Site icon NephroPOCUS

VExUS flash cards

Abhilash Koratala

In the previously posted videos and articles, we talked about the normal Doppler patterns of major abdominal veins used for VExUS grading and how they transition with worsening congestion. Here are some flashcards depicting the same.

Hepatic vein waveform. If you need a refresher on the wave genesis, watch this 1-minute slideshow.

Factors/conditions influencing hepatic vein waveform
Portal vein waveform

Renal parenchymal vein

Pathophysiology of congestive nephropathy
Below are a few infographics outlining how VExUS grading works; conveying the same concept but in different visual styles. Feel free to use them in your scientific publications, with appropriate attribution to NephroPOCUS.com. VExUS was initially validated in cardiac surgery patients but has since been tested in various other populations prone to venous congestion. Several modified versions have also been proposed, often excluding the technically demanding intrarenal component. That said, I strongly recommend capturing all waveforms, ideally with simultaneous EKG gating whenever feasible.
Winter edition
Graffiti style

VExUS card with moving waveforms:

eVExUS or the extended VExUS

Below is a graphic illustrating congestion across various venous waveforms. It doesn’t include the actual scoring system, but gives a more visual representation of the changes, including the femoral vein. Green waveforms are normal, while orange waveforms are abnormal, with the arrows indicating progressively worsening congestion.

Below: Modified VExUS incorporating femoral vein Doppler (based on Joyal et al., PMID: 41931445). This approach essentially replaces intrarenal Doppler with the femoral vein stasis index and introduces a few additional modifications, including incorporation of IVC collapsibility and defining severe hepatic vein abnormality as either S-wave absence (i.e., S/D = 0) or S-wave reversal (i.e., S/D <0).

Below are two additional scoring systems:

  1. mVExUS (modified VExUS): Basically ‘simplified’ VExUS without the intrarenal venous Doppler.
  2. Combined mVExUS–LUS score: Combines mVExUS with lung ultrasound to capture both right- and left-sided congestion.

This pediatric VExUS (P-VExUS) score below was evaluated in 56 mechanically ventilated children, mostly infants and young children. Unlike conventional adult VExUS grading, it uses a 0–7 point system, with ≥3 points identifying CVP >12 mmHg with 82% sensitivity and 91% specificity. The authors sampled segmental renal veins rather than interlobar veins for technical feasibility. Whether interlobar sampling might better capture the effects of renal interstitial edema remains a theoretical consideration. Importantly, they evaluated the score against CVP, not AKI – a promising step in pediatrics, with more validation needed.

A gentle reminder:

Exit mobile version