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The kidneys are located in the ______________ cavity.
The kidneys and adrenal glands are located in the ___________ space. The anterior border of this space is called ________________.
- Perinephric or perirenal space
- Gerota's fascia is the anterior boarder
The hypoechoic structures located in the renal medulla are: __________________
At the level of the renal hilum, list the anterior/posterior position of the renal vessels and ureter.
- Anterior: renal artery
- Mid: renal vein
- Posterior: ureter
List the further divisions of the renal artery and their location within the renal parenchyma.
- Renal pelvis: segmental arteries
- Renal pyramid: interlobar arteries
- Cortex: arcuate arteries
- Very outter rim: interlobular
Describe the sonographic patterns associated with unilateral renal agenesis.
Causes compensatory hypertrophy of contralateral kidney
Describe the sonographic patterns associated with fetal lobulation.
One or more rounded contour abnormalities
Describe the sonographic characteristics of the hypertrophied Column of Bertin.
- Can vary w/scan plane (iso to hypoechoic)
Most common urinary tract anomaly
Duplicated collecting system
Describe the sonographic characteristics and clinical symptoms associated with duplicated collecting system.
- Incomplete: 2 separate collecting systems, 2 ureters, Common orifice
- Complete: 2 separate collecting systems, 2 ureters, 3 jets
- superior system susceptible to obstructions
- Look for ureterocele>> cyst within bladder
Describe the clinical symptoms and sonographic characteristics of a pelvic kidney.
Hx pelvic mass, renal infections, stones, & hydronephrosis due to short course of ureter
Describe the clinical symptoms and sonographic characteristics related to horseshoe kidney.
- Lack of complete separation of kidneys
- 90% fused @ lower pole
- Isthmus anterior to AO
Complications of horseshoe kidney:
UPJ obstruction, renal stone formation, renal infection
Describe the clinical symptoms and sonographic characteristics related to congenital UPJ obstruction.
- Symptoms: Typically symptomatic in childhood, chronic back and flank pain, hx renal infections or stones
- Pattern: Distended renal pelvis and calyces with normal ureter
What are the normal measurements of the adult kidney? What is the “average” renal length?
- 9-13 L x 2.53 AP x 4-5 T
- ~10 L
Most frequent cause of acute renal failure:
Prerenal azotemia producing renal hypoperfusion
Symptoms of acute renal failure:
- Sudden decrease in renal function
- Hemorrhage, low cardiac output
- Dehydration, pancreatitis, burns, trauma
- Acute tubular necrosis, glomerulonephritis
Labs associated with acute renal failure:
Sudden increase in BUN and creatinine
Prerenal azotemia RI value:
- RI < 0.7
- Associated with: acute renal failure
Intrinsic renal disease RI value:
- > 0.7
- Associated with: acute renal failure
Most frequent cause of chronic renal failure:
Diabetes and HTN
Causes of chronic renal failure
- Cystic renal disease (PCKD)
Symptoms and lab values associated with chronic renal failure:
- Physical symptoms are vague
- Labs: increased serum BUN and creatinine
Sonographic pattern of chronic renal failure:
- Hyperechoic cortex
- Loss of corticomedulary junction
Labs associated with RCC:
- RBC casts in urine
- Increased BUN and creatinine
Stages of RCC
- Stage 1 < 7 cm
- Stage 2 > 7 cm
- Stage 3 IVC invasion
- Stage 4 Invasion of lymph nodes and organs
Large RCC pattern
- Normally hyperechoic but may present iso or hypoechoic
- May contain calcifications or areas of necrosis
Doppler evaluation of RCC
- Shift > 2.5 kHz
- Large systolic/diastolic flow differential
- Flow usually in peripheral
Common site of metastasis of RCC
- Through renal vein into IVC
- Check contralateral kidney
- Hepatic and retroperitoneal lymph node metastasis
Transitional cell carcinoma is also known as:
Renal urothelial CA
What are the differences between papillary and non papillary TCC?
- Papillary: lower grade with slower rate of renal involvement
- Non-papillary: more invasive infiltrating adjacent renal parenchyma and more distant sites
Most frequent location of TCC:
with in the kidney
with in ureter or bladder
Pattern of papillary vs. non papillary TCC:
- Papillary type: hypoechoic mass within renal sinus which may cause hydro
- Angiogenesis excludes blood clot, sloughed papilla and fungus ball
What are the clinical symptoms and sonographic features of lymphoma?
- Metastatic process
- Most frequently occurs with Non-Hodgkins Lymphoma
- Symptoms: Hematuria, flank pain and or mass
- Pattern: 1+ discrete hypo/anechoic mass, Diffuse infiltration = hypoechoic
Most frequent benign neoplasm of the kidney:
What is angiomyolipoma associated with:
- Bladder fills with blood
- True surgical emergency
What are the sonographic patterns associated with urachal anomalies including patient urachus and urachal diverticula?
- In women: secondary to infection of periurethral glands, some due to trauma in child birth
- Clinical symptoms:Soft anterior vaginal mass
- Pattern: Cystic/complex mass that communicates with urethra
What are the clinical symptoms and sonographic characteristics of MCDK or renal dysplasia?
- Symptoms: Pediatric: flank mass; Bilateral: renal failure; Unilateral: asymptomatic
- Pattern:Typical unilateral, rarely bilateral or focal unilateral, multiple cysts of various sizes; adults>> wall calcifications
What is the most common renal infection?
What are the clinical symptoms and sonographic characteristics of acute pyelonephritis?
- ~15-30yo females
- Symptoms:UTI, fever, flank pain, urgency, frequency
- Lab values: Urinalysis>> bacteriuria, pyuria, positive urine culture, normal RFTs (BUN/creatinine)
- Pattern: Mild cases = normal pattern, Renal enlargement with compression of sinus, Loss of corticomedullary junction; Hypoechoic pattern = edema; Hyperechoic = hemorrhage; Emphysematous = localized or diffuse air pockets
What are the sonographic patterns associated with renal abscess and perinephric abscess?
- Symptoms: Hx of diabetes, infection related to renal stones, prolonged UTI, immune system compromised, Diffuse or localized flank pain, Fever, increased WBC count
- Pattern: Hypoechoic, thick walled mass in renal parenchyma, May contain septa, internal debris, or gas pockets
What are the clinical symptoms and sonographic patterns related to renal hematoma?
- Renal injury due to blunt/sharp trauma
- Symptoms: Hx of malignancy, hydro, or cysts, Minimal bleeding = localized or diffuse pain, Massive trauma= severe pain, decreased hematocrit, symptoms of shock, ARF
- Pattern: Echogenic, complex, cystic (new to old), Major lacerations>> echogenic line,Doppler>> used to look for disruption of flow
fracture of capsule
fracture of collecting system
What are the clinical symptoms and sonographic characteristics of renal stones?
- Symptoms: Size does not correlate with severity of symptoms, Obstructing = sudden severe pain, Micro or gross hematuria
- Pattern: Hyperechoic with shadowing, Twinkle artifact( To optimize: *decrease gain *increase color scale (60-80) * threshold @ 90% (color scale))
Most common location = ureter adjacent to ureter-renal pelvis junction
What are the clinical symptoms and sonographic features related to obstructive renal disease?
- Causes: stones, strictures, infections, malignancy, BPH (most common)
- Symptoms: Vary with cause, Bilateral obstruction = renal failure
- Pattern: Prominent, anechoic calyces within renal sinus, Viscous urine (fluid/fluid level)
- RI > 0.7 or difference greater than 0.1 compared to unaffected kidney
- Asymmetric or absent jet
What are the clinical symptoms and sonographic patterns related to bladder diverticula?
- Secondary to bladder outlet obstruction
- Symptoms: Dysuria, UTI
- Pattern: Cystic pouches extending from wall, Demonstrate neck of diverticula merging with bladder, Demonstrate jets to r/o obstruction
Most frequnt cause of bladder outlet obstruction:
What are the sonographic features of bladder outlet obstruction?
- Increased WBC or hematuria
- Pattern:Large overextended bladder, Possible sludge, Obtain post void images
What are the clinical symptoms and sonographic patterns associated with cystitis?
- In women>> introduction of rectal bacteria into urethra
- In men>> prostatitis, bladder outlet obstruction
- Pattern: Chronic pattern: diffuse or focal wall thickening; Interstitial: smaller than normal bladder
The SMA is located ______ in relation to the splenic vein.
The splenic vein is located ______ in relation to the body of the pancrea.
The LRV is lovated _____ in relation to the SMA.
The RRA is located ______ posterior to the IVC
The GDA is located ______ in relation to the pancreatic head.
The CBD is located ______ in relation to the pancreatic head.
List the 3 tributaries of the celiac trunk:
Hepatic artery, LGA, splenic artery
The main pancreatic duct is termed ________ and enters the duodenum via the _______.
Duct of Wirsung; sphincter of Odi
Normal pancreatic duct measurement
The accessory pancreatic duct is called ________.
The duct of Santerini
The SMV is located ____ in relation to the uncinate process.
Three vessels that form the MPV
Splenic vein, SMV and IMV
Products secreted via the circulatory system
insulin and glucagon
Portal splenic confluence is located ______ in relation to the neck of the pancreas.
Most frequent cause of acute pancreatitis
Alcoholism/ biliary tract disease
Symptoms and lab values associated with acute pancreatitis:
- Severe epigastric pain, nausea, vomiting, abdominal distention
- Labs: increased serum and urine amylase, increase WBC count, increased BR if obstructed
Pattern of acute vs. chronic pancreatitis:
- Acute: normal in less severe cases; enlarged and hypoechoic due to edema, lt PE, dialated pancreatic duct >2mm
- Chronic: Hyperechoic die to fibrous tissue deposition, small, calcifications, tortuous ducts
Symptoms and labs associated with chronic pancreatitis:
- Mild epigastric pain, back pain, 10% develope diabetes
- Labs: decreased serum and urine amylase
Most common cystic mass of the pancreas
Symptoms and labs associated with pancreatic pseudocyst:
- Pain, fever, ileus (2-3 weeks after episode), nausea, vommiting, palpable mass
- Labs: increased amylase, increased ALP if obstructed
Pseudocyst sonographic pattern:
Unilocular, irregular boarders, 1-10cm, most common location= tail
Most common neoplasm of the pancreas:
Lab values associated with pancreatic cancer:
Increased ALK Phos x4, increased total BR (increased direct BR if obstruction)
Enlarged GB due to neoplasm distal to cystic duct (Pancreatic CA in the head of the panc)
Islet cell tumor
- Most frequent= insulinoma (90% benign)
- Symptoms: hyperglycemia, hyperinsulinemia
- Sonograhic pattern: hypoechoic mass in body/tail with well defined borders