Pinnacle Health System
RENAL ULTRASOUND WORKSHEET
Aorta: Maximum AP Diameter:________cm
□ Plaque
□ Dilatation
Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
-----------------------
Name:____________________________________________ Date:_____/_____/____ ID:_________________
DOB: _____/______/______ Age:______ Sex: M / F Referring Physician:_________________________
Indications:__________________________________________________________________ Tech:_________
Height: _____________ Weight:______________ BP:_______/________
[pic]
Right Kidney: _______ X _______ X _______cm
R/I:______________
□ Abnormal Echogenicity
□ Decreased Size
□ Cyst
□ Mass
□ Echogenic Focus
□ Dilated pelvis/ureter
[pic]
Left Kidney: _______ X _______ X _______cm
R/I:______________
□ Abnormal Echogenicity
□ Decreased Size
□ Cyst
□ Mass
□ Echogenic Focus
□ Dilated pelvis/ureter
Bladder:
( Unable to evaluate
Wall Thickness:_______cm
( Ureteral Jets Seen: RT / LT
Pre-Void Volume_____________cc
Post Void Volume_____________cc
................
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