SO I CAN DO IT WITH MY SONOSITE TITAN ULTRASOUND MACHINE,LOCATE THE STONE.A PATIENT WAS REFERRED TO ME FOR USG ABDOMEN WITH PROVISIONAL
DIAGNOSIS OF APPENDICITIS.
SHE WAS A YOUNG LADY OF 30 YEARS OF AGE WITH FLANK PAIN RADIATING TO BACK AND THIGH.IT WAS ASSOCIATED WITH MILD FEVER AND VOMITING SINCE LAST NIGHT BEFORE THE ULTRASOUND EXAMINATION WAS CARRIED OUT.WHEN I HAD EXAMINED HER ABDOMEN PHYSICALLY IT WAS SOFT WITH NO GUARDING.SHE HAD TENDERNESS IN RIGHT LOWER FLANK AND BACKSIDE TOWARDS RENAL AREA ON THE BACK.THERE WAS NOT REBOUND TENDERNESS WHICH IS HALLMARK OF APPENDICITIS.
WITH MY SONOSITE TITAN MACHINE WITH A PROBE OF 2-4 MHZ FREQUENCY I CARRIED OUT HERE ABDOMINAL ULTRASOUND EXAMINATION.THERE WAS NO EVIDENCE OF FREE FLUID IN THE CAVITY.APPENDIX COULD NOT BE LOCATED WITH MY PROBE AND THERE FORE I INFERRED THAT IT IS NOT THE CAUSE OF HER PAIN.
THEN I LOOKED FOR KIDNEYS.TILTING THE PATIENT ON LEFT LATERAL DECUBITUS AND SCANNING FOR MORRISON'S POUCH I FOUND OUT THAT THERE WERE DILATATION OF CALYCES IN THE RIGHT KIDNEY.DILATATION WAS MODERATE TO SEVERE.SMALL STONE WERE SEEN IN CALYCES MAKING EAR RING APPEARANCES.
WHEN I TRACED DOWN WITH PRESSURE TO SEE LEVEL OF OBSTRUCTION I COULD NOT FOUND OUT IT.
BUT WHEN SCANNING FOR BLADDER I SAW SHADOWING EFFECT OF THE STONE.AHHA! I FOUND OUT THE STONE WITH MY SONOSITE TITAN WITH THAT TO CARDIAC PROBE.HOW GOOD FEELING IT IS ,TO REACH A TOP OF MOUNTAIN.
I CAN FIND SITE OF OBSTRUCTION WITH MY MACHINE AND SINGLE PROBE.THERE WAS 2.13CM URETERO-VESICLE JUNCTION STONE OBSTRUCTING THE RIGHT URETER URINE FLOW AND CAUSING BACK PRESSURE HYDRONEPHROSIS ON RIGHT SIDE.
LEFT KIDNEY WAS NORMAL.
SO IT WAS RIGHT UV-JUNCTION STONE.
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