Advantages of Clinical Ultrasound in Primary Care

Marta Román Garrido,1* Patricia Alejandra Garrido Ruiz,2* Manuel Mejías Gil,1 Clara Timón Mohedas,1 Isabel Moreno Sánchez1

1Primary Care Department, Hospital Universitario de Salamanca

2Neurosurgery Department, Hospital Universitario de Salamanca

* These authors have equally contributed to this work and both should be considered as corresponding author.

Correspondence:

Patricia Alejandra Garrido Ruiz, Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca. Paseo de la Transición Española, 37007, Salamanca, Spain.

E-mail: [email protected] 

Received: September 30, 2023                                    |                         Published: October 12, 2023

Citation: Patricia A. Advantages of Clinical Ultrasound in Primary Care Consultation. HOJ Emerg and Int Med. 2023;1(1):06-08. 

Keywords

Hydronephrosis; uropathy; ultrasound

Background

A 63-year-old man presented with a self-limited episode of oliguria followed by pollakiuria and episodes of nonspecific incontinence. For months now, nocturia has been reported, with a weak and interrupted stream of urination. He had no medical history or regular treatment.

Introduction

We present the case of a 65-year-old patient who had constants within normality and unremarkable physical examination. We request control analysis with urine. He returned to the emergency room the next day due to an episode of bilateral lower back pain and difficulty urinating at night. We reviewed the requested analysis where we observed a significant deterioration in renal function, with anodyne urine output, microcytic and hypochromic anemia, a normal iron study, and a prostate-specific antigen of 3.18. Given the new symptoms and the analytical findings, we performed an ultrasound in consultation.1,2

Image1. Right Kidney with ureterohydronephrosis grade II-III

Image 2. Left Kidney with ureterohydronephrosis grade II

Image 3. Refilled bladder and enlarged prostate

Due to suspicion of obstructive uropathy, we proceeded to bladder catheterization, with a volume of urine in a bag of 1L. We started treatment with tamsulosin-dutasteride, we maintained catheterization at home and frequent check-ups. A few days later, he went to the hospital emergency room due to an episode of hematuria with clots, where he was evaluated by the on-call urology team, confirming obstructive uropathy secondary to prostate hyperplasia, pending completion of the study.

Differential diagnosis:

Renal colic; glomerulonephritis.

Clinical judgement:

Obstructive uropathy due to probable prostatic hyperplasia

Conclusion and Discussion

In recent decades, the suitability of the Primary Care level for the use of ultrasound in a large number of clinical scenarios in routine practice has been defended, increasing our diagnostic and resolution capacity.1,2 It is important to establish the indications and usefulness of ultrasound in those more cost-effective situations in which its use modifies our behavior and guides our decisions.

Conflict of Interest

The authors declare no conflicts of interest.

References

1. Sánchez Barrancos IM. Ecografía y Atención primaria. Aten Primaria. 2017;49(7):378–380.
2. MalónMusgo MM. Ultrasound in clinical practice in Primary Care. AnSistSanitNavar. 2018;41(2):157–160

Copyright: ©2023 Alejandra Garrido R. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.