Pleural effusion visualized from apical window
These images were obtained from a patient with acute kidney injury requiring renal replacement therapy. In the apical view, you can see a large anechoic area beside the left heart […]
Cyst or hydronephrosis?
Previously, we learned that parapelvic cysts can mimic hydronephrosis. However, any large cyst can be confused with hydro if you do not scan the kidney in both planes. For example, […]
Questionable hydroureter seen in the clinic
A middle-aged man was seen in the nephrology clinic after a recent hospitalization for acute pyelonephritis and acute kidney injury (AKI) requiring a few sessions of dialysis. AKI was thought […]
Strange white things in the liver
These images of the liver were obtained from an asymptomatic nephrology clinic patient while trying to find the IVC. What are the white things? Don’t they look like air bronchograms […]
The ‘ring of fire’ Foley balloon
Previously, we talked about the utility of ‘twinkling sign or artifact’ in detection of kidney stones. Interestingly, balloon of the Foley catheter can also twinkle on color Doppler appearing like […]
Pitfalls of inferior vena cava M-mode
Visual estimation of IVC collapse on B-mode (grey scale image) is generally preferred to M-mode, though in theory, M-mode measurement might be able to give accurate collapsibility index. There are […]
An intriguing tale of B-lines in a dialysis patient
Dr. X is rounding on an ESRD patient who initially presented with dyspnea after missing a dialysis (HD) session; underwent dialysis in the hospital. Pt asymptomatic at the time of […]
Sonographic appearance of an ureteral stent
Here is the image of right kidney obtained from a patient with history of obstructive uropathy. Note the hyperechoic double-lined structure in the collecting system area: that’s ureteral stent. Here […]
Execution of the NephroPOCUS curriculum
POCUS program runs smoothly when there are at least 2 (or more) key faculty who can dedicate significant amount of their time to the program development. Depending on the number […]
IVC collapse: fact or artifact?
In clinical practice, size, and collapsibility of the IVC is used as a surrogate for right atrial pressure (RAP). In spontaneously breathing patients, inspiration causes negative intrathoracic pressure and collapses […]
What is LV foreshortening?
This is a commonly heard term in echocardiography. Foreshortening occurs when the ultrasound beam does not cut through the true apex of the left ventricle but transects above and anterior […]
Retroperitoneal hematoma
While performing POCUS, it is important to pay attention to what’s happening ‘around’ the kidney as well – sometimes it can save lives. Here are sonographic images obtained from a […]
Septal bounce in a lupus patient
Here is a subcostal view of the heart obtained from a young lupus patient presenting with symptoms of new onset heart failure. Nephrologists may encounter this type of presentation in […]
The ‘double line’ sign
These images were obtained from a dialysis patient during routine screening for renal cell carcinoma. In addition to kidneys being small with thin parenchyma, note the hypoechoic, sharply demarcated area […]
Pericardial cyst
Pericardial cysts are uncommon and represent approximately 5% of thoracic cysts. Most of these are asymptomatic and usually detected incidentally. However, in case of chest trauma, they can rupture leading […]
Fluid in the subcostal view
What does this subcostal view show? In a twitter poll, more than 50% thought its either pericardial effusion or a pericardial tumor. The correct answer is ascites. Subcostal view of […]
Did you ever see on POCUS what hyperkalemia does to the heart?
Hyperkalemia is probably the most common reason for an urgent nephrology consult. Most of us are familiar with the EKG changes associated with hyperkalemia, though surprisingly, only ~55% of patients […]