Adomen Protocol: Sections 12-13

12. Sagittal and Transverse / Coronal Right Kidney Structures to identify

1. Sagittal view of liver and RK echogenicity comparison

2. Sag RK Medial

3. Sag RK Mid with Measurement

4. Sag RK Lat

5. Trv RK UP

6. Trv RK MID

Trv RK LP

12. Sagittal and Transverse / Coronal Right Kidney annotate, depth, focal zone, section width

Annotate: SAG RK (MED, MID, LAT), TRV or COR (UP, MID, LP). LDEC if better window.

Depth: Set at quadratus lumborum.

Focal zone: SAG Mid to posterior kidney.

Section width: Full for sagittal, ↓ for TRV views

12. Sagittal and Transverse / Coronal Right Kidney echogenicity

Renal Cortex should be hypoechoic to isoechoic to the liver parenchyma. More isoechoic in younger population.

12. Sagittal and Transverse / Coronal Right Kidney Tips:

Always scan posterior to kidneys looking for potential exophytic masses.

Medial: break in the cortex for the renal hilum.

Mid: cortex surrounding the sinus.

Lat: just cortex (no sinus).

TRV RK UP: liver is more visible

Evaluate medial to upper pole for adrenal gland masses

liver is a window for UP to mid portions of kidneys.

13. Sagittal and Transverse / Coronal Spleen and Left Kidney: Right Lateral Decubitus structures to identify

7. Sag Spleen with measurement

8. Trv Spleen

9. Sag Spleen with LK echogenicity comparison

10. Sag LK Medial

11. Sag LK Mid with Measurement

12. Sag LK Lat

13. Trv LK UP

14. Trv LK MID

15. Trv LK LP

13. Sagittal and Transverse / Coronal Spleen and Left Kidney: Right Lateral Decubitus annotations

Annotate Spleen: RDEC SAG & TRV

Annotate Kidney: RDEC SAG LK (MED, MID, LAT) RDEC TRV LK (UP, MID, LP)

13. Sagittal and Transverse / Coronal Spleen and Left Kidney: Right Lateral Decubitus depth, focal zone, section width and echogenicity

Depth: Spleen: Include entire spleen and left pleural space (include diaphragm poster landmark). Kidney set at quadratus lumborum.

Focal zone: 2/3 deep for spleen, SAG LK mid / posterior kidney

Section width: Full for spleen & LK. ↓ for TRV LK views.

Echogenicity: Renal Cortex should be slightly hypoechoic to the

spleen

13. Sagittal and Transverse / Coronal Spleen and Left Kidney: Right Lateral Decubitus tips

Evaluate medial to upper pole to evaluate for adrenal gland masses.

TRV LK UP: may see spleen

spleen is a window for UP to mid portions of kidney

Clinical Indications / Signs & Symptoms for Renal Exam: (13)

1. Urinary tract infection (UTI)

2. Palpable mass

3. Elevated serum creatinine, BUN levels

4. Severe flank pain

5. Hematuria (blood in urine)

6. Proteinuria (protein in urine)

7. Oliguria (not producing urine or enough urine)

8. Azotemia (high nitrogen)

9. Assessment of mass visualized on radiography, CT scans

10. Assessment of non-visualization of kidney on intravenous pyelogram (IVP)

11. Assessment of enlarged or small kidney

12. Uncontrollable Hypertension – Renal Artery Stenosis

13. Trauma or post-surgical complications

Dynamic Range

AKA: compression

Name of control can change from when the image is live (Dunamic range) to when it is frozen (compression)

increases or decreases the number of shades of gray that are displayed by the machine

measured in decibels (dB)

broad/wide range (high dB)

displays less black and white shades and more shades of gray = smoother image with less contrast

a small/narrow range (low dB)

displays less shades of gray and more black and white shades = higher contrast image

what is dynamic rand often tied to

gray maps control (adjusting one control can affect the other)

increasing the dynamic range

scanning the kidneys sagittaly

see: superior to inferior (upper pole and lower pole)

scan: medial to lateral

document: SAG medial, mid and lateral

scanning the kidneys transversely

see: medial to lateral (upper pole to lower pole)

scan: superior to inferior

document: TRV UP, Mid, LP

quadratus lumborum muscle