Urinary Retention
This week's IMAGE of the WEEK is brought to us by Dr. Porter and Dr. Chesson.
While evaluating an 83 year-old man with abdominal distention and urinary sediment, a bedside US captured the following bladder images.
These images show a significant abnormality in the bladder and kidney requiring prompt consultation and management.
Probe placement for bladder imaging is shown in the following images.
The sagittal view is obtained by rotating the probe 90 degrees - the indicator now toward the head of the patient. From both positions, subtle fanning movements permits full visualization of the fluid filled bladder.
Reviewing the ultrasound images, the critical finding is a grossly distended bladder with a large dependent area of mixed echogenicity, in this case, representing pus in the bladder. The patient has a history of BPH with outflow obstruction and uses a chronic Foley catheter. He was sent to the ER with concern for infection given the appearance of sediment in his Foley bag. The patient arrived tachycardic, but afebrile. Labwork revealed acute renal failure and a WBC >20.
The sagittal CT image demonstrates both the enlarged bladder and associated hydronephrosis – both of which were noted on the bedside US.
His foley was replaced, and with IV antibiotics and IV fluids, his clinical condition and renal function improved.
While evaluating an 83 year-old man with abdominal distention and urinary sediment, a bedside US captured the following bladder images.
Transverse:
Sagittal:
These images show a significant abnormality in the bladder and kidney requiring prompt consultation and management.
Probe placement for bladder imaging is shown in the following images.
Transverse:
Using the curvilinear probe, the transverse view is obtained with the probe indicator to the right of the patient.
Sagittal:
The sagittal view is obtained by rotating the probe 90 degrees - the indicator now toward the head of the patient. From both positions, subtle fanning movements permits full visualization of the fluid filled bladder.
Reviewing the ultrasound images, the critical finding is a grossly distended bladder with a large dependent area of mixed echogenicity, in this case, representing pus in the bladder. The patient has a history of BPH with outflow obstruction and uses a chronic Foley catheter. He was sent to the ER with concern for infection given the appearance of sediment in his Foley bag. The patient arrived tachycardic, but afebrile. Labwork revealed acute renal failure and a WBC >20.
The sagittal CT image demonstrates both the enlarged bladder and associated hydronephrosis – both of which were noted on the bedside US.
His foley was replaced, and with IV antibiotics and IV fluids, his clinical condition and renal function improved.
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