NephroPOCUS Profile picture
15 Feb, 11 tweets, 6 min read
#Nephrology #POCUS case of the day:
What do you think is this anechoic structure adjacent to liver?
See thread πŸ‘‡ for the answer and more images. #MedEd #IMPOCUS
Let's start with a poll before seeing other images: ☝️? #POCUS
The answer is right renal cyst. Note how the kidney appears with fanning the probe. #POCUS
Is rest of the kidney normal? doesn't appear to be...πŸ€”
More cysts? hydronephrosis?
Remember this #POCUS flashcard? πŸ‘‡ Image
More #POCUS images
We know that hydronephrosis is like a branching tree and cyst is like a ball. We see both here:
#POCUS ImageImage
Another #POCUS image showing more right renal cysts
So this kidney has cysts + hydronephrosis: a tricky combo!
Was the initial large cyst simple or complex?
Remember the definition? - any cyst that is not simple is complex 😎
Read this quick #POCUS post nephropocus.com/2019/06/20/ren…
As the cyst has a septation ☝️, it is complex.
How does the patient's left kidney look like? Also has multiple cysts; no significant hydronephrosis πŸ‘‡
This recent #POCUS post also belongs here:
nephropocus.com/2021/02/10/sho…

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More from @NephroP

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. πŸ‘‡
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
5 Feb
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 πŸ‘‡
#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 πŸ˜€
Read 5 tweets
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 πŸ‘‡
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 πŸ‘‡
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
25 Aug 20
#POCUS #IMPOCUS
Understanding #VExUS from scratch:
A mini #tweetorial on normal hepatic vein waveform genesis πŸ‘‡ #MedEd #echofirst

1/ Understanding color and direction
2/ What is S wave? #POCUS
3/ V wave #POCUS
Read 8 tweets
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
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

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