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NephroPOCUS

@NephroP

Sep 2

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

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. 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)

Read 6 tweets

NephroPOCUS

@NephroP

Aug 22

Time to update the #VExUS resources pinned thread 🧵📌
1/ Tweetorial on image acquisition.
#POCUS #MedEd

https://twitter.com/NephroP/status/1534646038753120260?s=20&t=yPbJFQOLKVhXFD7rF2nG_g

2/ The original #VExUS paper
theultrasoundjournal.springeropen.com/articles/10.11…

@nephrothaniel

3/ Review article on #VExUS by @nephrothaniel and me in @KidneyMed
🔗kidneymedicinejournal.org/article/S2590-…

Read 22 tweets

NephroPOCUS

@NephroP

Aug 22

#POCUS quiz for #VExUS enthusiasts.
Image obtained from a patient with heart failure with preserved EF. IVC 1.9 cm with 30% inspiratory collapse.
Here is the intra-renal image. Interpretation of the venous waveform?
POLL in thread 👇
#MedEd #Nephrology

👆#POCUS
S = systolic venous wave
D = diastolic venous wave

@khaycock2

@khaycock2 @ArgaizR @msenussiMD You'll like it (I know u know the answer 🤫)

Read 4 tweets

NephroPOCUS

@NephroP

Aug 20

CVP waveform - a variant of #VExUS #POCUS
Tracings obtained from a 38-year-old female with severe aortic stenosis and mild pulmonary hypertension who underwent aortic valve replacement. What's the difference from pre to post-op?
Se thread for answer and source.
#MedEd

ncbi.nlm.nih.gov/pmc/articles/P…

Read 4 tweets

NephroPOCUS

@NephroP

Aug 9

Cardiac tamponade on #POCUS #echofirst
Click on 'ALT' for description
#MedEd #IMPOCUS #Nephrology
From 🔗pubmed.ncbi.nlm.nih.gov/32572594/

Mitral inflow Doppler and LVOT VTI in tamponade.
'ALT' for description
#POCUS #echofirst #MedEd

Pulsus paradoxus: during inspiration, right heart filling occurs at the expense of the left, so that its transmural pressure transiently improves & then reverts during expiration (Ventricular interdependence). Seen as 👆on #POCUS

Read 5 tweets

NephroPOCUS

@NephroP

Jun 8

#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵

#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])

#2 👆BART holds good unless u invert the scale.
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)

#3
While performing any Doppler study, it's important to keep in mind that the angle between US beam & blood flow determines the accuracy of velocity displayed. Parallel = best, perpendicular = worst
As #VExUS does not rely on absolute velocities, its OK not to have perfect angle