VExUS Beyond Volume: What Tricuspid Regurgitation Teaches Us
VExUS is better thought of as a Doppler signature of elevated right atrial pressure (RAP) and reduced systemic venous compliance. We keep emphasizing that VExUS is not a volume-status gauge. […]
Making Sense of Abnormal Hepatic Vein Doppler Waveforms
In this post, we’ll discuss the diagnostic possibilities to consider when the hepatic vein waveform is abnormal, building on the short video I recently shared on hepatic vein waveform generation. […]
Not Every Dilated IVC or Pulsatile Portal Vein Is Pathological
The images below were obtained from a young healthy fit-looking individual during a POCUS workshop. They appear concerning, right? A dilated inferior vena cava (IVC) with minimal respiratory variation – […]
Hepatic Vein Doppler and EKG: Are There Any Workarounds?
Hepatic vein Doppler is a key component of both VExUS and eVExUS assessments. Getting the S and D waves right in the hepatic vein Doppler waveform can tell you a […]
VExUS in Tricuspid Regurgitation
People often claim that tricuspid regurgitation (TR) makes VExUS useless, assuming the regurgitation itself distorts the waveforms—especially causing hepatic S-reversal—rather than reflecting pressure changes. However, the portal vein remains a […]
VExUS: How I Do It and How Not to Do It
VExUS is a great tool for diagnosing congestion and monitoring decongestive therapy, but many physicians have never performed it or seen it in action. Even those with some POCUS training […]
A case of severe venous congestion: illustration of eVExUS
The aim of this case is to visually showcase severe right-sided congestion. As mentioned earlier, eVExUS, or ‘extended VExUS‘, involves examining more veins than the traditional trio of hepatic, portal, […]
VExUS grade 3 does not always mandate fluid removal.
Venous congestion often stems from fluid overload. However, it’s important to recognize that POCUS does not directly measure blood volume but instead assesses blood flows and pressure gradients. Whether to […]
Femoral vein Doppler before and after dialysis
Currently, there is growing interest in femoral vein Doppler, mainly due to its perceived ease of image acquisition. Elevated femoral vein pulsatility indicates venous congestion with reasonable specificity. However, this […]