Bladder ultrasound: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
|||
| (16 intermediate revisions by 5 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:2605 The Bladder.jpg|thumb|Anatomy of the bladder (male)]] | |||
[[File:Prostatelead.jpg|thumb|Prostate anatomy]] | |||
*Bladder ultrasounds can be used independently for volume measurements or in conjunction with other exams such as FAST, renal studies, and pelvic ultrasounds | *Bladder ultrasounds can be used independently for volume measurements or in conjunction with other exams such as FAST, renal studies, and pelvic ultrasounds | ||
*Bladder volume = length x width x height x 0.52<ref>Dicuio M et al. Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers. Arch Ital Urol Androl. 2005 Mar;77(1):60-2.</ref> | *Bladder volume = length x width x height x 0.52<ref>Dicuio M et al. Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers. Arch Ital Urol Androl. 2005 Mar;77(1):60-2.</ref> | ||
==Indications== | ==Indications== | ||
*Urinary retention | *[[Urinary retention]] | ||
*Urinary catheter confirmation | *Urinary catheter confirmation | ||
*Free fluid in the pelvis | *Free fluid in the pelvis | ||
*Determine post void residual | *Determine post void residual | ||
*Nephrolithiasis in the UVJ | *[[Nephrolithiasis]] in the UVJ | ||
*Typically included in [[ | *Typically included in [[Renal ultrasound|renal ultrasound]] and [[FAST exam|FAST exams]] | ||
==Technique== | ==Technique== | ||
| Line 21: | Line 23: | ||
#Use calc function to attain bladder volume | #Use calc function to attain bladder volume | ||
#Optimize image quality | #Optimize image quality | ||
#*May need to turn down far gain | #*May need to turn down far gain secondary to acoustic enhancement from bladder | ||
#*May use power | #*May use power Doppler over the inferior border can demonstrate ureteral jets | ||
==Findings== | ==Findings== | ||
*Bladder volume/post-void residual | *Bladder volume/post-void residual | ||
**Use calc mode and measure in 3 dimensions (anterior posterior, right left, and superior inferior) | **Use calc mode and measure in 3 dimensions (anterior posterior, right left, and superior inferior) | ||
**Normal PVR is <50mL, <100mL in patients >65. | |||
*Stones | *Stones | ||
[[File:Twinkle_Artifact_Perez.gif|thumbnail|Bladder bulge and twinkle sign<ref>http://www.thepocusatlas.com/renalgu-1/</ref>]] | |||
**Ureteral jets can indicate patent ureter | **Ureteral jets can indicate patent ureter | ||
**Bladder bulge may indicated a UVJ stone<ref> Bomann JS, Seman M, Sutijono D, et al. Bladder bulge: unifying old and new sonographic bladder wall abnormalities in ureterolithiasis. West J Emerg Med. 2012;13(6):517-523.</ref> | **Bladder bulge may indicated a UVJ stone<ref> Bomann JS, Seman M, Sutijono D, et al. Bladder bulge: unifying old and new sonographic bladder wall abnormalities in ureterolithiasis. West J Emerg Med. 2012;13(6):517-523.</ref> | ||
**Twinkle Sign: Rapid alternation of color immediately behind a stationary echogenic object, acquiring a false appearance of movement in color | **Twinkle Sign: Rapid alternation of color immediately behind a stationary echogenic object, acquiring a false appearance of movement in color Doppler mode | ||
*Free fluid | *Free fluid | ||
**Anechoic (black) fluid outside the bladder is suggestive of free fluid | **Anechoic (black) fluid outside the bladder is suggestive of free fluid | ||
| Line 37: | Line 41: | ||
==Images== | ==Images== | ||
===Normal=== | ===Normal=== | ||
<gallery> | |||
File:Normal sagittal bladder.jpg | |||
File:Ureteral jets.png|Ureteral jet | |||
</gallery> | |||
===Abnormal=== | ===Abnormal=== | ||
<gallery> | |||
File:FF near bladder.png|Free fluid superior to the bladder | |||
File:Bladder with wall thickening and protrusion from stone.png|Right UVJ stone | |||
File:Bladder with wall edema from stone.png|Right UVJ stone | |||
</gallery> | |||
==Pearls and Pitfalls== | ==Pearls and Pitfalls== | ||
| Line 52: | Line 59: | ||
A bedside ultrasound was conducted to assess for bladder volume with clinical indications of urinary retention. The bladder was identified and viewed in the transverse and sagittal plane. The bladder volume was calculated to be ***ml. | A bedside ultrasound was conducted to assess for bladder volume with clinical indications of urinary retention. The bladder was identified and viewed in the transverse and sagittal plane. The bladder volume was calculated to be ***ml. | ||
''See [[Renal ultrasound]], [[FAST exam]], and [[Transabdominal pelvic ultrasound]] for further documentation for in other indications'' | |||
==Clips== | ==Clips== | ||
| Line 63: | Line 70: | ||
==See Also== | ==See Also== | ||
*[[Ultrasound (main)]] | |||
*[[Ultrasound: In Shock and Hypotension]] | *[[Ultrasound: In Shock and Hypotension]] | ||
*[[Ultrasound: Pelvic]] | *[[Ultrasound: Pelvic]] | ||
*[[ | *[[Renal ultrasound]] | ||
*[[Ultrasound: Signs]] | *[[Ultrasound: Signs]] | ||
Latest revision as of 21:21, 17 September 2020
Background
- Bladder ultrasounds can be used independently for volume measurements or in conjunction with other exams such as FAST, renal studies, and pelvic ultrasounds
- Bladder volume = length x width x height x 0.52[1]
Indications
- Urinary retention
- Urinary catheter confirmation
- Free fluid in the pelvis
- Determine post void residual
- Nephrolithiasis in the UVJ
- Typically included in renal ultrasound and FAST exams
Technique
- Select probe
- Phased array or curvilinear probe
- Location
- Suprapubic
- Landmarks
- Identification: anechoic (black) fluid within a structure defined by hyperechoic (white) appearing borders
- Obtain sagittal and transverse images
- Use calc function to attain bladder volume
- Optimize image quality
- May need to turn down far gain secondary to acoustic enhancement from bladder
- May use power Doppler over the inferior border can demonstrate ureteral jets
Findings
- Bladder volume/post-void residual
- Use calc mode and measure in 3 dimensions (anterior posterior, right left, and superior inferior)
- Normal PVR is <50mL, <100mL in patients >65.
- Stones
Bladder bulge and twinkle sign[2]
- Ureteral jets can indicate patent ureter
- Bladder bulge may indicated a UVJ stone[3]
- Twinkle Sign: Rapid alternation of color immediately behind a stationary echogenic object, acquiring a false appearance of movement in color Doppler mode
- Free fluid
- Anechoic (black) fluid outside the bladder is suggestive of free fluid
- Look for 'pointy edges' which increases suspicion for fluid not in another structure (cyst, ovary, bowel, etc)
Images
Normal
Ureteral jet
Abnormal
Free fluid superior to the bladder
Right UVJ stone
Right UVJ stone
Pearls and Pitfalls
- Ureteral jets indicate patent ureter but the absence of it does not mean obstruction
Documentation
A bedside ultrasound was conducted to assess for bladder volume with clinical indications of urinary retention. The bladder was identified and viewed in the transverse and sagittal plane. The bladder volume was calculated to be ***ml.
See Renal ultrasound, FAST exam, and Transabdominal pelvic ultrasound for further documentation for in other indications
Clips
Normal Exam
External Links
See Also
- Ultrasound (main)
- Ultrasound: In Shock and Hypotension
- Ultrasound: Pelvic
- Renal ultrasound
- Ultrasound: Signs
References
- ↑ Dicuio M et al. Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers. Arch Ital Urol Androl. 2005 Mar;77(1):60-2.
- ↑ http://www.thepocusatlas.com/renalgu-1/
- ↑ Bomann JS, Seman M, Sutijono D, et al. Bladder bulge: unifying old and new sonographic bladder wall abnormalities in ureterolithiasis. West J Emerg Med. 2012;13(6):517-523.