Thread by @NephroP

Simple-appearing #IMPOCUS scenario but important!
Thread:
1/ Consulted for AKI. Patient: Middle-aged gentleman with significant peripheral edema.
Plan: Let's try diuretic
Oh, may be perform #POCUS
-> IVC looks plump, doesn't appear to collapse 👇 = needs diuretic. #MedEd

2/ but the renal attending likes to do #VExUS
Let's look at portal vein #POCUS
-> Looks great, doesn't seem to indicate congestion

3/ What about the renal vein #POCUS?
Not a great picture due to breathing but seems the waveform is continuous (appears noisy because the gain was increased intentionally) [don't pay attention to RI - its inaccurate]

Lungs?
Overall A-line pattern. Left sided image shown 👇

Something doesn't sound right...why was IVC plump? No h/o pulm HTN or severe TR based on recent Echo.
Let's repeat IVC #POCUS 👇

oh no...it's barely 1cm in max diameter and collapsing with normal inspiration.

What's wrong with the initial IVC (done few minutes before, same machine)?
Caudate lobe of the liver was mistaken for IVC!
IV diuretic would have worsened AKI🤔
Trust me, this is not an uncommon scenario. #VExUS is a great addition to day-to-day #POCUS Thanks to @ThinkingCC & co

Finally, the good old #POCUS saying...