A male in his 60s with a history of nephrolithiasis presents with left sided flank pain. He’s mildly uncomfortable with tenderness over the left flank. Vital signs: blood pressure 162/104, heart rate 102, respiratory rate 15, temperature 98.2 F (36.8 C). He’s never smoked cigarettes.
POCUS Renal shows a right kidney (clip 1 below) without hydronephrosis, and a left kidney with hydronephrosis (clip 2 below). The patient’s pain was alleviated with analgesia, and computed tomography showed a 1.9 cm obstructing left sided ureteral stone.
Really like this case because it falls into the category, I think, of clinicians confirming what they think to be true quickly, non invasively, at the bedside. Why? If there is no hematuria and a negative POCUS renal for hydro, Gaspari et al found that the negative predictive value for nephrolithiasis is high, and aortic pathology should be, could be, perhaps be creeping into your mind.
Clip 1: Right kidney negative for hydronephrosis.
Clip 2: Left kidney positive for hydronephrosis.