Following on from our previous post, how can PoCUS be incorporated into the assessment of flank pain. In many cases, the default investigation is CT. Whilst this has excellent diagnostic performance it also exposes many, often relatively young patients, to significant radiation.
Cox et al describe the use of ultrasound in the assessment of this patient group, with a systematic assessment of the aorta, kidneys and bladder to elucidate a cause of the patient's symptoms. They go on to describe a ultrasound based protocol for the assessment of patients with suspected ureteric colic.
The NEJM paper they reference comparing ultrasound to CT scanning in the investigation of nephrolithiasis can be found here. This showed a reduction in radiation exposure with no significant change in adverse outcomes through the use of a ultrasound based assessment.
Cox C, MacDonald S, Henneberry R, Atkinson PR. My patient has abdominal and flank pain: Identifying renal causes. Ultrasound. 2015; 23(4):242-50.
Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasound versus CT for suspected nephrolithiasis. New Eng J Med 2014; 371: 1100–10.
SonoSite have published a number of videos on the assessment of the abdominal aorta. The first two videos below are approximately ten minutes long and provide an overview of the techinique and show example abnormal findings. The third video shows the basic scanning technique alongside a 3D animation which makes it easy to understand the images you obtain.