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CR

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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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[ ]+

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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 !!