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68 Cards in this Set
- Front
- Back
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What are 8 reasons to order a renal US
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hydronephrosis
hematuria Complicatoin of infection Congenital anomalies Further charaterizing a lesion seen on CT decreased renal funtion renal vein thrombosis RAS |
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What is the test of choice for RAS
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MRA
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Describe the findings on US that distinguish hydronephrosis from a parapelvic cyst (different than extrarenal pelvis and perinephric cyst they are multiple and confluent and typically bilateral. they are likely lypmphatic origin and my compress the pelvis)
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central dilated pelvis that communicates with the infundibular region and the calcyxs
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What are two categories of hydronephrosis
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obstructive Vs functional
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What are the causes of functional hydronephrosis
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DI
pregnancy related VUR |
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How do you determine if hydro is acute or chronic
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the RI (S-D/S) will be greater than 0.7 if it is acute
S= max systolic velocity D= max diastolic velocity |
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How do you measure the RI
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you use doppler and look at the arcuate vessels which are adjacent to calcyx and medullary pyramids
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What do the arcuate vessels branch off of
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the intralobular vessels. The arcuate branch 90 degrees off of the interlobular vessesl and go over the top of the calyxes
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What side has more hydronephrosis in pregnancy
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the right side
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What is a clue that hydronephrosis may be due to VUR
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superior or inferior cortical thinning
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What are the 2 mimics of hydronephrosis
What is focal hydronephrosis |
extrarenal pelvis
parapelvic cyst obstruction of drainage of one portion of the kidney while the rest of the kidney drains normally |
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What is the DDX of the causes of obstruction that lead to focal hydronephrosis
6 |
prior infection (TB)
ischemia infundibular stricture papillary necrosis duplicated collecting system (most common cause--> upper pole) VUR |
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What is focal hyronephrosis sometimes mistaken with
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a parapelvic cyst
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What are two cause a infundibular stricture
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TB, stone
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What is ddx for a simple renal cyst
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AVM (differentiate with color doppler) rare
calyceal diverticulm focally dilated calyx focal hydronephrosis |
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What is a cause of a hydronephrotic sac (focal hydronephrosis) in the superior pole of the kidney
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a hydronephrotic sac of a duplicate collecting systema
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What is the DDX for a complex renal cyst (major categories)
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Hemorrhagic
neoplasm abscess hematoma |
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What 3 neoplastic lesions that may look like a complex cyst on US
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renal cell carcinoma
multilocular cystic nephroma mets |
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If you put a doppler on a cyst and there is flow is hemorrhagic cyst in the ddx
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no
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What is the management apprach for a complex cyst with internal echoes, a few thin septations, small amount of mural or septal calcification
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US f/u at 6/12/24 months
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What is the management if there are thickened walls, multiple or thick septations, extensive calcification, mural or septal nodularity
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CT
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What are the congental causes of multicystic kidneys
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ARPCKD
ADPCKD tuberous sclerosis with AML von hippel landau multicystic dysplastic kidneys |
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What does ARPCKD look like
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big, echogenic kidney with tiny cyst
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What does ADPCKD look like
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multiple big cyst of varing size
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What do the cyst of TS look like
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these are from angiomyolipomas and will have adjacent echogenic masses (fat)
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What do the cyst of van hippel landau look like
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multiple cyst of varying size
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What is the only 2 pathologic aquired cystic disease
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cyst in dialysis patients
RCC with cyst (a solid mass with cystic component |
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What 3 cystic diseases have increased risk of RCC
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VHL
dialysis pts |
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What are 5 renal neoplasms
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oncocytoma
AML RCC TCC lymphoma Mets |
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What are the 2 benign neoplasms of the kidney
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oncocytoma
AML |
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What are 4 main categories of solid renal masses
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Neoplasm
Inflammatory Infections trauma |
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What type of pathology causes a solid mass as a result of trauma
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hematoma may appear solid (note a hematoma has no flow on doppler)
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What are inflammatory/infectious causes of solid renal masses
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lobar nephronia, abscess
XGP, TB |
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If you see a solid renal mass on US what is the next step
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look at the renal vein and intrahepatic IVC for tumor
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What is a solid renal mass until proven otherwise
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a renal cell carcinoma
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What r 3 components of AML
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fat, muscle, vascular tissue
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Are AML benign
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not sure she said increased risk of RCC but also benign
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What does an AML look like on US
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hyperechoic
well defined notched acoustic shadowing sometimes with cyst (especially in TS) |
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What percent of AML have acoustic shadowing
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33%
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What is a concern once an AML becomes greater than 4cm
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they can rupture
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What is the ddx for a hyperechoic renal lesion (2)
What else do both these lesion have in common? |
AML
RCC they both can have cyst but only in AML with cyst |
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What are two findings that may differentiate an AML from RCC
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hypoechoic rim
no shadowing renal cell carcinoma is more likely to have cystic spaces but patients with TS have cystic lesion in addition to AML |
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If you see a hyperechoic mass of the kidney what should be done next
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CT
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What is the DDX for bilateral enlarged kidneys
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leukemia/lymphoma
Mets Multiple myeloma ATN AIN -acute interstitial nephritis amyloidosis AIDS Renal vein thrombosis |
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What is the ddx for medical renal disease (echogenic kidneys)
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glomerulonephritis
diabetes ATN acute interstitial nephritis AIDS nephropathy |
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Are the kidneys of aids nephropathy typically enlarged
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yes
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What is the most likely cause for marked echogenicity of the renal cortex
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cortical nephrocalcinosis
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What is the ddx for cortical nephrocalcinosis (marked echogenicity of the cortex)
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congenital oxalosis
acute cortical necrosis alperts syndrome chronic GN |
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What is alperts syndrome
what is medullary sponge kidney? |
malformations of the skull, face, hands and feet. It is classified as a branchial arch syndrome
Medullary sponge kidney (MSK) is a benign congenital disorder characterized by dilatation of collecting tubules in one or more renal papillae, affecting one or both kidneys |
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What is the ddx of medullary nephrocalcinosis (marked increased echogenicity of the medullary pyramids) in an adult
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medullary sponge sydrome
RTA hyperparathryoidism |
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What is the ddx of medullary nephrocalcinosis (marked increased echogenicity of the medullary pyramids) in an infant
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fourosimide treatment
idiopathic hypercalcemia (williams syndrome) |
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What is the kidney finding of medullary sponge kidney, rta and hyperparathyroidism
What is RTA |
marked increased echogenicity of the medullary pyramids which is from medullary nephrocalcinosis
Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. There are four types. |
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What is the ddx of an echogenic renal foci
6 |
nephrolithiaisis
vascular calcification gas sloughed papilla TCC with calcification disemnated PCP that has been treated with aerosized pentamidine |
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What is a clue that an echogenic foci is a result of a renal stone
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there will be shadowing
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What findings does a pt who has been treated with aerosolized pentamidine for pcp have on US
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diffuse disseminated echogenic foci of the liver and kidney
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Where do kidney stones get stuck
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the UPJ or the UVJ
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Is it helpful for a pt to have a full bladder to evaluate the UVJ obstruction
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yes, it is useful to see the distal ureter
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Do the presence of ureteral jets rule out a stone
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no, only if the ureter is completely obstructed which doesnt occur always
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What is more sensistive for stone; CT or US
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CT without contrast
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What is the most common finding on US for pyelonephritis
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nothing
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What is lobar nephronia
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Acute lobar nephronia (ALN) refers to a renal mass caused by acute focal infection without liquefaction
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What may be the findings on US for pyelo
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variable altered echogenicity
lobar nephronia pyonephrosis abscess emphysematous pyelo |
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What is pyonephrosis
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this is pus within the collecting system
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What does pyonephrosis look like on US
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increased echogenicity within the collecting system
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What must be done if pyonephrosis is found
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it must be drained either percutaneously or via a stent
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What does gas look like on US
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echogenic foci with ring down artifact
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What is a concern if gas is seen within the kidney
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emphysematous pyelo
abscess |
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What percent of pt with emphysematous pyellonephritis are diabetics
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90%
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