A 58-year-old woman with no known comorbidities presents with progressive fatigue and shortness of breath x several months. Noted to have bilateral pedal edema; BNP 2,473 pg/mL. #echofirst 👇❓
Answer and 🔗 to source in thread. #POCUS#MedEd#FOAMcc
Left atrial myxoma -> pulmonary hypertension (RVSP 93 mmHg) -> RV dysfunction (Note obvious RV enlargement ☝️ cvcasejournal.com/article/S2468-…
#MedEd image of the day. What's wrong with the 🫀?
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer. #POCUS
Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.
Dec 28, 2022 • 8 tweets • 6 min read
#POCUS puzzle 🧩of the day. Can you put together the pieces and arrive at an unifying diagnosis? Go through the thread 🧵below.
Context: #dialysis patient, physical examination #FOAMed#Nephrology#MedEd
You are performing physical examination in a patient with suspected fluid overload (plethoric IVC).
Parasternal short axis view demonstrates D-sign. But what's in the RV?
Apical view in thread. #Nephrology#MedEd#FOAMcc
🔗 to source will be posted in a few hours.
#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
S = systolic venous wave
D = diastolic venous wave
Aug 20, 2022 • 4 tweets • 2 min read
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. #MedEdncbi.nlm.nih.gov/pmc/articles/P…
#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)
In this PLAX view, what structure does the arrow indicate? + what's abnormal about it (if any)?
Clinical: 71y pt with fever/cough, initially thought to be pneumonia, later developed chest pain. BP 134/83 Pulse 106
Will post the answer/source tonight #MedEd
Dilated coronary sinus with a mobile echogenicity (vegetation/infective endocarditis in this case)
Full case: 🔗ncbi.nlm.nih.gov/pmc/articles/P…
From #POCUS standpoint, 2 main causes: persistent left superior vena cava & pulmonary HTN. This pt had the former.
Apr 19, 2022 • 22 tweets • 12 min read
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#Nephpearls2/ 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
Apr 18, 2022 • 5 tweets • 4 min read
Looks like #POCUS ologists are in a mood to revive old #VExUS posts and tweetorials today.
Let me re-share the VExUS flash card(s) 🧵 1. VExUS grading live card #MedEd#IMPOCUS
Hepatic vein #VExUS#POCUS
Apr 18, 2022 • 8 tweets • 6 min read
@Rajiv_Sinanan@ThinkingCC 1/ Real reason(s) based on my conversations with people from different backgrounds:
Private practice: "#POCUS sounds interesting but I ain't got time for that. Will consider if I get compensated"
Academia: (not generalizing but most places)
Emphasis is on funded research
@Rajiv_Sinanan@ThinkingCC 2/ Clinical faculty are hired for clinical duties, outreach dialysis etc., which is fair but the problem is educational endeavors are rarely rewarded/provided with protected time. Faculty who want to be #POCUS champions must first learn it (either from institutional experts or
Feb 17, 2022 • 21 tweets • 11 min read
Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.
1/ Parasternal long axis (PSAX) showing D-sign #VExUS#MedEd#Nephpearls#IMPOCUS2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗nephropocus.com/2021/07/12/the…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)