POCUS - Renal Flashcards
It’s important to remember that hydronephrosis can be caused by __________ or ___________ obstruction of the ureter.
intrinsic; extrinsic
AAA can cause left-sided hydronephrosis and flank pain, so be vigilant to use clinical reasoning.
The ____________ fascia surrounds the perinephric fat and the adrenal gland.
Gerota’s
The __________ kidney is located more caudally.
right
The kidneys are anterior and lateral to the _____________.
psoas muscles
Start the renal examination with the _________ view.
coronal
Have the patient supine and scan from their right side.
In order to assess for hydronephrosis, you need to view the _____________.
renal pelvis
The renal pelvis is ________-echoic.
hyper
Both views of the kidney are obtained in the mid-________ line.
axillary
From the sides
The transverse view of the kidney should be scanned with what motion?
Sliding
What six views do you need to obtain for a billable renal US?
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
If you are struggling to obtain your views, then consider having the patient ______________.
lie on their opposite decubitus side and take a deep breath
Superior to the prostate, you can see the _________ on US.
seminal vesicles
What is the “bowtie” structure?
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.
What does the word orthogonal mean?
Two lines or planes at right angles to each other
To calculate bladder volume, you need to measure _____________.
height, width, and depth of the bladder
The ureters enter the bladder from the ___________ side.
posterior
In the transverse view of the kidney, the indicator dot points ___________.
anteriorly
Review the grading of hydronephrosis.
- 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
How can you tell if a kidney has hydronephrosis or cysts?
Cysts look haphazard whereas hydronephrosis looks like a uniform evolution.
The _____________ pouch is also called the pouch of Douglas.
rectouterine
How can you tell the difference between mild hydronephrosis vs exaggerated renal pelvis?
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.
It’s important to remember that hydronephrosis can be caused by what two categories of pathologies?
Intrinsic obstruction and extrinsic compression of the ureter
How can you tell the differnce between acute severe hydronephrosis and chronic severe hydronephrosis?
In chronic disease, the parenchyma becomes thin (< 15 mm).
If you see an echogenic layer within the collecting system, this is likely one of which three things?
Blood
Stone
Pus
Calcyceal rupture can lead to what finding on US?
Perinephric fluid (aka urinoma)
If you see an anechoic structure that you think might be mild hydronephrosis, what can you do next to test if it actually is?
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.
How can you tell if an anechoic structure is an extrarenal pelvis?
All of the dilation will be outside the kidney with no dilation of the calyces.
All renal cysts should be what shape?
Round or oval
Renal cysts will display what artifact?
Posterior acoustic enhancement
A bulge on the lateral aspect of the kidney that is the same echogenicity of the parenchyma is likely what?
A dromedary hump, which is just a benign shape of thee kidney
Hyperechoic cortical tissue that extends inward radially are called what?
Columns of Burton
How is hyperechoic parenchyma diagnosed?
The kidney should not be hyperechoic to the liver or kidney, so if it is then this is abnormal
What can’t-miss diagnosis can cause left-sided hydronephrosis that is not stones or cancer?
AAA
If you see hypoechoic structures in the kidney, but the pelvis is not hypoechoic (i.e., it is mixed density), then is this hydro?
No
There are normally some scattered areas of anechoic areas in the kidneys that represent the pyramids.
What is the formula for bladder volume?
There is disagreement, but most people agree on LxWxH x 0.75 (cm to mL)
