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120 Cards in this Set
- Front
- Back
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The kidneys normally measure ___ cm in length, ___ cm anterior posterior, and ___ cm in width.
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11 cm in length (9-13)
2-3 cm AP 4-5 cm in width |
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Are the kidneys intraperitoneal or retroperitoneal?
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retroperitoneal
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Which kidney is typically higher and longer?
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left
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Which kidney is typically positioned lower?
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right, due to the liver
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What is the outer layer of fascia surrounding the kidney?
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Gerota's fascia
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What lies between Gerota's fascia and the true fibrous renal capsule?
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perinephric fat is in the middle
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The renal parenchyma is divided into 2 parts. What are they?
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cortex and medulla
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What 2 things are found in the cortex?
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Glomeruli and renal corpuscles
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How does the echogenecity of the cortex compare to the pyramids?
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The cortex is slightly more echogenic than the pyramids
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What 3 things are found in the medulla?
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pyramids
loops of Henle collecting tubules Netter 334 |
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What is found in the renal sinus?
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major and minor calyces, renal pelvis
vessels, fat, nerves, lymphatics |
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What enters and leaves the kidney at the renal hilum?
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veins, arteries, ureters, lymph vessels, and sympathetic fibers
Netter 334 |
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Where do the renal arteris branch off from the aorta?
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just below the SMA
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Does the right renal artery travel in front of or behind the IVC?
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behind
Netter 332 |
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Does the left renal vein travel in front of or behind the aorta? What is it's path?
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in front. it passes just under the SMA
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How does the renal artery divide once in the renal pelvis?
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renal artery > segmental artery > interlobar arteries > arcuate arteries
Netter 335 |
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What are 5 functions of the kidneys?
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secretion of urine
storage of urine removal of waste products regulation of blood pressure control of blood concentration |
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What are the 4 layers of the bladder?
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inner mucosa, submucosa, detrusor muscle, outer serosa
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Where do the ureters enter the bladder?
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posteriorly, in the superolateral trigone area through 1-way valves
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Where does the urethra exit the bladder?
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at the base of the bladder. it can be seen in women as an indentation at the bladder base and in men through the perineum.
Netter 366 |
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Normal Variants: What is a dromedary hump?
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a bulge on the lateral portion of the left kidney that has a normal vascular flow pattern and the same echogenicity and composition as the remainder of the cortex.
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Normal Variants: What are Columns of Bertin?
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double layers of cortex located between the pyramids, in the middle third of the kidney. They may contain a renal pyramid.
Middleton 105 Fig 5-4 |
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Normal Variants: What is persistent fetal lobulation?
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It can persist into adulthood and appears as a smoothly lobulated outline to the kidney
Middleton 105 Fig 5-3 |
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Normal Variants: What is a junctional parenchymal defect?
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a hyperechoic, wedge-shaped area on the anterior aspect of the kidney relating to the incomplete fusion of the two embryological components of the kidney, located in the upper and middle thirds
Middleton 104 Fig 5-2 |
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Normal Variants: What is extrarenal pelvis dilation?
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dilation of the extrarenal component of the renal pelvis only. It can simulate hydronephrosis, but the infundibulum and calyces are unaffected
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Normal Variants: What is the sonographic appearance of duplication of the collecting system?
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two separate areas of sinus echoes are present within an elongated kidney with a band of cortical tissue separating them
Middleton 105 Fig 5-5 |
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What percentage of the population has multiple renal arteries?
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25%
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T/F In a renal transplant patient, the collecting system can be slightly distended at baseline.
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True
Middleton 104 Fig 5-1 |
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What is the sonographic appearance of horseshoe kidney?
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A thick band of renal tissue extending from both lower poles and connects anterior to the aorta below the level of the IMA. On an aorta scan, appears as an oval hypoechoic mass anterior to the aorta.
Middleton 106 Fig 5-6 |
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What should you do if you see renal agenesis?
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Look for other anomalies in the GU tract such as duplication of the uterus and anomalies of the seminal vesicles and vas deferens.
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If you are going to scan the kidneys in a position other than supine, which would you pick?
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Decubitus, and maybe a bolster under the flank touching the bed. Full inspiration can help.
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Is it better to scan the bladder empty or full?
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full
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What approaches for scanning the bladder might be helpful for visualizing distal urethral calculi or masses in the anterior bladder wall?
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endovaginal or transrectal
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What is urinary pH used for?
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To determine the cause of stone formation
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What are some causes of low specific gravity? (poor ability to concentrate urine)
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renal failure and pyelonephritis
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What are some causes of proteinuria or albuminuria?
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benign and malignant neoplasms
urinary calculi infection nephrotic syndrome pyelonephritis |
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What are some causes of elevated BUN?
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renal failure
parenchymal disease obstructive uropathy dehydration hemorrhage |
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What are some causes of decreased BUN?
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overhydration
pregnancy liver failure |
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What are some indications for scanning the urinary system?
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renal failure
hematuria possible renal mass UTI pain in the region of the kidneys or bladder renal trauma possible congenital anomaly family history of PCKD post-renal transplant assessment prior to renal transplant donation |
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What are some causes of renal parenchymal disease?
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acute or chronic glomerulonephritis
diabetes lupus and sclerodermatous nephritis nephrotic syndrome heroin-induced nephropathy acute tubular necrosis leukemia chronic renal vein thrombosis amyloidosis |
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What is the most common benign renal neoplasm?
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Angiomyolipoma
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What does an angiomyolipoma consist of?
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vessels, muscle, fat (as the name implies)
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In what demographic do angiomyolipomas most commonly occur?
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middle-aged women
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What is a rare complication of angiomyolipomas if they exceed 4cm?
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bleeding
Middleton 128 Fig 5-39E |
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What is the sonographic appearance of an angiomyolipoma?
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homogenious, well-defined cortical mass
Middleton 128 Fig 5-39 |
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10% of RCC can appear like an angiomyolipoma. What can help to differentiate them?
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20-30% of angiomyolipomas will have some degree of shadowing. If the absence of shadowing, in a mass >1cm, MRI or CT should be obtained to further evaluate for fat. If fat is not present, then RCC is a strong consideration.
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What is a benign renal mass that can occur in infants and is solid +/- cystic areas?
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Mesoblastic nephroma
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What is the most common solid renal mass in adults?
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Renal cell carcinoma
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RCC constitutes about ___% of primary renal malignancies.
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90%
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What are risk factors for RCC?
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smoking
von Hippel-Lindau syndrome long-term dialysis Male:femals 2:1 advanced age |
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What are clinical features of RCC?
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hematuria in 60%
anemia weight loss fatigue flank pain |
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What are the sonographic features of RCC?
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unilateral focal mass
hyperechoic or isoechoic (rarely hypoechoic) may have cysts or calcifications Middleton 118-121 |
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Where should you look for tumor invasion if suspected RCC is present
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IVC and main renal vein
Middleton 122-123 |
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Where does RCC metastisize?
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local LNs
lungs bone liver |
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A solid renal mass in an adult is RCC until proven otherwise. How can you document the presence of fat in the mass and therefore prove that it is not RCC?
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CT or MRI
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Is RCC generally a vascular or hypovascular tumor?
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vascular, however lack of Doppler enhancement does not r/o RCC
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You see a solid, hyperechoic mass in the kidney. It has some cysts. Is this more likely to be an angiomyolipoma or RCC?
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RCC. Angiomyolipomas don't have cysts, but RCC can have cysts.
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Does vascular invasion by RCC affect prognosis?
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No, but it will change the surgical approach
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What is a variant of RCC that is seen in sickle cell trait pts?
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Medullary renal cancer
It is seen at an earlier age, is more agressive, and more commonly presents with metastasis. Middleton 123 Fig 5-32 |
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What can commonly be confused with RCC?
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angiomyolipoma
Columns of Bertin Residual functioning renal parenchyma near an atrophic kidney Middleton 124 Fig 5-33 |
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DDx of a solid renal mass
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RCC
angiomyolipoma Column of Bertin focal renal hypertrophy transitional cell carcinoma oncocytoma lymphoma metastasis juxtaglomerular cell tumor focal pyelonephritis |
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Describe oncocytoma
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5% of renal neoplasms
look like RCC may be benign or malignant |
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Why is percutaneous needle biopsy of suspected RCC rarely indicated?
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A negative biopsy does not r/o RCC and is unlikely to influence the need for surgical management
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Is von Hippel-Lindau syndrome autosomal dominant or autosomal recessive?
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Autosomal dominant
It is associated with a greatly increased risk of RCC (75% of those with renal involvement get RCC) |
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What are the clinical features of von Hipple-Lindau syndrome?
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retinal angiomas
pancreatic cystic neoplasms cerebral aneurysm or CNS hemangioma pheochromocytoma RCC (75%) Middleton 116 Fig 5-20 cysts do not cause renal failure or HTN |
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Where does transitional cell carcinoma originate?
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It is a urothelial tumor that usually originates in the urinary bladder
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How are most TCCs detected?
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IV urography or retrograde pyelography, because most are too small to be detected by US
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What is the sonographic appearance of TCC?
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nonspecific solid mass centered in the renal sinus
Middleton 124 Fig 5-34 |
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What is a common pitfall that can be mistaken for TCC as a filling defect in the renal calicies?
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When hydronephrosis is present, the renal papillae can appear as filling defects in the calicies. They are differentiated from TCC because they appear in all the calicies but TCC will be more focal.
Middleton 125 Fig 5-36 Netter 334 |
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What are 2 other entities commonly mistaken for TCC?
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peripelvic cyst
sinus lipomatosis |
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Where do metastases to the kidney commonly originate?
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lungs, breast, colon
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Is most metastatic disease to the kidneys detected during life or at autopsy?
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autopsy
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Does lymphoma spread to the kidneys early or late in the course of disease?
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late
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What is the sonographic appearance of renal lymphoma?
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bilateral
enlarged kidneys with multiple hypoechoic areas Middleton 126 Fig 5-37 |
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What is the most common demographic for Wilms' tumor (nephroblastoma)?
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boys 3-5yrs
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What is the clinical presentation of Wilms' tumor?
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palpable mass
hypertension pain weight loss |
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What are the sonographic findings of Wilms' tumor?
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large mass with even, high-level echogenicity
cysts spaces represent areas of necrosis 10% bilateral metastasizes to LNs, lungs, liver, bone |
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What is the most common renal mass?
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Renal cysts
50% of people over age 50 have them |
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What are the typical charactericis of cysts?
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round or oval shape
smooth walls no internal echoes well-defined back walls acoustic enhancement Middleton 111 Fig 5-13 |
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How many benign cysts are considered normal in a kidney?
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1-5
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Thin septations are seen in 5% of benign cysts. Thick septations should make you suspicious of what?
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cystic neoplasm
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5% of renal cysts have intraluminal hemorrhage. What is the sonographic appearance?
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low-level echos
fibrinous membranes internal echogenic clots fluid-debris level (appearance can overlap with RCC) Middleton 111 Fig 5-14 |
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A thin, curvilinear, peripheral caclification should/should not raise the suspicion of carcinoma. A thick, globular calcification does/does not indicate an underlying malignancy.
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should not
does |
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What is a milk of calcium cyst?
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crystalline material that accumulates in a cyst and may layer
Middleton 112 Fig 5-15 |
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It is a good idea to evaluate complex cysts with ___ to ensure that you are not looking at an AVM.
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Doppler
Middleton 112 Fig 5-16 |
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What is the origin of a peripelvic cyst
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lymphatic origin
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Is a peripelvic cyst a true cyst?
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no
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Why are peripelvic cysts important?
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They can be confused with hydronephrosis
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What is the sonographic appearance of a peripelvic cyst?
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irregular in shape and outline
located in the renal hilum do not communicate with the collecting system Middleton 113 Fig 5-17 |
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What leads to acquired cystic disease?
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Being on dialysis for >3 yrs
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What is the sonographic appearance of acquired cystic disease?
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multiple cysts in a kidney that is normal sized to slightly enlarged
Middleton 115 Fig 5-19 |
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What is a common complication of acquired cystic disease?
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cyst hemorrhage
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Solid renal nelplasms occur in ___% of patients with acquired cystic disease, but most are small and exhibit benign behavior.
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7%
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Tuberous sclerosis is an AD/AR disease?
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autosomal dominant
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What are the clinical features of someone with Tuberous Sclerosis?
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mental retardation
seizures skin lesions |
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What is the most common renal finding in Tuberous Sclerosis?
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95% have angiomyolipomas
renal cysts Middleton 117 Fig 5-21 |
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What is the most common clinical feature of Autosomal Dominant Polycystic Kidney Disease (PCKD)?
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hypertension
renal failure |
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What is the formula for determining post-void residual bladder volume?
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L x W x H x 0.53
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What is the most common cause of bladder wall thickening?
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bladder outlet obstruction
other causes: neurogenic bladder, cystitis, edema from adjacent inflammatory process, radiation, neoplasm |
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Bladder wall thickening will vary with the degree of distension. Normal bladder wall thickness for a nondistended bladder is ___mm and for a distended bladder is ___mm.
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nondistended = 5mm
distended = 3mm Middleton 176 Fig 6-39 |
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TCC causes ___% of bladder tumors
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90% are transitional cell carcinoma
5% are squamous cell and 2% are adenocarcinoma |
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What are risk factors for TCC of the bladder?
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smoking, analgesic abuse, industrial carcinogen exposure
middle-aged male |
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What is the sonographic appearance of TCC?
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located on the posterior wall in the region of the trigone
polypoid and extending into the bladder lumen less commonly infiltrative into the bladder wall Middleton 176 Fig 6-40 |
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What is the primary Ddx for bladder cancer?
How can it be distinguished? |
blood clot
blood clot is mobile and does not light up with Doppler Middleton 177 Fig 6-41 |
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What is the sonographic appearance of bladder stones?
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hyperechoic, shadowing and mobile
Middleton 178 Fig 6-42 |
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How can you distinguish a BPH mass in the bladder from TCC?
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it is located in the midline and continuous with the prostate
both are vascular on Doppler Middleton 178 Fig 6-43 |
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What is the sonographic appearance of bladder diverticula?
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A fluid-silled structure adjacent to the bladder.
They usually occur due to outlet obstruction and often coexist with a thick bladder wall If a connection between the bladder and diverticulum cannot be seen, compression of the bladder may demonstrate urine flow between the 2 structures on Doppler. Urine jets may be demonstrated Middleton 178 Fig 6-44 |
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Urinary statis in a diverticulum predisposes to ___ (3 things), so scan carefully.
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infection, stones, cancer
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What is the sonographic appearance of a urachal diverticulum or cyst?
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a cyst anterior to the bladder.
Middleton 179 Fig 6-45 |
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What neoplasms are adjacent to the bladder and could invade directly, mimicking TCC?
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rectum
prostate cervix uterus |
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What is the etiology of a urachal diverticulum or cyst?
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incomplete closure of the urachus
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What is the sonographic appearance of a ureterocele?
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dilatation of the intramural portion of the distal ureter protruding into the bladder lumen
located at the expected location of the ureteral orifice formed by mild stenosis of the ureteral orifice round, thin-walled, cystic structures on the posterior wall of the bladder ureteral jets may be seen change size as they fill and empty Middleton 180 Fig 6-46 |
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What is the sonographic appearance of the female urethra? What view would you use to visualize it?
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transvaginal and transperitoneal scan
hypoechoic linear structure arising from the base of the bladder and passing inferior to the symphysis pubis Middleton 180 Fig 6-47 |
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What is the sonographic appearance of a urethral diverticula in a female?
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usually arise from the mid urethra
usually extend posteriorly may wrap around one or both sides of the urethra Middleton 181 Fig 6-48 |
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What is the sonographic appearance of a periurethral absecss?
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more remote than a urethral diverticula
usually associated with a hyperemic inflammatory reaction Middleton 181 Fig 6-49 |
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What procedure is done when evaluating for a urethral stricture in a man?
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inject the urethra with saline or viscous lidocaine
Middleton 182 Fig 6-50 |
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Ultrasound evaluation of the penis for erectile dysfunction evaluates blood flow patterns after ___ or ___ injection into the corpora cavernosa, causing increased arterial flow.
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papaverine
prostaglandin E |
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Erectile Dysfunction evaluation:
Arterial velocities exceeding ___ cm/sec is considered normal. Less than ___ cm/sec is abnormal. |
>35 cm/sec = normal
<25 cm/sec = abnormal (arterial insufficiency) 25-35 cm/sec = indeterminate |
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Erectile Dysfunction evaluation:
T/F Diastolic flow reversal indicates intact venous outflow mechanism. |
true
The arterial resistive index is used to measure this Middleton 182 Fig 6-51 |
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What is the sonographic appearance of Peyronie's disease?
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calcification of the tunica albuginea, along the dorsum of the penis
Middleton 183 Fig 6-52 |
