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14 Sep, 26 tweets, 16 min read
Tired of irradiating your patients with CT scans🙋‍♀️? Learn Renal Ultrasound #POCUS!

1⃣Perform Renal Ultrasound
2⃣Download Hydronephrosis PDF Guide!
3⃣Renal Pathology
4⃣Renal Hemodynamics (RRI/Venous Doppler)

✅New Blog Post! 👉🔗pocus101.com/Renal

#medtweetorial (1/25)👇
1 Download the FREE Hydronephrosis Grading PDF Pocket Guide! 👉🔗pocus101.com/Renal
2 The kidneys are retroperitoneal organs located on either side of the vertebral column from T12-L3. Notice that the right kidney is slightly more posterior than the left kidney because of the larger size of the liver relative to the spleen. 👉🔗pocus101.com/Renal
3 To perform renal ultrasound here are the key renal anatomic structures you should know:

Renal Cortex
Medullary Pyramids
Minor Calyces
Major Calyces
Renal Pelvis
Renal Sinus

👉🔗pocus101.com/Renal
4 Right Kidney Longitudinal View:
Point probe indicator towards the patient’s head.
Place your probe at the Right Midaxillary Line around the 10th to 11th intercostal space.

👉🔗pocus101.com/Renal
5 Identify the: Medullary Pyramids, Renal Pelvis, Renal Sinus, Mainor Calyces, Minor Calyces, and Renal Cortex.
*The normal size of an adult kidney is around 10-11cm in the longitudinal view.

👉🔗pocus101.com/Renal
6 Slowly tilt/fan the probe anteriorly and posteriorly to assess the entire kidney.

👉🔗pocus101.com/Renal
7 Right Kidney Transverse View:
*Maintaining the longitudinal view of the right kidney, center the kidney on your screen, and then rotate your probe 90 degrees counterclockwise.
*The probe indicator should be pointing Posteriorly.

👉🔗pocus101.com/Renal
8 Here is the ultrasound image transition that you should see as you go from the longitudinal kidney ultrasound view to the transverse view.

👉🔗pocus101.com/Renal
9 In the transverse view, identify the Renal Cortex, Medullary Pyramid, and Renal Pelvis.
Tilt the probe superiorly and inferiorly to assess the right kidney.

👉🔗pocus101.com/Renal
10 Left Kidney Longitudinal View:

*Point the probe indicator towards the patient’s head.
*Place your probe at the Left Posterior Axillary Line around the 8th to 10th intercostal space.
*Knuckles should touch the bed.

👉🔗pocus101.com/Renal
11 Left Kidney Transverse View:

*Maintaining the longitudinal view, then rotate your probe 90 degrees counterclockwise.
*The indicator should be pointing Anteriorly.
*Tilt the probe superiorly and inferiorly to assess the entire left kidney.

👉🔗pocus101.com/Renal
12 Don’t memorize the hydronephrosis grading system, just think that the structures closest to the obstruction will be the first to be dilated.

So the order of hydronephrosis will be Renal Pelvis -> Major Calyces -> Minor Calyces -> Renal Cortex.

👉🔗pocus101.com/Renal
13 There are multiple ways Hydronephrosis is described/graded.

👉🔗pocus101.com/Renal
14 Size Matters!

The cutoff size for a significant kidney stone size is around 5mm. Stones <5mm have a significantly higher chance (81-98%) of spontaneously passing while stones >5mm will have a lower chance (9-65%) of passing (Jendeberg 2010).

👉🔗pocus101.com/Renal
15 Sometimes renal stones can be seen in the renal cortex, pelvis, or the ureteropelvic junction. Look for a hyperechoic structure with Acoustic Shadowing.

👉🔗pocus101.com/Renal
16 If a suspected kidney stone is lodged within the ureter or ureterovesical junction, you may find an absence of ureteral jets on the obstructed side when scanning the bladder.

👉🔗pocus101.com/Renal
17 The Twinkling Artifact is a sonographic artifact located behind calcifications of ureteral calculi when color Doppler is applied. It will appear as a multicolored high-intensity signal, similar to signals produced by turbulent flow with aliasing.

👉🔗pocus101.com/Renal
18 Renal Cyst Ultrasound Findings
*Thin-walled and smooth, without septations or any internal elements.
*The anechoic areas of cysts are localized and do not connect to the calyces.
*Round or oval in shape
*Are located in the cortex or by the pelvis.

👉🔗pocus101.com/Renal
19 If you see multiple renal cysts, this could indicate Polycystic Kidney Disease (PCKD) or acquired renal cystic disease (ARCD). Image from @thepocusatlas!
20 Renal Cell Carcinoma (RCC)
*Most common Renal Malignancy in Adults.
*Highly variable with regards to size, shape, and location.
*Variable echogenicity: isoechoic, hypoechoic, or echoic

👉🔗pocus101.com/Renal
21 Angiomyolipoma
*Most common Benign Renal Tumor. (Tublin, 2011)
*Clearly circumscribed (i.e. angiomyolipoma) or irregular in shape (i.e. renal cell carcinoma).
*In some circumstances, renal cell carcinoma and angiomyolipoma can look very similar

👉🔗pocus101.com/Renal
22 Renal Resistive Index Forumla: RRI = (PSV – EDV)/PSV

👉🔗pocus101.com/Renal
23 Below is a quick summary on how to interpret the intravenous venous Doppler tracings. #vexus

👉🔗pocus101.com/Renal
24 Recognize Hydronephrosis Mimics!

Extrarenal Pelvis
Parapelvic Cysts
Prominent Vasculature or Vascular Malformation

👉🔗pocus101.com/Renal

Figures from @NephroP, visit his website to learn even MORE about them and renal ultrasound. He is the Kidney Jedi!
25 Want to learn even MORE about Renal ultrasound. Check out our Ultrasound Review book. The Renal Chapter written by @thepocusatlas @EMedCurious @MedakSD!

👉🔗pocus101.com/RevBook

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More from @Pocus101

2 Sep
#POCUS is the FASTEST way to assess your patient's Bladder!

1⃣Learn How to Perform Bladder Ultrasound
2⃣Measure Bladder Volume Correctly
3⃣Recognize Bladder Pathology
4⃣FREE Bladder Volume Calculator!

✅New Blog Post! 👉🔗pocus101.com/bladder

#medtweetorial (1/20)
1 Although it is easy to think of the bladder as a sphere it actually takes on other shapes in the body: Triangular Prism, Cylinder (Ellipsoid), or Cuboid

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2 In addition to the bladder itself, it is also important to understand the surrounding structures including the pubic bone, abdominal cavity and rectum. The uterus and prostate are also important landmarks for females and males respectively.

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19 Aug
Don't let your patients die from AAA or Aortic Dissection! #POCUS

1⃣Learn how to Easily do Aorta Ultrasound
2⃣Learn how to perform the Suprastenral View
3⃣Recognize AAA and Aortic Dissection

✅New Blog Post 👉🔗pocus101.com/aorta

#medtweetorial👇(1/25)
2 Start with the Short axis approach and place the probe near the subxiphoid area

👉🔗pocus101.com/aorta
3 Identify the Vertebral Body, Aorta, and IVC

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Fundoscopy 👁‍🗨 got you down? See clearly into the 👀 with #POCUS!

1⃣Learn How to Perform Ocular Ultrasound
2⃣Recognize Retinal Detachment, PVD, ⬆️ ICP, + MORE!
3⃣Free Ocular Ultrasound PDF Pocket Card!

✅New Blog Post! 👉🔗pocus101.com/Ocular

#medtweetorial👇(1/21)
(2) Download the Free Ocular Ultrasound PDF Pocket Card! 👉🔗pocus101.com/Ocular
(3) Obtain the Transverse View:

Place the probe lightly on the gel covering the patient’s eye with the probe indicator pointed towards the patient’s right to obtain a transverse view.

👉🔗pocus101.com/Ocular
Read 23 tweets
30 Jun
Having trouble figuring out Ultrasound Knobology, Probes, Modes?

Master #POCUS settings including probe movements, orientation markers, ultrasound planes, B-mode, M-mode, all Doppler settings, and MORE!

New Blog Post! 👉🔗pocus101.com/knobology

#medtweetorial👇(1/27)
(2) Before choosing your ultrasound probe, always ask yourself:

• What application am I using this for?
• How deep are the structures?
• How big or small of a footprint do I need?
• Does it involve a procedure?
• Does it involve a cavity?

👉🔗pocus101.com/knobology
(3) Handling the ultrasound probe and proper movement is essential to obtaining optimal ultrasound images. Learn the Essential Movements:

•Sliding
•Tilting
•Rotating
•Rocking
•Compression

👉🔗pocus101.com/knobology
Read 27 tweets
2 Jun
Learning Ultrasound Physics, Doppler, and Artifacts doesn’t have to be Terrible!

Learn Ultrasound Physics in a Practical, Relevant, and Clinically USEFUL way.

New Blog Post! 👉🔗Pocus101.com/Physics

#medtweetorial👇(1/20)
(2/20) Ultrasound machines create images using the Piezoelectric Effect

👉🔗Pocus101.com/Physics
(3/20) Here are the main Ultrasound values and trends you need to understand ultrasound physics

👉🔗Pocus101.com/Physics
Read 20 tweets
11 May
Learning Diastolic Dysfunction can seem Overwhelming! But what if ANYONE could Learn/Understand #Diastology using a Simple "PUSH and PULL" Analogy?

New Blog Post! Step By Step #POCUS Guide, PDF Pocket Card, & Calculator.
👉🔗pocus101.com/diastology

#medtweetorial👇(1/18)
(2/18) Learning diastolic dysfunction doesn’t have to be hard. In this Post, we will go over the TWO main findings: Mitral Inflow and Tissue Doppler Measurements.

Download the summary Pocket Card PDF:
👉🔗pocus101.com/diastology
(3/18) Mitral Inflow measures BLOOD coming into the LV during diastolic filling (E and A waves).

Here are some Pulse Wave Doppler tips:
1. Place the sample gate at mitral valve tips
2. Bring the baseline down
3. Set Scale to about 120cm/s

👉🔗pocus101.com/diastology
Read 18 tweets

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