Thread by @NephroP

Time to follow up on #VExUS #POCUS
Today's images will demonstrate the improvement in congestion with IV diuretic therapy.
#tweetorial
1/ Portal vein - note the pulsatility is ~55% (<30% taken as normal) & the whole waveform is above the baseline now = improvement!! #IMPOCUS

https://twitter.com/NephroP/status/1253068122640261121

2/ Also note the RAP meter in the above image with arrow pointing to current state.
Below is the side-by-side comparison between the initial #POCUS image and the current one.

3/ Hepatic vein waveform: Note the improvement; arrow points to current state on the RAP meter. #POCUS @ThinkingCC @ArgaizR feel free to comment if you don't agree with the labeling.

4/ Side-by-side comparison with the initial image.

5/ Now the renal vein: note venous flow during both systole and diastole (using arterial flow as the marker for cardiac cycle); diastolic component appears more prominent. Arrow points to the current state on RAP meter. No comparison available for this. #POCUS

6/ Good old IVC: Note the improvement in the size (~3 cm initially, now ~2.1) and collapsibility (still on the higher side of RAP however).

6/ If you like to see the staghead (transverse IVC with hepatic venous confluence) #POCUS

7/ Lungs: A-lines bilaterally (4+4 zones). Representative image (left w adjacent heart) included. #POCUS

8/ Representative image of the cardiac function: PSAX view - note severely reduced systolic function with global hypokinesis. No septal flattening. #POCUS #MedEd
Looks like there is trace pericardial effusion.

This case is a great example of how #VExUS & #POCUS in general can be integrated into #nephrology /IM practice for objective assessment of volume status. #MedEd