IOTW 12-07-17

Case

-23 yo M presents with RLQ abdominal pain
-CT abdomen with contrast ordered by primary team to r/o appy
-Upon further questioning, the pain is actually in RUQ as well
-Which CT should we order? With or without contrast??
-Let’s do an ultrasound!

What do you think?

iotw12-7-17-image1.png

 

Color Flow

iotw12-7-17-image2.jpg
There is no color flow, which means this is hydronephrosis!

 

iotw12-7-17-image3

 

Ultrasound Saves the Day!

The patient’s CT was changed to “without contrast” due to the likelihood of nephrolithiasis.
-Official CT read:
-Edematous right kidney with perinephric stranding. Mild right hydronephrosis caused by 2 mm stone that probably recently passed into the urinary bladder.
-2 mm nonobstructive stone in the upper pole of the right kidney.
-The patient’s ED course was altered by ultrasound!

 

Renal US Pearls

-Curvilinear probe
-Always do a full renal US exam, including right and left long and short views, and bladder long and short view
-Start with the unaffected side
-If you see a cyst, measure it and put on color flow
-Abdominal exams change- always do them serially!

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