Pediatric emergency medicine trisk 4503 4503
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addressing the use of bedside pelvic sonography in the pregnant female. In
general, if an IUP is not seen in a patient with a positive urine B-HCG,
gynecology consultation should be arranged. A low-serum HCG level, implying
an early IUP, may allow outpatient follow-up with precautions for possible
ectopic pregnancy.
Pitfalls
A pregnancy less than 5 weeks’ gestational age (3 weeks post conception) may
not be visible. The gestational sac should be located off-center and should have a
circular appearance; elliptically shaped, centrally located sacs are concerning for
an abnormal sac that may not be representative of an IUP.
Kidney Ultrasound
Kidney ultrasound provides important diagnostic information in patients
presenting with hematuria and/or abdominal pain. Nephrolithiasis is an
increasingly recognized cause of pediatric abdominal pain and bedside ultrasound
offers the ability to quickly determine a diagnosis in the patient presenting with
obstructive nephropathy.
Early obstruction may initially only result in hydroureter but as the obstruction
persists, hydronephrosis will develop. Identification of hydronephrosis in a
patient with undifferentiated abdominal pain can help to focus further treatments
for presumed nephrolithiasis and often precludes the need for additional
diagnostic tests. While nephrolithiasis is the most common cause of acute
obstructive nephropathy, the possibility of extrinsic compression should also be
considered.
Ultrasound has become the first-line imaging modality in cases of suspected
renal colic. The pediatric literature is limited to case reports regarding the use of
bedside ultrasound for evaluation of renal pathology. In contrast, adult literature
has shown that bedside ultrasound is sensitive and specific for identification of
hydronephrosis secondary to obstructive uropathy in patients with renal colic.
Anatomy
Bilateral kidneys are located in the retroperitoneum, with the left kidney located
slightly more cephalad than the right. The kidneys are obliquely oriented with the
upper pole oriented medially and posteriorly. The kidney, along with the adrenal
gland, is surrounded by Gerota fascia, a hyperechoic linear structure. The outer
layer of the kidney comprises the renal cortex, a hypoechoic homogeneous tissue
with anechoic-appearing medullary pyramids interspersed. In the central kidney
the calyces, which appear hyperechoic due to the fat in the area, converge to form
