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42 Cards in this Set
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- Back
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10 year old female is sent to hospital for renal ultrasound following a Dr's appointment where she presented with hematuria and unexplained hypertension. Elevated BUN and creatinine show on labs. US revealed bilateral enlarged kidneys with echogenic cortex and medulla and lack of corticomedullary differentiation.
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Autosomal-recessive polycystic kidney disease (ARPKD)- is a rare genetic disorder. There is a dilation of renal collecting tubules which cause renal failure and in later forms there is liver involvement. 4 forms: perinatal, neonatal, infantile, and juvenile. AKA infantile polycystic kidney disease or autosomal recessive polycystic renal disease
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45 year old male sent for routine renal ultrasound, has a history of chronic renal failure and has been on dialysis for 3.5 years. Labs reveal an elevated BUN and creatinine level. US finds the right kidney small- measuring 6cm x 2cm x 3cm with small simple cysts in the cortex and the left kidney measuring 5.8cm x 1.7 x 2.9cm . This patient has an increased risk of Renal cell carcinoma.
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Acquired cystic kidney disease- occurs in patients on renal dialysis for over 3 years. AKA Acquired renal cystic disease
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32 year old female was sent for renal ultrasound after presenting to her physician for hematuria but no other symptoms. A well defined vascular hyperechoic mass with internal calcifications is found in the renal cortex of the kidney measuring 8mm x 7mm x 9mm. Its malignant counterpart is RCC which needed to be determined by a biopsy.
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Renal Adenoma
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86 year old male with lordosis presents to ER with the unnecessary urgency to void. An US is ordered to evaluate the bladder. A thickened bladder wall measured 8mm in distended state. Also found were trabeculae of the bladder wall and the post void scan revealed excessive urinary retention.
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Neurogenic Bladder- a bladder that is poorly functioning secondary to any type of neurological disorder. The detrusor muscle surrounding the bladder is not working properly. Causes incomplete emptying of the bladder which causes urine stasis which leads to bladder inflammation (cystitis).
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28 year old female with a history of a recent MVA presents to Er with flank pain and hematuria. US is ordered and reveals an enlarged heterogeneous right kidney measuring 15cm x 8cm x 5cm. Further investigation shows the absence of doppler signals in the renal vein which appears enlarged also. Sonographer tries to follow renal vein out to IVC but bowel gas obstructs the view.
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Renal Vein Thrombosis- blood clot in renal vein
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42 year old male with uncontrollable hypertension is sent to ER by his primary care physician. Patient also complains of headaches, tremors, anxiety, and excessive sweating. US is ordered and a large hyperechoic mass superior to the right kidney is found.
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Pheochromocytomas- benign adrenal mass that causes uncontrollable hypertension. Arises from the adrenal medulla and secretes epinephrine and nor epinephrine in excessive quantities.
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An African-American, HIV positive man came to the emergency room who was short of breath and had painful erythematous cutaneous lesions on his upper trunk, face, and inside his mouth. These lesions were caused by the human herpes virus 8, which is a viral cause for cancer that affects cells in the lymph vessels and blood vessels. His doctor informed him that he now had AIDS.
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Kaposi Sarcoma (5 types)....... "AIDS defining illness"
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A middle aged man comes in for a routine ultrasound for his liver when an anechoic, well-defined, round structure that has posterior acoustic enhancement is seen in his right renal sinus. He is asymptomatic and his labs are normal. The sonographer thinks this might represent a mild hydronephresis within the renal sinus. Using color flow on the bladder, urinary jets are visualized on the left and right sides.
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Parapelvic cyst
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Clinical: 30 year old female with severe flank pain, chills and fever with a history of recurrent acute urinary tract infections caused by susceptibility for renal calculi was referred for a renal ultrasound by her primary care physician.
Ultrasound: An atrophied right kidney with a thin cortex was observed. Additionally, renal echogenicity is increased in a patchy pattern and the corticomedullary differentiation is lost. AKA: Reflux Nephropathy Treatment: Long Term Antibiotic Treatment |
CHRONIC PYELONEPHRITIS
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Clinical: A 52 year old male with uncontrolled diabetes presented to the E.R. with flank pain, nausea, and fever.
Ultrasound: Ultrasound revealed an enlarged kidney that demonstrated high-amplitude, nondependent echoes with ‘dirty shadows’ within the renal parenchyma and collecting system. Treatment: Percutaneous drainage with antibiotics Note: life-threatening necrotizing infection of the kidneys |
EMPHYSEMATOUS PYELONEPHRITIS
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Clinical: A 57 year old female with recurrent UTIs was referred for ultrasound by her family doctor based on urinalysis.
Labs: Hematuria and Pyuria Ultrasound: Renal ultrasound revealed an echogenic, enlarged kidney with a Staghorn calculus and dilated calyces. Treatment: Partial or Total Nephrectomy Note unusual form of chronic Pyelonephritis characterized by infection that ultimately results in focal or diffuse renal destruction |
XANTHROGRANULOMATOUS PYELONEPHRITIS
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Clinical: A 55 year old female was referred for a renal ultrasound by her doctor after presenting with hematuria, dysuria and urinary urgency.
Ultrasound: Bladder wall thickening along with multiple polypoid, vascular, solid masses within the bladder lumen were identified on ultrasound. Treatment: Antibiotics Note: Chronic inflammation of the bladder; Greek word meaning ‘soft plaque’ |
MALACOPLAKIA
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Clinical: A 27 year old female with muscle weakness, hypertension, excessive thirst and excessive urination was referred for a renal ultrasound by her physician.
Labs: elevated sodium; low potassium levels Ultrasound: A 1.5 cm. cortical adenoma was identified on the left adrenal gland. Treatment: surgical removal of adenoma AKA: aldosteronism; APA (aldosterone producing adenoma) |
CONN’S SYNDROME
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Clinical: A 55 year old male with hematuria was referred for an ultrasound after his yearly physical.
Labs: elevated BUN and Creatinine; proteinuria Ultrasound: Bilateral enlarged kidneys with very high echogenicity and an increased Renal Resistive Index (> .7 - .8) were observed. Treatment: chemotherapy and steroids Note: rare condition where proteins are deposited in organs or tissues: biopsy necessary to differentiate from cancer |
AMYLOIDOSIS
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40 year old pregnant female presents to the ER complaining of severe abdomen pain and hematuria. After refusing an abdominal CT due to radiation exposure to her baby, an Ultrasound is ordered. US reveals an echogenic focus with posterior shadowing. This measures 8 mm. The “twinkie sign” is seen when Color Doppler is used
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Nephrolithiasis
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67 year old male with a history of polycystic kidney disease presents to the ER with hematuria. Labs reveal an increased BUN/CREATININE and elevated BP. Ultrasound demonstrates normal kidneys at first, but the sonographer does note that they appear more echogenic than normal. Otherwise, the abdomen US is normal
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Acute Renal Failure
*MCC of ARF is Acute Tubular Necrosis |
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38 year old female presents with RUQ pain. Gallstones are seen on US. Incidentally there is a 3 x 4 cm round, anechoic nodule in the upper pole of the right kidney. This demonstrates posterior acoustic enhancement and is avascular.
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Simple Renal Cyst
*MC benign renal mass |
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A 6 year old comes in with symptoms of a urinary tract infection. Renal US reveals an anechoic, balloon-like structure within the lumen of the urinary bladder near the ureterovesicular junction.
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Ureterocele
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An asymptomatic 33 year old male comes in for a routine renal US. He has recently been diagnosed with Cushing Syndrome. Sonography reveals a solid, hypoechoic mass measuring 3 cm in the area of the adrenal gland. A CT confirms that this mass is arising from the adrenal gland and not from the liver or kidney. Biopsy reveals this is benign.
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Adrenal Adenoma
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An 87 year old male with Alzheimer’s comes in for hematuria. He cannot hold still for a CT so an Ultrasound is ordered. US reveals a 10 mm echogenic structure with posterior acoustic shadowing in the left ureterovesicular junction, near the bladder. Bilateral hydronephrosis is also present.
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Urolithiasis in the Bladder
*UVJ is the MC location for a stone to be lodged |
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Case 3
A 45 year old woman with a history of hyperthyroidism and hypercalcemia came to the emergancy room complaining of flank pain. Her labs were abnormal and on ultrasound small calculi in the renal cortex were documented. |
Cortical Nephrocalcinosis.... caused by hypercalcemia, hyperthyroidism, AIDS, and malignancies
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Case 4
A 50 year old male with a history of urinary calculi came to the emergancy room with with a fever and signs of infection. On ultrasound the renal pyramids were highly echogenic and cast shadows. His labs were elevated and his doctor reported calcium in abnormally dilated collecting ducts. |
Medullary Sponge Kidney
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A 47 year old women came to the emergency room with a fever, flank pain, painful urination, and leukocytosis. Ultrasound showed a complex mass on her left kidney that produced dirty shadows. It appeared to be a collection of purulent material that had leaked out of the renal capsule.
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Renal Abscess AKA Perinephric Abscess
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A 37 year old diabetic women went to her primary care doctor complaining of a urinary tract infection, fever, chills, and flank pain. Ultrasound showed multiple round, mobile, non-shadowing structures in the collecting system. Her doctor stated she had the most common type called candida albicans.
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Fungal Infection
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A 56 year old woman came for a renal ultrasound to rule out hydronephrosis. An incidental finding included a round structure with well-defined walls and posterior acoustic enhancement that was superior to the upper pole of the right kidney. She had no other symptoms and her labs were all normal.
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Adrenal Cysts
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A 78 year old patient came in for a routine renal ultrasound. Labs were normal. The left kidney appeared normal. The right kidney had dilated calices. The full urinary bladder was normal. Post void, the right kidney appeared normal with no sign of the previous dilation. This pathology is also known as pyelocaliectasis.
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Hydronephrosis
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A 53 year old female comes in for a vascular abdomen ultrasound. The patient is a diabetic smoker with hypertension that does not respond to treatment. Labs show elevated renin and aldosterone. Bilaterally the renal arteries are not seen due to bowel gas. The waveforms attained from the right kidney are normal. The waveform taken of the left interlobar artery shows a Tardus Parvus wave. A CT is ordered and shows calcification of the left renal artery
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Renal artery stenosis
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A female patient goes to see a nephrologist with complaints of flank pain, urinary frequency and dysuria. Her urine sample shows signs of bacteruria, hematuria, and proteinuria. Sonographically her kidneys seem enlarged.
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Acute pyelonephritis
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A 34 year old patient comes to the ER with complaints of fever, hypertension, and a recent throat infection. A urine sample shows hematuria, proteinuria, and smoky urine. Ultrasound bilateral enlarged kidneys with prominent renal pyramids.
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Acute glomerulonephritis
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A renal ultrasound is ordered for a patient who is in the ER for fever, flank pain, leukocytosis, bacteruria, and pyuria. The ultrasound shows hydronephrosis in the left kidney. On closer inspection low-level echoes are seen within the dilated renal pelvis
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Pyonephrosis
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A neonate, born premature, is sent for an abdominal ultrasound for a sudden drop in hematocrit and blood pressure. Ultrasound shows an echogenic mass superior to the right kidney. Both kidneys and the left adrenal gland are normal. This mass is harmless and will resolve on its own.
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Adrenal hemorrhage
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A 34 year old female comes in for a scheduled abdominal ultrasound, for abdomen pain. While examining the spleen several cysts of varying sizes were seen in the renal fossa. On further examination no normal renal tissue was seen and the right kidney was enlarged.
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Multicystic Dysplastic Kidney disease. AKA multicystic renal dysplasia or multicystic dysplasic renal disease. Thought to be caused by an early first trimester obstruction of the ureter. If bilateral it is fatal.
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A renal ultrasound was ordered for a 29 year old male after having a head CT. The CT revealed multiple small retinal and CNS hemangioblastomas. Ultrasound showed a large complex cyst on the right kidney that contained mural nodules. Also a large, hyperechoic mass in the area of the left adrenal gland was seen and diagnosed as a pheochromocytoma.
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Von hippel lindau syndrome. An inherited disorder characterized by tumors of the CNS and orbits, and potential for malignant transformation in multiple organ systems.
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A 6 week old female infant is admitted to the hospital with persistent vomiting, jaundice and abd. distension. An abdominal ultrasound is ordered by the physician. The ultrasound reveals hepatosplenomegaly and bilateral calcification of the adrenal glands. The prognosis is not good with only 2 to 5 months to live.
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Wolman's disease. rare inherited condition involving the breakdown and use of fats and cholesterol in the body. In affected individuals harmful amounts of lipids accumulate in the spleen, liver, bone marrow, small intestine, adrenals and lymph nodes. Calcium deposits in the adrenals as well.
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A RUQ ultrasound was order for a 45 year old female for RUQ tenderness and nausea. The ultrasound revealed gallstones, and there was an incidental finding of a well-circumscribed echogenic mass in the upper pole of the right kidney. It measured 3 cm X 2cm X 3cm
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Renal lipoma benign fatty tumor. MC in women
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A 43 year old male comes in for a scheduled abd. complete ultrasound. He has a history of tuberous sclerosis. The ultrasound reveals multiple, bilateral renal masses. The masses are solid and echogenic, a few have shadowing.
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Angiomyolipoma, common benign renal tumor that consists of a network of blood vessels, muscle, and fat. AKA renal hamartoma. generally unilateral and asymptomatic, but patients with tuberous sclerosis tend to have multiple ones bilaterally. 20-30% shadow secondary to its high fat component
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A 28 year old female comes in for an OB ultrasound at 30 weeks gestation as a follow up to an exam done at 28 weeks gestation. On the prior exam the bladder of the male fetus was enlarged and was not seen to empty during the 30 minute exam. The ultrasound today reveals bilateral hydronephrosis, and dilated ureters. The bladder is still distended and part of the urethra is seen as well (key hole sign)
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Posterior urethral valve
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63-yr-old male referred for routine ultrasound. Sonogram revealed a small hypoechoic solid mass in the right kidney. The mass had a central scar and a “spokewheel” pattern with color assessment. A biopsy was ordered.
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ONCOCYTOMA
Benign; Asymptomatic, but can have hematuria; Not always a central scar in the tumor Differential: RCC (even if central scar is present, RCC can also have a central scar. Biopsy is only way to determine |
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47-year-old male, chronic smoker, presents with a history of intermittent pain in the right abdomen, hematuria for the past month, and irregular episodes of fever and chills. On physical exam, tenderness and a palpable mass were found in the right abdomen. Blood tests were all within normal limits. Urine test, however, showed albumin and large amounts of pus and blood. Ultrasound examination showed 2 staghorn calculi in the right kidney with moderate hydronephrosis and a thin cortex. A 4 x 3 cm mass was identified in the renal pelvis area.
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RENAL SQUAMOUS CELL CARCINOMA
Usually late stage or metastasized by the time of finding MC in urinary bladder and male urethra, rarely in renal pelvis |
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72-year-old male sent for renal ultrasound after experiencing painless hematuria. Ultrasound showed a hypoechoic solid mass in the bladder rising from the bladder wall. Vascularity was present in the tumor.
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TRANSITIONAL CELL CARCINOMA
MC bladder tumor, but can also occur in renal sinus of kidneys usually not detected until advanced stage |
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A 4-year-old male was taken to his pediatrician with complaints of RUQP and bone pain. Physician found a palpable mass in right abdomen and referred him for ultrasound. Ultrasound showed a large hypoechoic solid mass with large calcifications occupying the right abdominal area. Origin seemed to be superior to right kidney, although tumor was encroaching on right kidney and surrounding nearby vessels. No mets were found in liver at this time.
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NEUROBLASTOMA
MC pediatric tumor |
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40-year-old female presented with similar symptoms to those associated with Cushing Syndrome (those of a hyper functioning adrenal), and was referred for abdominal ultrasound. A small hypoechoic mass with echogenic capsule was identified superior to the right kidney. It was homogeneous and isoechoic to renal cortex, and demonstrated lobulated borders. The tumor displayed calcifications and was well-vascularized.
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ADRENOCORTICAL CANCER
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