basic tips and tricks in performing ultrasound examination for urinary tract in emergency and clinics .

1. Basic skills in UT
ultrasound
Dr/Ahmed Bahnassy
consultant Radiologist
MBCHB-MSc-FRCR(UK)
Alexandria Urology
Hospital AUH

2. aims of the lecture
• Build a systematic and
rationale approach to routine
UT ultrasound .
• Reach an answer to a
question..(retention vs
failure..renal colic vs other
causes)

5. Scanning
technique
initial look

6. Tricks
• Rocking
• Fishing
• Pressing
• Graded compression
• Angulating

8. Renal Scanning 4 points (X2)

11. Normal kidney

14. The adrenal

15. Renal
differential

16. Hydronephrosis

17. Grades

18. Hydronephrosis due to ureteric
stone

19. Absent kidney

20. Large kidney-uni or bilateral

21. unilateral

22. focal lesions

23. Surgical cysts

24. solid mass

25. Abscess versus mass

26. Small kidney

27. Renal calculi

28. ureteric stone

29. Renal trauma

30. Adrenal mass

31. The urinary bladder

32. ureteric jet

34. Generalized thickening

35. Localized thickening

36. Density within

37. Overdistended bladder

38. Small bladder

40. FAST
Focused Abdominal
Sonography in Trauma

41. FAST
• Advantages
– Can be performed in 5
minutes at the bedside
– Non-invasive
– Repeat exams
– Sensitivity and
specificity for free fluid
equal to DPL and CT
• Disadvantages
– Operator dependent
– May not identify
specific injury
– Poor for hollow viscus
or retroperitoneal
injury
– Obesity, subcutaneous
air may interfere with
exam

42. FAST Principles
• Detects free
intraperitoneal fluid
• Blood/fluid pools in
dependent areas
• Pelvis
– Most dependent
• Hepatorenal fossa
– Most dependent area
in supramesocolic
region

43. FAST Principles
• Pelvis and Supra-
mesocolic areas
communicate
– Phrenicolic ligament
prevents flow
• Liver/spleen injury
– Represents 2/3 of cases
of blunt abdominal
trauma

44. FAST- principles
• Intraperitoneal fluid may be
– Blood
– Preexisting ascites
– Urine
– Intestinal contents

45. FAST – limitations and advices
• US relatively insensitive for detecting
traumatic abdominal organ injury
• Fluid may pool at variable rates
– Minimum volume for US detection
– Multiple views at multiple sites
– Serial exams: repeat exam if there is a
change in clinical picture
• Operator dependent