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PoCUS–MeasurementsandQuickReference2.0–DrHeatherFlemming–DEMDalhousie2017

EditedbyDrHeatherFlemming,DrDavidLewisandDrRyanHenneberry

Areaofinterest

PoCUS–MeasurementsandQuickReferenceAbdominalAorta

Normal=<3cmdiameter

Renal

DegreesofhydronephrosisMild-MinimalseparationofcalycesModerate-DilationofmajorandminorcalycealsystemSevere-Markeddilationoftherenalpelvis,thinningofparenchyma

Gallbladder

Width:40-50mmWallthickness:Average2-3mmPathologic>3.5mmCBD:Normal4mm(<6mm)

• AgedependentCBDdiameterchange(Normalsizeinmmroughlyequalsageindecades)

• 8-10mmaftercholecystectomymaybenormalBladder

Width:Normalemptybladder<5mm

• Distendedbladder<3mmPostvoidresidual<100-150ml

Opticnerve

Diameter:Normal<5mm(measured3mmposteriortoglobe)

Appendix

Featuresofanormalappendix:

• Compressible,blind-endedtubularstructure• Surroundedbynormalappearingfat• Wallthickness<3mm(serosatolumen)• Diameter<6mm(serosatoserosa)

Featuresofappendicitis:• Characterizedbywallthickness>3mm,diameter>6mm.• HypervascularwallwithcolorDoppler,• Freefluidandpresenceofappendicolitharesecondarysigns.

SmallBowel

SBO:≥3loopsdilated(>25mm),non-compressiblesmallbowelproximaltocollapsed,compressiblebowelSecondarysigns:localizedbowelwalledema(>3mmthick),freefluidbetweenbowelloops(Tangasign),abnormalperistalsis(toandfroperistalsis)



Areaofinterest

PoCUS–MeasurementsandQuickReferenceMSK:

Tendinopathy:NormalAchilles:<6mmmeasuredatlevelofmedialmalleolusPatellarTendon:Normal=3-4mmPlantarfascia:Plantarfascitiis>4mm

Obstetric

Embryonicstructure

TransVagU/S TransAbdoU/S

GestationalSac 4.5-5wks 5.5-6wksYolkSac 5-5.5wks 6-6.5wksFetalPole 5.5-6wks 6.5-7weeksFetalHeartBeat 6wks 7wksDefinitiveIUP=YolkSacandorFetalPoleinsideGestationalSacLevelofbeta-HCGabovewhichIUPtypicallyseen:Transvaginal-1,500-2,000Transabdominal-6,500

IVC

IVCcollapsesslightlyoninspirationinspontaneouslybreathingpatient,butcollapsesonexpirationinmechanicallyventilatedpatient



CardiacPoCUS–MeasurementsandQuickReferenceAssessment

Parameters

Values

RVthickness

Measuredonsubcostalviewatleveloftricuspidvalvecordae.

Lessthan0.5cmisnormal

Mitralannularplanesystolicexcursion(MAPSE)

Surrogateoftheleftventricularlongitudinalfunction.SystolicexcursionofthelateralmitralannulusMeasuredinM-mode

Normalrange12+/-2mm

E-pointseptalseparation(EPSS)

Measuredfromtheanteriormitralvalveleaflettotheventricularseptuminearlydiastole.

≥7mmindicatesEF<30%.

TricuspidAnnularPlaceSystolicExcursion(TAPSE)

Lineisplacedfromtheapextothelateraltricuspidvalveandthemotionmeasured.A4Cview/M-mode

Normal>2cm

Valves:Aorticvalvediameter

MeasurementsinPSLAX

Leafletsnomorethan2mmMinimumtipseparation2cminmidsystole

Interventricularseptalthickness

DiastolicM-moderecordingsPSLAX

Normal:<1cmMen<0.9cmwomen