Hydronephrosis - Dr. Charles Brown


Flank Pain - Dr. Torey Alling

  • 23-year-old man presents with 3 days of flank pain

  • +Nausea

  • +Urinary urgency

  • No significant pmh, no family history

POCUS: hyrdo-ureteronephrosis.

Patient avoided radiation, extra costs, and increased length of stay.

You can avoid radiation with POCUS with: appropriate history, no UTI, no fever, no AKI, <age 55, and if pain is well-controlled.


Back Pain after a fall. - Dr. Alain Artiles

-60 y/o M presents with back pain after a fall.

-PMH of HTN, DM, and alcoholic cirrhosis.

-Negative ROS

-Negative CXR & negative XR lumbosacral

-Note the cystic structure atop the superior pole of the right kidney. There appears to be a hyperechoic wall surrounding hypoechoic contents (likely fluid), also note the septations. No mass effect of the kidney or surrounding structures is noted.

-CT abd+pelvis (2017): Large mixed density mass (6.2 x 7.8 x 6.9 cm) in the right suprarenal location with central and peripheral calcification. Mass is favored to represent an adrenal mass or retroperitoneal mass. Differential considerations includes adrenal cortical carcinoma, pheochromocytoma, adrenal metastasis, and retroperitoneal sarcoma with other etiologies not excluded.

-No change in size was noted from comparison to CT scan in 2017.

-Patient was already aware of suprarenal mass, he was advised to follow-up outpatient for continued investigation of mass. Patient was discharged with diagnosis of rib contusion.


Nephrolithiasis - Struvite Stone. Dr Carlos Garcia-Rodriguez

•67 yo M w/ hx of HTN, DM, EtOH abuse, Renal Colic 2/2 nephrolithiasis who presents for hematuria, left flank pain, dysuria, and increased hesitancy x 1 day.

•Pain started the night prior to ED presentation, localized to the left flank radiating to the left groin. Pain is constant, but denies F/NS/C, no N/V.

•HR:106, BP: 197/104, RR: 18, T:37, SpO2, 95% ORA

POCUS: US LT Kidney Noted large hyperechoic structure involving inferior calyx into the renal pelvis. Notice the hydronephrosis as well towards the end of the video clip

CT Abd/Pelvis w/o contrast: Moderate left hydronephrosis with perinephric fat stranding secondary to a large obstructing staghorn calculus involving the inferior calyx and extending into the renal pelvis.

Hospital Course: Urology Recommended IR intervention for nephrostomy catheters. Pt s/p IR Placement of B/L 8 Fr nephrostomy catheters. Pt started on Zosyn.


  • Struvite stones made out of Magnesium-ammonia-phosphate

  • More common in women

  • Struvite occurs 10-15% and is made out of urea splitting organisms (Proteus, Staph, Klebsiella)

  • Surgical management requires complete removal via endoscopic techniques such as percutaneous nephrolithotomy.

  • High risk pts require suppressive antibiotics to prevent recurrent infections

  • Metabolic evaluation is recommended for individuals who develop these stones


Flank Pain - Dr. Anna Culhane

45 year old male with a history of renal colic

•4 hours of 10/10 RLQ excruciating pain that radiates to R flank

•Associated with nausea/vomiting and blood clots in urine

Hydronephrosis + Shadowing on POCUS

•Patient diagnosed with obstructing staghorn calculi and he was admitted for nephrostomy tube placement

•Staghorn calculi can be common in those with recurrent UREASE-PRODUCING bacteria, neurogenic bladder, reflux or certain HIV meds


Left Flank Pain/Renal Colic - Dr. Oswald Perkins

  • 52 YO M with PMH of HTN well controlled and HLD presents to ED with small amount of hematuria as well as L groin pain that comes and goes.

  • Note the mild left hydronephrosis, and the twinkle artifact at the left UVJ. Pain was well-controlled, normal creatinine, and no UTI. The patient received a diagnosis of renal colic and avoided CT imaging!