Abdominal Ultrasound : Aorta, Kidneys, Bladder
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1 Abdominal Ultrasound : Aorta, Kidneys, Bladder Nilam J. Soni, MD, MSc Associate Professor of Medicine Divisions of Hospital Medicine and Pulmonary/Critical Care Medicine Department of Medicine University of Texas Health Science Center San Antonio
2 Low-frequency Transducers Phased-array Curvilinear
3 Anatomy of Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
4 Image Acquisition Transverse Longitudinal
5 Transverse Longitudinal
6 Complete Exam of Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
7 Celiac Trunk SMA From Point-of-Care Ultrasound, 1 st edition, 2014
8 Celiac Trunk Seagull Sign Common Hepatic Artery Splenic Artery Celiac Trunk
9 Celiac Trunk Seagull Sign Common Hepatic Artery Splenic Artery Celiac Trunk
10 Proximal Aorta Splenic Vein Celiac Trunk SMA Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
11 Proximal Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
12 Mid-Abdominal Aorta Splenic Vein SMA Au IVC Renal Arteries Vertebral Body From Point-of-Care Ultrasound, 1 st edition, 2014
13 Proximal Aorta
14 Distal Aorta Right and Left Common Iliac Arteries From Point-of-Care Ultrasound, 1 st edition, 2014
15 Distal Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
16 Abdominal Aortic Aneurysm?
17 Abdominal Aortic Aneurysm?
18 Measurement of Aortic Diameter Measure outer wall to outer wall in both transverse and longitudinal views Normal < 3cm proximally (<2cm distally) Diameter >4.5cm referral to vascular surgery
19 AAA? From Point-of-Care Ultrasound, 1 st edition, 2014
20 AAA? From Point-of-Care Ultrasound, 1 st edition, 2014
21 Aorta Pearls Bowel gas limits visualization NPO Firm pressure or sweep transducer Types of AAA Fusiform Saccular (Pseudoaneurysm) Measure in transverse and longitudinal planes
22 Kidney Anatomy 2 Anatomical Sections Sonographic Double Density Renal Parenchyma = Cortex + Medulla Renal Sinus = Fatty tissue + Calyces + Vessels
23 Image Acquisition From Point-of-Care Ultrasound, 1 st edition, 2014
24 Normal Kidneys 1. Perinephric fat + Gerona's fascia = hyperechoic 2. Renal cortex = hypoechoic 3. Medullary pyramids = hypo-/anechoic 4. Renal sinus = hyperechoic with small pockets of urine (not contiguous) and vessels 5. Ureter normally obscured by bowel gas
25 Normal
26 Atrophy Hydronephrosis Stone Cysts Mass Renal Pathologies
27 Atrophic Kidney
28 Hydronephrosis Mild = central dilation with preservation of renal pyramids Moderate = blunting of renal pyramids, rounding of calices, bear-claw appearance, preservation of cortex Severe = cortical thinning, calyceal ballooning, distortion of architecture From Point-of-Care Ultrasound, 1 st edition, 2014
29 Mild Hydronephrosis From Point-of-Care Ultrasound, 1 st edition, 2014
30 Severe Hydronephrosis From Point-of-Care Ultrasound, 1 st edition, 2014
31 Bladder Indications Estimate bladder volume Confirm catheter placement Ureteral obstruction (ureteral jets) Detect stones Work-up for renal failure
32 Posterior and inferior to symphysis pubis (tilt US beam into pelvis) Ureters enter trigone on postero-inferior wall Prostate normally <5cm transversely Bladder Anatomy From Point-of-Care Ultrasound, 1 st edition, 2014
33 Image Acquisition Transverse View Longitudinal View From Point-of-Care Ultrasound, 1 st edition, 2014
34 Normal Male Bladder Transverse View
35 Foley + Decompressed Bladder
36 Distended Bladder + Foley + Enlarged Prostate
37 Bladder Volume Estimation Volume (ml) = 0.75 x width x length x height Transverse View Longitudinal View
38 Ultrasound-guided Lumbar Puncture Nilam J. Soni, MD, MSc Associate Professor of Medicine Divisions of General & Hospital Medicine / Pulmonary & Critical Care Medicine University of Texas Health San Antonio
39 Anatomy Lumbar Spine -Spinal cord ends at L 1 -L 2 in adults -Lumbar puncture can be safely performed below L 2 L1 L1 L2 L3 L4 L4 L5 L5
40 Lumbar Spine Transverse Plane Longitudinal Plane Spinous Process Spinous Process Interspinous Space Spinous Process
41 Lumbar Puncture Mapping Transverse Plane
42 Midline Shadow = Spinous Process L 3 L 4 Transverse Plane
43 Lumbar Puncture Site Mapping Longitudinal Plane
44 Lumbar Puncture Mapping
45 L5 = Deep and Small
46 Lumbar Puncture Mapping Mark 2 widest interspinous spaces Patient must remain in position Higher success in sitting position
47 Lumbar Spine
48 Lumbar Spine PITFALL: Lamina / articular processes can be mistaken for spinous processes No muscle should be seen superficial to spinous processes Erector spinae muscles Lamina / articular processes Paramedian View
49 Lumbar Spine
50 Lumbar Spine Paramedian View
51 Questions?
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