Duplex ultrasound of the lower extremity performed by vascular labs typically include PW (pulsed wave) and color Doppler evaluation of the venous system. This may include the use of augmentation. These techniques can complement a well-performed proximal compression ultrasound. However, compression ultrasound alone has very high sensitivity and is effective in ruling out a proximal leg DVT. Keeping exams simple and focused makes POCUS (point-of-care ultrasound) more straightforward and accessible for practitioners who are not specialized sonographers.

Would you like to share your technique in doing this procedure?

@@POCUSGeek Sure, I'd love to share my experience. How would you like me to do it? By private message?

@@albertoangeloviedogarcia7045 Here would be great as it may help others. If there are any resources, pictograms, or videos online please include those links. Thanks for sharing. Also if you’d like to help with further education you can email me at [email protected].

Glad it was helpful!

Glad you enjoyed it!

Nope. Good catch and you are right. I don't refer to it as the renal sinus because this complicates the understanding I want people to have. It's easier to teach people that this is the renal pelvis and that this is where they should watch for hydronephrosis.

@@POCUSGeek thank you for you answer 🙏🏻 great video btw Sure it helped a lot of people

This video was done as part of a lecture that I'll be giving to 2nd year medical students about diagnosing cholecystitis and cholangitis. It is part of a larger overview of imaging strategies. I won't be doing another video because it's utility it low in the ED but we should understand when to obtain it and how it is performed. Here's a further breakdown - Ultrasound is the primary modality for imaging the gallbladder and biliary tree. This is because it is easily performed and can be done quickly at the bedside or radiology suite. It can diagnose cholecystitis and can suggest choledocholithiasis (1st step to cholangitis). Limitation: If someone has had a cholecystectomy it is a waste of time to perform an ultrasound (my opinion). HIDA scan is thought to be the gold standard for diagnosing cholecystitis but is not easily performed. I've maybe ordered one of these exams in the emergency department in the past 2 years and less than 5 in my 17 years of practice. It is useful when the ultrasound is non-diagnostic for cholecystitis - doesn't happen very often but maybe needed to further clarify if cholecystitis is the diagnosis. Outside of the emergency department it can show liver pathology especially in transplants, biliary atresia, and GB function. It is time consuming and requires specialized equipment and personell. These are read by radiologist and not be an emergency physician. If you think that you're going to order a HIDA scan don't given the patient morphine as this will cause it to be an equivocal exam due to its effect on the sphincter of Oddi. MRCP or ERCP are my test of choice if the patient has a cholecystectomy and I'm worried about development of choledocholithiasis or other biliary tree stenosis. Ultrasound is very limited in it's ability to assess for choledocholithiasis post cholecystectomy and is often non-diagnostic due to the compensatory dilation of the common bile duct (CBD). MRCP is my test of choice in the ED post cholecystectomy because where I work this can still be obtained during business hours. ERCP requires a procedure by GI but may be need if MRCP shows stricture or choledocholithiasis. CT casts a wide net if they have pain outside the right upper quadrant or epigastric region. It can show fat stranding around the GB which would indicate cholecystitis but is limited in identifying cholelithiasis given that most stones are radiopaque. It also can't diagnose early cholecystitis when a stone is initially impacted in the GB neck or cystic duct. It gives the benefit when other diagnosis are just as likely as biliary tree pathologies. It is, however, the test of choice in painless jaundice. It should be performed with IV contrast unless contraindicated.

@@POCUSGeek Thank you very much for your very clear and enlightening reply!

I'm glad it was helpful.

HIDA: Cholecystitis, biliary dyskinesia, bile duct, injury MRCP: choledocholithiasis

You're very welcome!

@@NasrMousa00 yep should be out soon. First step is being good at this portion.

Glad it was helpful!