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Kim DJ, Bell CR, Sheppard G. Genitourinary Ultrasound. Emerg Med Clin North Am 2024; 42:819-838. [PMID: 39326990 DOI: 10.1016/j.emc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Renal and genitourinary (GU) complaints are common reasons for presentation to the emergency department (ED). This article reviews the approach to renal, bladder, and testicular point-of-care ultrasound (POCUS) with specific discussions of commonly encountered ED pathology. It presents algorithms highlighting the clinical integration of renal and GU POCUS into the evaluation and management of these patients.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Emergency Medicine, Vancouver General Hospital, 855 12th Avenue West, Vancouver, British Columbia V5Z 1M9, Canada.
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, 7007 14 Street Southwest, Calgary, Alberta T2V 1P9, Canada. https://twitter.com/colinrbell
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, Newfoundland A1B 3V6, Canada. https://twitter.com/GillianSheppar9
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Orso D, Peric D, Di Gioia CC, Comisso I, Bove T, Ban A, Fonda F, Federici N. Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview. Healthcare (Basel) 2024; 12:1356. [PMID: 38998890 PMCID: PMC11241743 DOI: 10.3390/healthcare12131356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field. A thorough summary that can be utilized as a guide for emergency and critical care healthcare providers is presented. The daily hemodynamic management of critically ill patients involves the implementation of new protocols, such as VexUS or the evaluation of the renal resistance index. The role of ultrasound in managing acute nephropathy and genitourinary issues is increasingly crucial given its bedside availability, thus this imaging modality not only facilitates the initiation of therapeutic interventions but also provides swift prognostic insights that are vital to provide tailored patient care. As further advances in ultrasound will arise, it is important for healthcare providers to foster the use of these technologies capable of improving patient outcomes.
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Affiliation(s)
- Daniele Orso
- Department of Emergency "Santa Maria della Misericordia", University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Daniele Peric
- Department of Emergency, University Hospital of Trieste, Azienda Sanitaria Universitaria Giuliano-Isontina, 34128 Trieste, Italy
| | - Carmine Cristiano Di Gioia
- Department of Emergency Medicine, Community Hospital of Baggiovara (MO), Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
| | - Irene Comisso
- Department of Emergency "Santa Maria della Misericordia", University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Tiziana Bove
- Department of Emergency "Santa Maria della Misericordia", University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
- Department of Medicine (DME), University of Udine, 33100 Udine, Italy
| | - Alessio Ban
- Department of Pediatrics, Community Hospital of Latisana (UD), Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Federico Fonda
- Department of Emergency "Santa Maria della Misericordia", University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Nicola Federici
- Department of Emergency "Santa Maria della Misericordia", University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
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Whitworth P, Courtney KG, Oto A, Allen BC, Akin O, Barker SJ, Bartel TB, DuBeau C, Gerena M, Kraft KH, Lew SQ, Mankowski Gettle L, Turkbey B, Uyeda JW, Nikolaidis P. ACR Appropriateness Criteria® Hydronephrosis on Prior Imaging-Unknown Cause. J Am Coll Radiol 2024; 21:S144-S167. [PMID: 38823942 DOI: 10.1016/j.jacr.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Initial imaging evaluation of hydronephrosis of unknown etiology is a complex subject and is dependent on clinical context. In asymptomatic patients, it is often best conducted via CT urography (CTU) without and with contrast, MR urography (MRU) without and with contrast, or scintigraphic evaluation with mercaptoacetyltriglycine (MAG3) imaging. For symptomatic patients, CTU without and with contrast, MRU without and with contrast, MAG3 scintigraphy, or ultrasound of the kidneys and bladder with Doppler imaging are all viable initial imaging studies. In asymptomatic pregnant patients, nonionizing imaging with US of the kidneys and bladder with Doppler imaging is preferred. Similarly, in symptomatic pregnant patients, US of the kidneys and bladder with Doppler imaging or MRU without contrast is the imaging study of choice, as both ionizing radiation and gadolinium contrast are avoided in pregnancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Pat Whitworth
- Thomas F. Frist, Jr. College of Medicine, Belmont University, Nashville, Tennessee.
| | - Kelsey G Courtney
- Research Author, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Twyla B Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas; Commission on Nuclear Medicine and Molecular Imaging
| | - Catherine DuBeau
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; American Geriatrics Society
| | - Marielia Gerena
- Stony Brook University Medical Center, Stony Brook, New York
| | - Kate H Kraft
- University of Michigan, Ann Arbor, Michigan; American Urological Association
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | | | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer W Uyeda
- Brigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER
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Allen R, deSouza IS. Risk-benefit analysis of PoCUS for suspected, ruptured abdominal aortic aneurysm. Acad Emerg Med 2022; 29:812-813. [PMID: 35420235 DOI: 10.1111/acem.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Robert Allen
- Department of Emergency Medicine SUNY Downstate Health Sciences University Brooklyn New York USA
- Department of Emergency Medicine Kings County Hospital Center Brooklyn New York USA
| | - Ian S. deSouza
- Department of Emergency Medicine SUNY Downstate Health Sciences University Brooklyn New York USA
- Department of Emergency Medicine Kings County Hospital Center Brooklyn New York USA
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