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8/6/2019 EUS Urology
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High frequency (7~12MHz)
soft tissue
Curved Low frequency (2.5-3.5 MHZ Probe)
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Acoustic shadow
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35
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T12 -L4
/ /
/ /
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: 9-13 cm; : 4-6 cm; : 2.5-3.5 cmGerota’sfascia:
– kidney, capsule, perinephricfatSinus
– Hilum: vessels, nerves, lymphatics, ureter
– Pelvis: major and minor calycesParenchyma surrounds the sinus – Cortex: site of urine formation, contains
nephrons – Medulla: contains pyramids that pass
urine to minor calyces. Columns ofBertinseparate pyramids
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Hydronephrosis
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Pyonephrosis
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Acute calyceal rupture
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Renal stone
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UPJ stone
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UVJ stone
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Renal cyst1.smooth, round, or oval2.no internal echo
3.well-defined margin4.posterior enhancement
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Polycystic kidney
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Renal abscess
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Bladder mass ()
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49y/o f DM hx fever + left flank pain for 7 days
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Emphysematous pyelonephritis
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Emphysematous Cystitis
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Psoas muscle abscess
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1.
2. iliac crest
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Renal Laceration
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Retroperitoneal Hematoma
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Scrotum ultrasound
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LogisticsLinear Array (7-10 MHz)Scan asymptomatic side first
PositioningFrog leg position
Drape for support and elevationGenerous amount of warm gel
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Anatomy
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Tunica albuginea
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Epididymis
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Ultrasound – B-Mode
Compare echotexture(straddle view)
Visualize each testicle in two planes
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Ultrasound – B-ModeNormal: homogenous symmetric
Early ischemia: enlargement, no Δ echogenicity
Hemorrhage: hyperechoic areas in aninfarcted testis, heterogenous
• Late ischemia/infarct:hypoechoic
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Ultrasound: Color Doppler
NormalIntratesticular artery
Torsion
Arterial flow absentNormal / increasedin detorsion
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Ultrasound: Color Doppler
Early TorsionNo flow, echogenicitysimilar
Late TorsionHeterogenous echotextureIncreased extra testicularblood flow
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Physical
Elevated testicle, tenderLoss of cremaster reflexThick, tender spermatic cord
Brunzel sign – horizontal lieGer sign - skin pitting at the scrotal basePrehn sign – persistent pain despite elevation
Image: American Family Physician
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Treatment
Definitive treatment: surgicaldetorsion and orchioplexy
Manual detorsion: medial tolateral; “opening a book”
May need to rotate 2-3 times for
complete detorsion
Roberts: Clinical Procedures in Emergency Medicine
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Epididymitis
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Epididymal abscess
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Testicular abscess
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Fournier’s gangrene
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Incarcerated inguinal hernia
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Testicular rupture
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Special thanks to~~
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Thanks for your attention !!