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Sep 2, 2022 6 tweets 5 min read Read on X
A short 🧵 on hepatic vein #VExUS and key pathologies
From: jacc.org/doi/10.1016/j.…

1/ HV Anatomy & Normal Flow Profile, respiratory variation (forward flow [S,D] ⬆️ during inspiration)

Click ‘ALT’ for normal waveform description

#POCUS #MedEd #Nephrology #IMPOCUS #FOAMed The normal flow profile in ...
2/ A. Tricuspid regurgitation: Systolic flow reversal
B. Tricuspid stenosis: prolonged deceleration time of the D-wave + prominent A-wave

Click ‘ALT’ for further description

#POCUS #VExUS (A) Severe tricuspid regurg...
A. Constrictive pericarditis: expiratory ⬇️ in tricuspid flow & RV filling with associated flow reversals on HVD
B. Restrictive cardiomyopathy: prominent D reversals during inspiration
C. ⬆️RVEDP: prominent A-wave
D. RV systolic dysfunction: ⬇️ S-wave

‘ALT’ for description (A&B) A) Constrictive pericarditi...
4/
(A) Atrial fibrillation: absent A-wave, blunted or absent S-wave
(B) Atrioventricular dissociation: cannon A-waves

‘ALT’ for further description

#POCUS #VExUS (A) Atrial fibrillation. A ...
5/
(A) Severe pulmonary HTN: HVD demonstrates a prominent A-wave (arrows) + an attenuated or absent D-wave.
(B) COPD: increase in forward flow velocities during inspiration with merging of the waveforms and loss of distinct S and D waves (arrows).

‘ALT’ - further description (A) Severe Pulmonary hypert...
6/
(A) obesity: (fatty liver) dampening of waveforms with a biphasic flow pattern showing forward S and D waves with no A- and V-wave reversals.
(B) cirrhosis: low velocity monophasic forward flow and no reversals

Click ‘ALT’ for further description

#POCUS #VExUS

End of 🧵 The HVs are thin-walled int...

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More from @NephroP

Mar 26
#eVExUS (= extended #VExUS) includes evaluation of additional veins when the original 3 veins are unobtainable or unreliable for any reason.
Below👇🧵 is an illustrative case showing abnormal pattern in all these veins.
#POCUS #FOAMed #Nephpearls
1⃣ IVC #ultrasound: dilated Image
2⃣ Hepatic vein #Doppler
Systolic flow reversal #POCUS #VExUS Image
3⃣ Portal vein #Doppler
100% pulsatile Image
Read 14 tweets
Nov 15, 2023
#echofirst views used to evaluate the right heart.
From ASE comprehensive echocardiography textbook/2010 guidelines
#POCUS #MedEd #CriticalCare #IMPOCUS
(🧵of 5 tweets) Image
#POCUS Image
#POCUS Image
Read 5 tweets
Aug 12, 2023
Common #echofirst views used in the #POCUS setting, image acquisition pearls and structures visualized.
Thread below🧵
Courtesy, ASE TTE guidelines 2018
#MedEd #FOAMed #FOAMcc
1⃣ Parasternal window Image
2⃣ Parasternal window continued Image
3⃣ Parasternal window, short axis plane
Often underutilized, can get an idea of TR when apical window is difficult, can do RVOT Doppler as well Image
Read 11 tweets
Jun 27, 2023
Focused question: Is HTN in a #dialysis patient always⬆️ intravascular volume? Remove💧?
Clinical: ESRD due to polycystic kidney disease, BP 160s/~100, IVC not well-visualized.
Next step to assess RAP: #VExUS
Below is hepatic vein Doppler
#POCUS #Nephpearls #FOAMcc
Follow the🧵 https://t.co/xZe23bHvJVtwitter.com/i/web/status/1…
2/ 👆What do you think?
3/ 👆HV #VExUS is showing resiprophasic D-reversal.
We commonly talk about S-reversal. Where do you see D-reversal? - constrictive pericarditis, tamponade, some cases of severe pulmonary HTN.
Next step: Evaluate the🫀
👇PV looks fine
Read 21 tweets
May 12, 2023
Cardiac #POCUS views - image acquisition pearls from JACC POCUS workbook
#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
1/ Image
2/ Image
3/ Image
Read 4 tweets
May 10, 2023
#POCUS enthusiasts, is this IVC normal, abnormal? (asking about possibilities, not definitive conclusions)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread)
IVC transverse #POCUS
#POCUS answer:
I deliberately avoided clinical context in the original tweet to gather multiple opinions.
Image obtained from a thin, trained athlete with resting HR in 40s-50s.
A dilated IVC is commonly seen in this setting with no right heart pathology. In addition, particulate… twitter.com/i/web/status/1… Image
Read 5 tweets

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