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8 Apr, 4 tweets, 2 min read
@khaycock2 @ArgaizR @katiewiskar @ThinkingCC
Any comments on this portal vein pulsatility obtained from a pt with cirrhosis? (Why prox is more pulsatile?)
No cardiac issue that I know of; was reviewing rad-performed images 🤔
Splenic seems to be fine, looks more like that of distal portal.
Hepatics
Anything to do with hepatic artery position 🤔

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More from @NephroP

NephroPOCUS Profile picture
9 Apr
Time for a #POCUS #tweetorial on optimization of Doppler. Very important for #VExUS enthusiasts. #MedEd
1/ Unlike greyscale imaging which depends on amplitude of the returned signal, Doppler depends on frequency information. This graphic explains why perpendicular angle is bad. Image
2/ other way of saying this, in relevance to color Doppler #POCUS
RBC moving away from the probe = Fr<Ft = negative Doppler shift = Blue color
RBC moving towards = Fr>Ft = positive Doppler shift = Red color
Rest of the images/videos from this excellent paper: pubs.rsna.org/doi/10.1148/rg…
3/ Anatomy (components) of a spectral Doppler waveform (carotid shown)👇
Above baseline is like red on color (towards probe), below = blue. As 0 degree angle is not always possible, <60 is considered OK. Image
Read 19 tweets
NephroPOCUS Profile picture
6 Apr
1/ Thought of doing a quick #tweetorial on image acquisition for #POCUS friends starting to do #VExUS
It's kind of "how I do it" guide and not necessarily optimized for research.
1st: Look at the IVC in both long and short axes
If big, do further scans 👇 #MedEd #FOAMed
2/ Lateral approach works best to obtain a straight segment of the portal vein (straight = best Doppler shift) and a nice hepatic vein too.
Place transducer approximately in the anterior axillary line pointing towards sternal notch. Then fan antero-posteriorly.
#POCUS #VExUS
3/ Forgot what is fanning?
Its also called tilting or some people say, "look" in a particular direction from the same spot.
#POCUS
Read 18 tweets
NephroPOCUS Profile picture
15 Feb
#Nephrology #POCUS case of the day:
What do you think is this anechoic structure adjacent to liver?
See thread 👇 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...🤔
Read 11 tweets
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
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 👇
#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 😀
Read 5 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

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