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US of the AortaRenal US

Brett Beel MD, RDMS

Clinical Instructor, UCSF Fresno Department of Emergency Medicine

Clinical Indications

• “There is no disease more conducive to clinical humility than the aneurysm of the aorta.”

‐‐William Osler

• Prevalence:  2‐5% in population  >50yoa, 10% of men >65 with vascular risk factors

Clinical Indications

• Ruptured AAA has wide clinical presentation

• Patients >50 yoa with abdominal pain, flank pain, back pain, testicular pain, constipation

• Syncope, hypotension 

Clinical Indications

• <25% ruptured AAA have classic triad of abdominal/back/flank pain, palpable abdominal mass and hypotension

• 30‐60% of ruptured AAA are misdiagnosed upon initial presentation

• Mortality for ruptured AAA is 80%

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Ultrasound Nuts/Bolts Sonographic Views

• Transverse Umbilical

• Transverse Subxiphoid

• Longitudinal

• Bifurcation into the iliac arteries

Transverse UmbilicalSubxiphoid

TransverseUmbilical

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Transverse Subxiphoid

Transverse Umbilical

TransverseSubxiphoid

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LongitudinalLongitudinal

Longitudinal

Longitudinal

Bifurcation into Iliacs

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AAA = >3 cm AAA risk of rupture per year

• AAA 3‐4cm:  2%

• AAA 4‐5cm: 1‐5%

• AAA 5‐6 cm: 3‐15%

• AAA 6‐7cm: 10‐20%

• AAA>7cm: 20‐50%

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Caveats

• Adventitia to Adventitia measurements

• Cylinder Tangent Error

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Questions? Renal/Bladder US

Clinical Indications

• Determination of presence/degree of  hydronephrosis

• Detection of UVJ stones

• Bladder volume

• Incidental findings

Ultrasound Nuts/Bolts

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Sonographic Views

• Long/Short Axis View of each kidney

• Bladder transverse/sagittal views of bladder

Long Axis

Long Axis

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Short Axis Short Axis

Bladder Transverse Bladder Transverse

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Bladder Sagittal

Bladder Sagittal

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Hydronephrosis

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UVJ Stone

Bladder Volume

• Height (cm) x Width (cm) x Depth (cm) x 0.7

• = bladder volume in mL

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Renal Cyst

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Renal Mass Emphysematous Pyelonephritis

Questions?