📄 SonoAcademy
Positive
Bladder Swirl Sign
Ultrasound confirmation of correct urinary Foley catheter position and catheter patency
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Swirl Sign
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Saline Test
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USG Report
USG
Positive Bladder Swirl Sign refers to visualization of mobile echogenic swirling echoes or turbulence within the urinary bladder lumen during real-time ultrasound after gentle saline instillation through a urinary catheter. It helps confirm that the catheter tip is correctly placed inside the bladder and that the catheter is patent.
Ultrasound Features of Positive Bladder Swirl Sign:
Bladder Lumen: Adequately distended or partially distended urinary bladder.
Catheter Tip / Balloon: Catheter balloon may be visualized within the bladder lumen when adequately inflated.
Swirling Echoes: Mobile echogenic turbulence appears immediately after saline injection.
Color Doppler: Not mandatory; grayscale real-time visualization is usually sufficient.
Perivesical Region: No extravesical fluid collection should be seen.
Key Diagnostic Clue: Echogenic swirling movement inside bladder after saline flush confirms catheter communication with bladder lumen.
Short Report Line:
Positive bladder swirl sign is seen following saline instillation through the urinary catheter, confirming correct intravesical catheter position and catheter patency.
Detailed Report Line:
Real-time ultrasound demonstrates mobile echogenic swirling turbulence within the urinary bladder lumen following gentle saline instillation through the Foley catheter. The catheter balloon/tip is seen within the bladder lumen. No extravesical fluid collection is identified. Findings confirm correct intravesical catheter placement and catheter patency.
Main Finding:
FINDINGS: Real-time ultrasound demonstrates mobile echogenic swirling echoes within the urinary bladder lumen following gentle saline instillation through the urinary catheter. The finding confirms intravesical entry of instilled fluid.
CONCLUSION: Positive bladder swirl sign.
RECOMMENDATION: Correct catheter position and catheter patency are confirmed sonographically.
FINDINGS: Real-time ultrasound demonstrates mobile echogenic swirling echoes within the urinary bladder lumen following gentle saline instillation through the urinary catheter. The finding confirms intravesical entry of instilled fluid.
CONCLUSION: Positive bladder swirl sign.
RECOMMENDATION: Correct catheter position and catheter patency are confirmed sonographically.
Bladder Lumen: Adequately distended or partially distended urinary bladder.
Catheter Tip / Balloon: Catheter balloon may be visualized within the bladder lumen when adequately inflated.
Swirling Echoes: Mobile echogenic turbulence appears immediately after saline injection.
Color Doppler: Not mandatory; grayscale real-time visualization is usually sufficient.
Perivesical Region: No extravesical fluid collection should be seen.
Key Diagnostic Clue: Echogenic swirling movement inside bladder after saline flush confirms catheter communication with bladder lumen.
Short Report Line:
Positive bladder swirl sign is seen following saline instillation through the urinary catheter, confirming correct intravesical catheter position and catheter patency.
Detailed Report Line:
Real-time ultrasound demonstrates mobile echogenic swirling turbulence within the urinary bladder lumen following gentle saline instillation through the Foley catheter. The catheter balloon/tip is seen within the bladder lumen. No extravesical fluid collection is identified. Findings confirm correct intravesical catheter placement and catheter patency.
Technique / How to Demonstrate Bladder Swirl Sign:
1. Scan suprapubic region in transverse and longitudinal planes.
2. Identify urinary bladder lumen and catheter balloon if visible.
3. Attach sterile saline syringe to catheter sampling/irrigation port as per local protocol.
4. Gently instill small amount of sterile saline while observing bladder in real time.
5. Look for mobile echogenic swirling echoes within bladder lumen.
6. Positive sign means saline is entering bladder through the catheter.
7. Absence of swirl may suggest obstruction, malposition, kink, empty bladder, poor acoustic window, or technical failure.
8. Avoid excessive pressure during saline instillation.
9. Correlate with urine drainage, clinical status, and catheter function.
10. If doubt persists, repeat scan after repositioning or clinical catheter check.
1. Scan suprapubic region in transverse and longitudinal planes.
2. Identify urinary bladder lumen and catheter balloon if visible.
3. Attach sterile saline syringe to catheter sampling/irrigation port as per local protocol.
4. Gently instill small amount of sterile saline while observing bladder in real time.
5. Look for mobile echogenic swirling echoes within bladder lumen.
6. Positive sign means saline is entering bladder through the catheter.
7. Absence of swirl may suggest obstruction, malposition, kink, empty bladder, poor acoustic window, or technical failure.
8. Avoid excessive pressure during saline instillation.
9. Correlate with urine drainage, clinical status, and catheter function.
10. If doubt persists, repeat scan after repositioning or clinical catheter check.
Differential / Don’t Miss:
Key Point: Positive intravesical swirl + catheter balloon/tip within bladder + no extravesical fluid strongly supports correct catheter placement.
Catheter Malposition:
FINDINGS: Catheter balloon may not be visualized within bladder lumen. No intravesical swirl is seen after saline instillation. Bladder may remain distended despite catheter placement.
CONCLUSION: Findings may suggest catheter malposition or non-functioning catheter.
RECOMMENDATION: Clinical catheter reassessment/repositioning is advised.
FINDINGS: Catheter balloon may not be visualized within bladder lumen. No intravesical swirl is seen after saline instillation. Bladder may remain distended despite catheter placement.
CONCLUSION: Findings may suggest catheter malposition or non-functioning catheter.
RECOMMENDATION: Clinical catheter reassessment/repositioning is advised.
Blocked Catheter:
FINDINGS: Bladder is distended with absent or poor urine drainage. No clear intravesical swirling echoes are seen during saline flush.
CONCLUSION: Possibility of catheter blockage/kinking should be considered.
RECOMMENDATION: Catheter flushing, replacement, or urology review may be required depending on clinical condition.
FINDINGS: Bladder is distended with absent or poor urine drainage. No clear intravesical swirling echoes are seen during saline flush.
CONCLUSION: Possibility of catheter blockage/kinking should be considered.
RECOMMENDATION: Catheter flushing, replacement, or urology review may be required depending on clinical condition.
Extravesical Fluid / Suspected False Passage:
FINDINGS: Fluid is seen outside the bladder or catheter balloon is not confidently intravesical. Intravesical swirl is absent or equivocal.
CONCLUSION: Extravesical catheter position or urethral injury cannot be excluded.
RECOMMENDATION: Stop forceful instillation and obtain urgent clinical/urology correlation.
FINDINGS: Fluid is seen outside the bladder or catheter balloon is not confidently intravesical. Intravesical swirl is absent or equivocal.
CONCLUSION: Extravesical catheter position or urethral injury cannot be excluded.
RECOMMENDATION: Stop forceful instillation and obtain urgent clinical/urology correlation.
Key Point: Positive intravesical swirl + catheter balloon/tip within bladder + no extravesical fluid strongly supports correct catheter placement.
Important Reporting Points — Don’t Miss Anything:
1. Mention bladder distension status.
2. Mention catheter balloon/tip position if visible.
3. Mention saline instillation was performed under real-time ultrasound.
4. State whether intravesical swirling echoes are present or absent.
5. Confirm catheter patency when swirl is positive.
6. Mention absence of extravesical fluid collection.
7. Mention bladder wall abnormality, clot, debris, or stone if seen.
8. Mention residual urine/bladder distension if clinically relevant.
9. Mention limitation if bowel gas, obesity, empty bladder, or poor window affects assessment.
10. Recommend clinical catheter correlation if findings are equivocal.
FINDINGS:
Urinary bladder is visualized on suprapubic ultrasound. Foley catheter balloon/tip is seen within the bladder lumen. On gentle saline instillation through the urinary catheter, mobile echogenic swirling echoes are demonstrated within the bladder lumen, consistent with a positive bladder swirl sign. No extravesical fluid collection is identified.
IMPRESSION:
Positive bladder swirl sign, confirming correct intravesical urinary catheter position and catheter patency.
RECOMMENDATION:
No immediate catheter repositioning is required based on ultrasound findings. Clinical correlation with urine drainage is advised.
LIMITATION:
Assessment may be limited by poor bladder distension, bowel gas, obesity, patient discomfort, or inability to adequately visualize the catheter balloon/tip.
1. Mention bladder distension status.
2. Mention catheter balloon/tip position if visible.
3. Mention saline instillation was performed under real-time ultrasound.
4. State whether intravesical swirling echoes are present or absent.
5. Confirm catheter patency when swirl is positive.
6. Mention absence of extravesical fluid collection.
7. Mention bladder wall abnormality, clot, debris, or stone if seen.
8. Mention residual urine/bladder distension if clinically relevant.
9. Mention limitation if bowel gas, obesity, empty bladder, or poor window affects assessment.
10. Recommend clinical catheter correlation if findings are equivocal.
FINDINGS:
Urinary bladder is visualized on suprapubic ultrasound. Foley catheter balloon/tip is seen within the bladder lumen. On gentle saline instillation through the urinary catheter, mobile echogenic swirling echoes are demonstrated within the bladder lumen, consistent with a positive bladder swirl sign. No extravesical fluid collection is identified.
IMPRESSION:
Positive bladder swirl sign, confirming correct intravesical urinary catheter position and catheter patency.
RECOMMENDATION:
No immediate catheter repositioning is required based on ultrasound findings. Clinical correlation with urine drainage is advised.
LIMITATION:
Assessment may be limited by poor bladder distension, bowel gas, obesity, patient discomfort, or inability to adequately visualize the catheter balloon/tip.
Case Study
Patient: Adult patient with poor urine drainage after Foley catheter placement.
Ultrasound Findings: Urinary bladder is visualized. Foley catheter balloon is seen within the bladder lumen. Following gentle saline instillation through the catheter, mobile echogenic swirling echoes are seen within the bladder lumen. No extravesical fluid collection is noted.
Diagnosis: Positive Bladder Swirl Sign.
Teaching Point: Real-time visualization of intravesical saline swirl confirms catheter communication with the urinary bladder and supports correct catheter placement.
Patient: Adult patient with poor urine drainage after Foley catheter placement.
Ultrasound Findings: Urinary bladder is visualized. Foley catheter balloon is seen within the bladder lumen. Following gentle saline instillation through the catheter, mobile echogenic swirling echoes are seen within the bladder lumen. No extravesical fluid collection is noted.
Diagnosis: Positive Bladder Swirl Sign.
Teaching Point: Real-time visualization of intravesical saline swirl confirms catheter communication with the urinary bladder and supports correct catheter placement.
SonoAcademy Digital MCQ Examination
Topic: Positive Bladder Swirl Sign
Total Questions: 10 | Total Marks: 10 | Time: 30 Minutes
Instruction: Enter your details, start the exam, answer all questions, and download your PDF marksheet after submission.
Exam Result
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Topic: Positive Bladder Swirl Sign
Total Marks: 10
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