NephroPOCUS

Time to update the #VExUS resources pinned thread 🧵📌 1/ Tweetorial on image acquisition. #POCUS #MedEd twitter.com/NephroP/status…

@khaycock2 Please add any perspectives you may have on this - you usually have great evolution-physiology-POCUS connections. I made reasonable effort to review the available literature (linked where applicable).

Latest post on NephroPOCUS.com - “Not Every Dilated IVC or Pulsatile Portal Vein Is Pathological” #POCUS #Nephpearls #echofirst 🔗 nephropocus.com/2026/05/15/not…

The A5C can still underestimate the LVOT VTI it appears perfectly aligned if the jet is off in the orthogonal plane (or Z plane) to the A5C. I usually check an A3C LVOT VTI in addition to the A5C as an internal quality check.

Ultrasonido en infección urinaria alta. Pielonefritis y pionefrosis unilateral derecha en paciente diabético (confirmación por laboratorio y Uro-TC).

What do you think about this anomaly ⁉️⁉️⁉️

@FibrilloFlutter @Frances98392343 @DrRajeshG1 @argulian @Irina67790690 @alex1708ander Looks similar to this 👇. Differential is parachute 🪂 x.com/NephroP/status…

4⃣ In such cases ☝️, you can try the apical 3-chamber view (apical long-axis view with the probe marker directed toward the right shoulder from the apical window). Sometimes, it gives you a better Doppler angle. #POCUS

#POCUS #echofirst #Nephpearls thread of the day 🧵 The concept of estimating stroke volume and cardiac output. See thread for some pearls and pitfalls ⚠️

DI has prognostic significance 👇🏼 🔗 onlinelibrary.wiley.com/doi/10.1111/ec…

#POCUS #echofirst #FOAMed The dimensionless index (DI) is the ratio of left ventricular outflow tract (LVOT) velocity to aortic valve velocity, calculated as either the ratio of LVOT time-velocity integral to aortic valve jet time-velocity integral, or as the ratio of peak velocities. By eliminating LVOT cross-sectional area from the continuity equation, DI expresses the effective valve area as a proportion of the LVOT area, with values approaching 1 in the absence of stenosis and decreasing with increasing stenosis severity. A DI <0.25 is suggestive of severe AS. Like all Doppler metrics, it’s not immune to technical error and still needs clinical context.

@NephroP Pre and post - love physiology - takes out the guess work

@DrZebra1 *I know you know, just putting it there for thread readers.

Agree, and I mentioned this in the thread as well. However, relying too much on absolute VTI cutoffs can sometimes be misleading, especially in patients with unusually narrow or wide LVOTs. It has happened to me before. In general, I usually just measure the VTI, but if I suspect over- or underestimation, will measure the LVOT diameter in a zoomed parasternal long-axis view. If I realize it later and am no longer with the patient, would at least compare it with prior echocardiogram report.

5⃣ Another lesser-known #POCUS tip: if you get an unusually high VTI that doesn’t fit the clinical picture, for example, not a cirrhosis patient who may normally live around a VTI of 28–30, think about whether your sample volume is sitting in the flow acceleration zone in someone with dynamic LVOT obstruction (= high VTI does not imply high stroke volume in this case). In that situation, go back to the parasternal long-axis view and do an M-mode assessment. Also place continuous-wave Doppler across the LVOT from the apical view and look for a high-velocity, late-peaking “dagger-shaped” waveform.

Practical example

LAP estimation in MR - not perfect, but still helpful to know. #echofirst #POCUS #Nephpearls