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5 Feb, 5 tweets, 3 min read
Renal #POCUS in a #dialysis patient: Looks fine at first glance (thin parenchyma as expected) but fanning anteriorly reveals a large cyst, which would have been missed otherwise. Labeled images and notes in thread 👇
#Nephrology #MedEd #IMPOCUS
Labeled first image #POCUS
Note: peri-renal fat (usually prominent in ESRD patients) can be confused with free fluid.
Labeled second image #POCUS (obtained with phased array probe)
Note: EKG is not needed 😀
CT scan
Brief note on this #POCUS scenario:
nephropocus.com/2021/02/05/a-c…

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More from @NephroP

NephroPOCUS Profile picture
5 Feb
OK #VExUS #POCUS hemodynamicians, welcome back to the case. As promised, here are some follow up images:
@ArgaizR @ThinkingCC @khaycock2 @katiewiskar @Thind888 @MDBeni et al.
Hepatic v. 👇
Looks D-only but could this be S-wave? (or a delayed D? Pt has Afib and predisposed to having smaller S but wondering if there is some S-D fusion here)
Forgot, here is the IVC. Similar to previous.
Read 13 tweets
NephroPOCUS Profile picture
11 Nov 20
#Nephrology consult for worsening creatinine in the context of diuresis in a patient with #heartfailure
Documented weight 3 kg ⬇️ than the previous day. No accurate urine output. Pt feels OK (has some unrelated issue).
Question: over diuresis?
#POCUS #MedEd #VExUS see thread 👇
So, there is decreased LV systolic function and obviously diastolic dysfunction. Bi atrial enlargement. No significant pericardial effusion (there was trace on PLAX).
Next step in the hemodynamic circuit #POCUS assessment?
btw repeat weight was similar.
Next: IVC #POCUS assessment to assess right atrial pressure.
Here it is 👇
Big and plethoric (take it as 15 mmHg in a spontaneously breathing person - we get RVSP of ~41 mmHg based on the above tricuspid gradient)
Read 10 tweets
NephroPOCUS Profile picture
25 Aug 20
#POCUS #IMPOCUS
Understanding #VExUS from scratch:
A mini #tweetorial on normal hepatic vein waveform genesis 👇 #MedEd #echofirst

1/ Understanding color and direction
2/ What is S wave? #POCUS
3/ V wave #POCUS
Read 8 tweets
NephroPOCUS Profile picture
18 Aug 20
#POCUS Intra-renal vein Doppler waveform looking exactly like that of hepatic vein!
#VExUS obtained from a #nephrology clinic patient with pulmonary hypertension. #MedEd
Normal hepatic vein waveform #POCUS Image
Portal vein #POCUS in this patient - increased pulsatility. Image
Read 6 tweets
NephroPOCUS Profile picture
11 Jul 20
@Thind888 @FH_Verbrugge @khaycock2 Dear hemodynamic masters, saw a cirrhotic pt with oliguria (relatively preserved Scr) & pulmonary congestion. Based on these findings, suggested norepinephrine (pressors). Agree? any educational input appreciated.
Basically I interpreted as high output cardiac failure with elevated filling pressures leading to pulmonary congestion.
This tracing I believe is right intra-renal 'arterial' with diminished diastolic flow. Correct me if I'm wrong.
Sorry, didn't realize that the scale dropped
Read 4 tweets
NephroPOCUS Profile picture
18 Jun 20
1/ #Nephrology #POCUS case study:
Dr. X is rounding on an ESRD pt who initially presented with dyspnea after missing a dialysis (HD) session; underwent dialysis in the hospital. Pt asymptomatic at the time of exam and lung #ultrasound revealed 👇 Further story in thread #MedEd
2/ Based on the 2-zone lung #POCUS, Dr. X orders for another session of HD. Notably, pt says he is at his 'dry weight' and HD nurse says they could only get 1.5L off during first session. Dr. X doesn't change his/her mind.
Info on various lung scan zones👇
3/ Patient becomes hypotensive during HD and only ~500cc fluid could be removed.
Why can't we get more fluid out of a hypervolemic patient? Dr. X is perplexed and decides to more #POCUS Here is the IVC
Read 16 tweets

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