Bladder ultrasound: Difference between revisions

(clinical use)
 
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==Background==
==Background==
volume = length x width x heigth x 0.52
[[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 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==
*[[Urinary retention]]
*Urinary catheter confirmation
*Free fluid in the pelvis
*Determine post void residual
*[[Nephrolithiasis]] in the UVJ
*Typically included in [[Renal ultrasound|renal ultrasound]] and [[FAST exam|FAST exams]]


==Technique==
==Technique==
*Use phase probe
#Select probe
*Find the bladder suprapubically
#*Phased array or curvilinear probe
**usually need to turn down far gain 2/2 acoustic enhancement from bladder
#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


==Clinical Uses==
==Findings==
*Look for abdominal free fluid
*Bladder volume/post-void residual
*Can be used to calculate PVR noninvasively
**Use calc mode and measure in 3 dimensions (anterior posterior, right left, and superior inferior)
**Normal PVR is <50mL, <100mL in patients >65.
==Source==
*Stones
Arch Ital Urol Androl. 2005 Mar;77(1):60-2.
[[File:Twinkle_Artifact_Perez.gif|thumbnail|Bladder bulge and twinkle sign<ref>http://www.thepocusatlas.com/renalgu-1/</ref>]]
Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers.
**Ureteral jets can indicate patent ureter
Dicuio M, Pomara G, Menchini Fabris F, Ales V, Dahlstrand C, Morelli G.
**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 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===
<gallery>
File:Normal sagittal bladder.jpg
File:Ureteral jets.png|Ureteral jet
</gallery>
 
===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==
*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===
[[File:Bladder sagittal.gif]]
[[File:Bladder transverse.gif]]
 
==External Links==
*[http://www.fpnotebook.com/uro/Rad/BldrUltrsnd.htm FP Notebook: Bladder Ultrasound]


==See Also==
==See Also==
[[Ultrasound (Main)]]
*[[Ultrasound (main)]]
*[[Ultrasound: In Shock and Hypotension]]
*[[Ultrasound: Pelvic]]
*[[Renal ultrasound]]
*[[Ultrasound: Signs]]
 
==References==
<references/>


[[Category:Rads]]
[[Category:Ultrasound]]
[[Category:Radiology]]
[[Category:Urology]]

Latest revision as of 21:21, 17 September 2020

Background

Anatomy of the bladder (male)
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 volume = length x width x height x 0.52[1]

Indications

Technique

  1. Select probe
    • Phased array or curvilinear probe
  2. Location
    • Suprapubic
  3. Landmarks
    • Identification: anechoic (black) fluid within a structure defined by hyperechoic (white) appearing borders
  4. Obtain sagittal and transverse images
  5. Use calc function to attain bladder volume
  6. 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

Abnormal

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

Bladder sagittal.gif Bladder transverse.gif

External Links

See Also

References

  1. 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.
  2. http://www.thepocusatlas.com/renalgu-1/
  3. 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.