POCUS - Renal

Question 1

It’s important to remember that hydronephrosis can be caused by __________ or ___________ obstruction of the ureter.

Answer 1

intrinsic; extrinsic

AAA can cause left-sided hydronephrosis and flank pain, so be vigilant to use clinical reasoning.

Question 2

The ____________ fascia surrounds the perinephric fat and the adrenal gland.

Answer 2

Gerota’s

Question 3

The __________ kidney is located more caudally.

Answer 3

right

Question 4

The kidneys are anterior and lateral to the _____________.

Answer 4

psoas muscles

Question 5

Start the renal examination with the _________ view.

Answer 5

coronal

Have the patient supine and scan from their right side.

Question 6

In order to assess for hydronephrosis, you need to view the _____________.

Answer 6

renal pelvis

Question 7

The renal pelvis is ________-echoic.

Answer 7

hyper

Question 8

Both views of the kidney are obtained in the mid-________ line.

Answer 8

axillary

From the sides

Question 9

The transverse view of the kidney should be scanned with what motion?

Answer 9

Sliding

Question 10

What six views do you need to obtain for a billable renal US?

Answer 10

R kidney coronal/longitudinal
R kidney transverse/axial
L kidney coronal/longitudinal
L kidney transverse/axial
Bladder longitudinal/sagittal
Bladder transverse/axial

Bonus points for ureteral jets and the ureters entering the bladder

Question 11

If you are struggling to obtain your views, then consider having the patient ______________.

Answer 11

lie on their opposite decubitus side and take a deep breath

Question 12

Superior to the prostate, you can see the _________ on US.

Answer 12

seminal vesicles

Question 13

What is the “bowtie” structure?

Answer 13

In the transverse view of the male bladder, you can see the seminal vesicles posterior to the bladder and superior to the prostate appear like a bowtie.

Question 14

What does the word orthogonal mean?

Answer 14

Two lines or planes at right angles to each other

Question 15

To calculate bladder volume, you need to measure _____________.

Answer 15

height, width, and depth of the bladder

Question 16

The ureters enter the bladder from the ___________ side.

Answer 16

posterior

Question 17

In the transverse view of the kidney, the indicator dot points ___________.

Answer 17

anteriorly

Question 18

Review the grading of hydronephrosis.

Answer 18

• Mild: enlargement of the pelvis; no change in calyces
• Moderate: enlargement of pelvis and major calyces (bear paw)
• Severe: enlargement of the pelvis and obliteration/effacement of the differentiation between major and minor calyces

Question 19

How can you tell if a kidney has hydronephrosis or cysts?

Answer 19

Cysts look haphazard whereas hydronephrosis looks like a uniform evolution.

Question 20

The _____________ pouch is also called the pouch of Douglas.

Answer 20

rectouterine

Question 21

How can you tell the difference between mild hydronephrosis vs exaggerated renal pelvis?

Answer 21

Use the HPI and the other kidney!

If a person has unilateral pain and unilateral findings, then it’s likely mild hydronephrosis. If a person has unilateral pain but bilateral findings, then it’s probably an exaggerated renal pelvis.

Question 22

It’s important to remember that hydronephrosis can be caused by what two categories of pathologies?

Answer 22

Intrinsic obstruction and extrinsic compression of the ureter

Question 23

How can you tell the differnce between acute severe hydronephrosis and chronic severe hydronephrosis?

Answer 23

In chronic disease, the parenchyma becomes thin (< 15 mm).

Question 24

If you see an echogenic layer within the collecting system, this is likely one of which three things?

Answer 24

Blood
Stone
Pus

Question 25

Calcyceal rupture can lead to what finding on US?

Answer 25

Perinephric fluid (aka urinoma)

Question 26

If you see an anechoic structure that you think might be mild hydronephrosis, what can you do next to test if it actually is?

Answer 26

Put color flow on it. Vessels are centrally located in parallel to the collecting system and can appear like mild hydronephrosis. Color showing flow can help elucidate what is a blood vessel.

Question 27

How can you tell if an anechoic structure is an extrarenal pelvis?

Answer 27

All of the dilation will be outside the kidney with no dilation of the calyces.

Question 28

All renal cysts should be what shape?

Answer 28

Round or oval

Question 29

Renal cysts will display what artifact?

Answer 29

Posterior acoustic enhancement

Question 30

A bulge on the lateral aspect of the kidney that is the same echogenicity of the parenchyma is likely what?

Answer 30

A dromedary hump, which is just a benign shape of thee kidney

Question 31

Hyperechoic cortical tissue that extends inward radially are called what?

Answer 31

Columns of Burton

Question 32

How is hyperechoic parenchyma diagnosed?

Answer 32

The kidney should not be hyperechoic to the liver or kidney, so if it is then this is abnormal

Question 33

What can’t-miss diagnosis can cause left-sided hydronephrosis that is not stones or cancer?

Answer 33

AAA

Question 34

If you see hypoechoic structures in the kidney, but the pelvis is not hypoechoic (i.e., it is mixed density), then is this hydro?

Answer 34

No

There are normally some scattered areas of anechoic areas in the kidneys that represent the pyramids.

Question 35

What is the formula for bladder volume?

Answer 35

There is disagreement, but most people agree on LxWxH x 0.75 (cm to mL)