Bedside Renal Ultrasonography: Limited, Goal-Directed

imagesConfirmation of the diagnosis of obstructive uropathy in patients suspected of ureteral colic


   imagesAbdominal or flank pain


   imagesHematuria


   imagesGroin pain


imagesAcute urinary retention


imagesKnown or suspected acute renal failure


imagesLaboratory evidence of renal failure


imagesOliguria or anuria


imagesPainless hematuria or proteinuria


imagesSuspected renal abscess


imagesInfected urine with fever and abdominal or flank pain


imagesSuspected or known abdominal trauma


CONTRAINDICATIONS



imagesNone


RISKS/CONSENT ISSUES



imagesAllergy to the ultrasonography gel


LANDMARKS



imagesThe right kidney is usually located inferior and posterior to the liver


imagesThe left kidney is located inferior to the spleen


imagesThe bladder should be imaged in the suprapubic region


TECHNIQUE



imagesA 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


imagesThe Right Kidney


   imagesWith 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


   imagesRotate 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).


imagesThe Left Kidney


   imagesThe 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


   imagesRotate the probe 90 degrees to obtain a transverse view of the left kidney


imagesThe Bladder


   imagesThe bladder is best imaged when it is moderately filled at the time of examination


   imagesPlace 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.


   imagesRotate the probe 90 degrees to obtain a sagittal view



images


FIGURE 40.1 Renal ultrasonography (photo courtesy of Dr. Charles Martinez).

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Renal Ultrasonography: Limited, Goal-Directed

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