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
Low-frequency Transducers Phased-array Curvilinear
Anatomy of Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
Image Acquisition Transverse Longitudinal
Transverse Longitudinal
Complete Exam of Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
Celiac Trunk SMA From Point-of-Care Ultrasound, 1 st edition, 2014
Celiac Trunk Seagull Sign Common Hepatic Artery Splenic Artery Celiac Trunk
Celiac Trunk Seagull Sign Common Hepatic Artery Splenic Artery Celiac Trunk
Proximal Aorta Splenic Vein Celiac Trunk SMA Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
Proximal Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
Mid-Abdominal Aorta Splenic Vein SMA Au IVC Renal Arteries Vertebral Body From Point-of-Care Ultrasound, 1 st edition, 2014
Proximal Aorta
Distal Aorta Right and Left Common Iliac Arteries From Point-of-Care Ultrasound, 1 st edition, 2014
Distal Aorta From Point-of-Care Ultrasound, 1 st edition, 2014
Abdominal Aortic Aneurysm?
Abdominal Aortic Aneurysm?
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
AAA? From Point-of-Care Ultrasound, 1 st edition, 2014
AAA? From Point-of-Care Ultrasound, 1 st edition, 2014
Aorta Pearls Bowel gas limits visualization NPO Firm pressure or sweep transducer Types of AAA Fusiform Saccular (Pseudoaneurysm) Measure in transverse and longitudinal planes
Kidney Anatomy 2 Anatomical Sections Sonographic Double Density Renal Parenchyma = Cortex + Medulla Renal Sinus = Fatty tissue + Calyces + Vessels
Image Acquisition From Point-of-Care Ultrasound, 1 st edition, 2014
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
Normal
Atrophy Hydronephrosis Stone Cysts Mass Renal Pathologies
Atrophic Kidney
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
Mild Hydronephrosis From Point-of-Care Ultrasound, 1 st edition, 2014
Severe Hydronephrosis From Point-of-Care Ultrasound, 1 st edition, 2014
Bladder Indications Estimate bladder volume Confirm catheter placement Ureteral obstruction (ureteral jets) Detect stones Work-up for renal failure
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
Image Acquisition Transverse View Longitudinal View From Point-of-Care Ultrasound, 1 st edition, 2014
Normal Male Bladder Transverse View
Foley + Decompressed Bladder
Distended Bladder + Foley + Enlarged Prostate
Bladder Volume Estimation Volume (ml) = 0.75 x width x length x height Transverse View Longitudinal View
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
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
Lumbar Spine Transverse Plane Longitudinal Plane Spinous Process Spinous Process Interspinous Space Spinous Process
Lumbar Puncture Mapping Transverse Plane
Midline Shadow = Spinous Process L 3 L 4 Transverse Plane
Lumbar Puncture Site Mapping Longitudinal Plane
Lumbar Puncture Mapping
L5 = Deep and Small
Lumbar Puncture Mapping Mark 2 widest interspinous spaces Patient must remain in position Higher success in sitting position
Lumbar Spine
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
Lumbar Spine
Lumbar Spine Paramedian View
Questions?