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Kidney Week

Abstract: TH-PO126

Focus on POCUS: Do Not Blindly Trust the Bladder Scanner in Patients with Ascites

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Bejjanki, Harini, University of Florida, Gainesville, Florida, United States
  • Koratala, Abhilash, University of Texas Health Science Center, San Antonio, Texas, United States
Introduction

Urethral catheterization, an invasive procedure with infection risk, was regarded as gold standard for measuring residual urine volume(UVol). It has now been superseded by portable automated bladder scanners(BS) performed by nurses at the patient’s bedside. The benefits include fewer invasive catheterizations and increased patient comfort. However, caution has to be exercised when using BS to identify UVol in complex cases such as patients with ascites or other pelvic pathology. We report a case of pelvic ascites, where nephrologist-performed point-of-care ultrasonography (POCUS) has facilitated the correct diagnosis.

Case Description

A 45-year-old woman with history of liver cirrhosis was admitted for failure to thrive. Hospital course was complicated by decompensated cirrhosis, septic shock, and Acute Kidney Injury requiring renal replacement therapy. A routine BS to monitor renal recovery revealed UVol of ~800ml. However, there was no urine return on insertion of a urethral catheter. Urology consult was requested to assist with the catheter placement. Meanwhile, nephrology team performed POCUS, which demonstrated a large amount of anechoic fluid in the pelvis, which was ‘continuous’ with the peritoneal cavity in the longitudinal plane indicating that it is pelvic ascites and not the urinary bladder. In the transverse plane, uterus was seen floating in the pelvic ascites and together with ovarian ligaments, gave the appearance of a “TIE fighter” (‘Star Wars’ fictional Starfighter) [Figure]. A CT scan obtained later confirmed decompressed bladder deep in the pelvis.

Discussion

The blind nature of BS measurement does not allow differentiation of bladder from other fluid collections. Hence, nephrologists should perform POCUS and need to be aware of the pelvic anatomy in patients prone to ascites, which likely avoids unnecessary consultations and catheterizations.