commonly suitable for most adults, although a 5.0-MHz probe can be used in patients with a thinner body habitus and in children
The Right Kidney
With the patient supine, start at the midaxillary line at the level of the lower ribs holding the probe in the longitudinal axis or slightly oblique and scan laterally until the sagittal view of the hepatorenal space (Morison pouch) and the right kidney are visible
Rotate the probe 90 degrees to obtain a transverse image of the kidney. Move the probe superiorly and inferiorly to locate the renal hilum and visualize the full extent of the parenchyma (FIGURE 40.1).
The Left Kidney
The left kidney is most easily located by placing the probe hand against the bed while scanning the left flank at the posterior axillary line at the level of the lower ribs
Rotate the probe 90 degrees to obtain a transverse view of the left kidney
The Bladder
The bladder is best imaged when it is moderately filled at the time of examination
Place the probe suprapubically in the transverse plane. Angle the probe toward the patient’s feet. Color Doppler techniques can be used over the trigone area to verify the presence of ureteral flow jets indicating urine flow into the bladder.
Rotate the probe 90 degrees to obtain a sagittal view