Thread by @NephroP

One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls

2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS

3/ Apical 4-chamber view
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS

4/ Subxiphoid view #POCUS
Good view to quickly look for circumferential pericardial effusions

5/ Pericardial effusion is usually detectable on IVC long axis view as well. You just need to pay attention and identify anechoic space between the diaphragm and the heart.
#POCUS

6/ Pleural effusion (left) from PLAX view - posterior to descending aorta. Often the lung is visible floating in the effusion.
#POCUS

7/ Here is another example of left pleural effusion on PLAX view. While lung is not visualized, the effusion is NOT wedge shaped and follows the curvature of the chest wall.
#POCUS

8/ #POCUS = #anatomy + commonsense
Here is the anatomic correlation that explains why descending thoracic aorta is an important landmark to distinguish pericardial and pleural effusions.

9/ Sometimes (thin patients, increased depth) you can see both left and right pleural effusions from the PLAX window. Compare with CT image above.
#POCUS

10/ Pleural effusion from PSAX window. Note the floating lung, which is a big clue in any window.
#POCUS

11/ Another PSAX image showing both pericardial and pleural effusions.
#POCUS

12/ Pleural effusion seen from the apical window.
#POCUS

👆 is called the 'fox tail' sign #POCUS

14/ Apical window demonstrating both pericardial and left pleural effusion.

15/ #POCUS #anatomy correlation for above images

16/ We see a circumferential pericardial effusion in this subxiphoid view. Anything else?
Answer in next tweet
#POCUS

17/ It's ascites
#POCUS #anatomy 👇

18/ Another example of ascites seen in the subxiphoid window. Liver comes into view intermittently, which is a clue to ascites (like lung is to pleural effusion)
#POCUS

19/ The famous Boomerang sign - right pleural effusion seen from the subxiphoid window. This is often confused with ascites.
#POCUS

#POCUS #anatomy correlation for the Boomerang sign 👆

21/ Coming to the end of long 🧵
#POCUS example showing multiple effusions seen from the subxiphoid window.

All the above images can be found in my recent RFN posts. Unfortunately, the gif files are not playing.
🔗renalfellow.org/2021/10/21/ide…
🔗renalfellow.org/2022/04/18/ide…