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Abdominal Sonography > Urinary Tract > Flashcards

Urinary Tract Flashcards

(111 cards)

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1
Q

Where are the paired kidneys and ureters located?

A

Retroperitoneal lying against the deep muscles of the back

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2
Q

How are the structures located in the hilum of the kidney?

A

Vein exits anteriorly
Artery enters between vein and ureter
Ureter exits posteriorly

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3
Q

Describe the echogenicity of the kidney structures.

A

Renal cortex - isoechoic or hypoechoic
Medullary pyramids - anechoic
Renal sinus - hyperechoic

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4
Q

What is the renal cortex?

A

Outer renal parenchyma from renal sinus to renal capsule (1 cm)

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5
Q

What is the renal medulla?

A

Inner hyperechoic portion of kidney which contains fat, calyces, renal pelvis, CT, renal vessels, and lymphatics

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6
Q

What are the medullary pyramids?

A

Anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus

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7
Q

What is the renal pelvis?

A

Funnel-shaped transition from the major calyces to the ureter

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8
Q

What is the renal hilum?

A

Medial opening for entry/exit of artery, vein and ureter

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9
Q

What are the major calyces?

A

3 extensions for the renal pelvis

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10
Q

What are the minor calyces?

A

Extensions of the major calyces that collects urine from the medullary pyramids

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11
Q

What are the renal papilla?

A

Apex of medullar pyramids

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12
Q

What is Gerota’s fascia?

A

Fibrous sheath enclosing kidney and adrenal glands (perirenal space)

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13
Q

What is a nephron?

A

Functional unit of kidney - renal corpuscle, proximal convoluting tubule, desc and asc limbs of Henle’s loop, distal convoluted tubule, and collecting tubules

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14
Q

What is the renal corpuscle (Malpighian body)

A

Glomerulus and glomerular capsule (Bowman’s capsule)

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15
Q

Describe blood flow from aorta to kidney.

A

Aorta > Main renal artery > 5 Segmental arteries > Interlobar arteries > Arcuate arteries > Interlobular arteries

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16
Q

What are some complications associated with congenital abnormalities?

A

Obstruction and stasis
Impaired renal function
Infection
Calculus formation

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17
Q

What is an ectopic kidney?

A

Kidney that failed to “ascend” into the abdomen and remains in the pelvis

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18
Q

What is the most common fusion anomaly?

A

Horseshoe kidney - lower poles typically connect across midline anterior to the aorta

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19
Q

Where is the horseshoe kidney located?

A

Lower in the abdomen because ascent is prevented by the IMA

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20
Q

What is the difference between a complete and incomplete duplex kidney?

A

2 ureters v 1 ureter

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21
Q

What is a duplex kidney?

A

Duplication of the collecting system

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22
Q

What is a frequent complication of the ectopic ureter in a duplex kidney?

A

It inserts in an ectopic location on the bladder and develops a ureterocele - a prolapse of the distal ureter into the bladder

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23
Q

What is a Column of Bertin?

A

Septal cortex - a normal variation of prominent renal cortical parenchyma located between 2 medullary pyramids

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24
Q

What is bilateral renal agenesis commonly associated with?

A

Oligohydramnios and pulmonary hypoplasia

Incompatible with life

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25
What is unilateral renal agenesis frequently associated with?
Bicornuate uterus in females | Seminal vesicle agenesis in males
26
What is an extrarenal pelvis?
A renal pelvis that lies outside the renal sinus sonographically appearing as a cystic collection medial to the renal hilum
27
What is a common cause of urinary obstruction in the male neonatal patient?
Posterior uretheral valve
28
What are sonographic findings of a posterior urethral valve?
Large bladder Hydroureter Hydronephrosis Urinoma
29
What is the incidence of renal cysts?
50% of people over age 50
30
What are most renal cysts?
Cortical cysts that originate from obstructed uriniferous tubules
31
What are the different types of renal cysts?
Cortical cysts Pylogenic cysts Parapelvic cysts Peripelvic cysts
32
Where are renal cysts located?
Cortical and parenchymal cysts - periphery | Peripelvic cysts - center (renal sinus)
33
What can mimic a simple cyst and is associated with a hx of renal biopsy or trauma?
Renal pseudoaneurysm
34
How can an abscess be differentiated with a hemorrhagic cyst?
Percutaneous aspiration
35
What are characteristics of atypical renal cysts?
Multiple or thick septations Thick calcifications Mural nodule/Solid component
36
What is autosomal dominant polycystic kidney disease?
Bilateral renal enlargement d/t development of numerous cysts of varying sizes
37
What occurs in advanced stages of PCKD?
Renal failure and HTN
38
What are commonly associated with PCKD?
Arterial aneurysms - particularly cerebral artery (Berry) aneurysms of the circle of Willis
39
What is autosomal recessive PCKD?
Multiple small cysts that result from cystic dilation of the collecting tubules secondary to hyperplasia of interstitial portions of the ducts
40
What is autosomal recessive PCKD associated with?
Renal dysfunction Pulmonary hypoplasia Periportal fibrosis Portal HTN
41
What is Potter Syndrome?
Appearance of a neonate as a direct result of oligohydramnios and compression while in utero
42
What are causes of oligohydramnios?
``` B/L renal agenesis AR PCKD AD PCKD Multicystic renal dysplasia Obstructive uropathy Early ROM ```
43
What is the most common cause of an abdominal mass in newborns?
Multicystic dysplastic kidney
44
What is multicystic dysplastic kidney?
Renal dysplasia from multiple noncommunicating cysts with the absence of renal parenchyma from atresia of the UPJ during fetal development
45
What are associated urinary malformations of MDK?
``` Contralateral UPJ obstruction Contralateral renal agenesis or hypoplasia Crossed fused renal ectopia Horseshoe kidney Patent urachus Ureterocele Vesiocureteral reflux ```
46
What causes congenital UPJ obstruction?
Ureteral hypoplasia High insertion of ureter into the renal pelvis Compression by segmental artery
47
What is acquired cystic disease?
Development of multiple cysts in chronically failed kidney during long-term HD
48
What is a medullary sponge kidney?
Congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia
49
How does medullary sponge kidney appear on US?
Hyperechoic medullary pyramids - from Ca++ deposits
50
What is Von Hippel-Lindau disease?
Inherited disease that presents in 2nd-3rd decade of life with serious visual impairment from retinal and CNS hemangioblastomas
51
What is an angiomyolipoma?
Hyperechoic benign renal tumor
52
What is tuberous sclerosis?
Multi-system genetic disease that presents as seizures, MR and facial angiofibromas with increased incidence of renal cysts and angiomyolipomas
53
What is renal cell carcinoma?
Most common solid renal mass in adult - typically unilateral encapsulated mass
54
How does renal cell CA appear on US?
Hypoechoic relative to normal adjacent renal parenchyma
55
How does renal cell CA present?
Hematuria (most common) Flank pain Palpable mass
56
Where is the most common site of distant mets for renal cell CA?
Lung
57
How do renal mets appear on US?
Hypoechoic masses or | Diffusely enlarged inhomogeneous kidney
58
What is a Wilm's tumor?
Nephroblastoma - most common childhood renal tumor
59
How do patient's present with a Wilm's tumor?
``` Age 3-5 Large asymptomatic flank mass HTN Fever Hematuria ```
60
What must a Wilm's tumor be differentiated from?
Adrenal neuroblastoma | Wilm's tumors destroy the renal contour
61
How does acute pyelonephritis appear on US?
Renal enlargement Hypoechoic parenchyma Absence of sinus echoes
62
What is lobar nephronia?
Acute focal bacterial nephritis or focal acute pyelonephritis
63
What is emphysematous pyelonephritis?
Bacterial infxn associated with renal ischemia
64
Which populations are most commonly affected by emphysematous pyelonephritis?
Diabetics Immunosuppressed patients Pts with urinary tract obstructions
65
What is chronic pyelonephritis?
Renal injury induced by recurrent renal infection due to anatomic anomalies, obstruction, ureteral reflux
66
What is xanthogranulomatous pyelonephritis?
Chronic pyelonephritis resulting from chronic infxns due to long term obstruction
67
What are associated findings of xanthogranulomatous pyelonephritis?
``` Renal enlargement Parenchymal abscesses Staghorn calculus Papillary necrosis Hydronephrosis Pyonephrosis Loss of cortical-medullary boundary Cortical thinning ```
68
What is pyonephrosis?
Purulent material in the collection system of the kidney associated with an infxn secondary to renal obstruction
69
What is a mycetoma?
Fungal ball - candidiasis most common
70
What are hyperechoic renal masses?
``` Mycetoma Angiomyolipoma Blood clots Pyogenic debris Sloughed papilla Renal stones ```
71
How is US used to dx cause in AKI?
Hydronephrosis | Abnormal resistive index
72
What is renal vein thrombosis associated with?
``` Extrinsic compression Nephrotic syndrome Renal tumors Renal transplants Trauma ```
73
How does renal vein thrombosis appear on US?
Dilated thrombosed renal vein Absent intrarenal venous flow Enlarged hypoechoic kidney High-resistance renal artery waveform
74
What occurs in renal artery thrombosis?
Sudden cause of prerenal failure Acute flank pain Hematuria Sudden rise in BP
75
How does renal artery thrombosis appear on US?
Focal hypoechoic areas of infarct Absence of intrarenal arterial flow Renal enlargement
76
What is acute tubular necrosis?
Most common cause of AKI from prolonged ischemia or nephrotoxins causing damage to the tubular epithelium of the nephron leading to acute renal failure
77
What is acute glomerulonephritis?
Inflammatory response resulting in glomerular damage caused be infectious (Strep) and noninfectious causes
78
How does acute glomerulonephritis appear on US?
Renal enlargement | Increased resistive index
79
What is evaluated when diagnosing obstructive nephropathy?
Intrarenal vascularity | Threshold resistive index (RI) > 0.7 - obstructive hydronephrosis
80
What are the most common causes of newborn/prenatal hydronephrosis?
Vesicoureteral reflux Non-obstructive hydronephrosis UPJ obstruction
81
What is nephrocalcinosis?
Disorders of Ca++ metabolism resulting in the formation of calcium renal stones and deposition of calcium int he renal parenchyma
82
What is Twinkle Sign?
Color Doppler artifact that appears as a rapidly alternating mixture of red and blue Doppler signals distal to a strongly reflective surface, like a stone.
83
What are different causes of nephrocalcinosis?
Medullary - Primary hyperparathyroidism, RTA, Medullary sponge kidney Cortical - Chronic GN, Renal cortical necrosis, Transplant kidney
84
What is papillary necrosis?
Ischemia of the medullary pyramids
85
What is papillary necrosis associated with?
DM Urinary tract obstruction Analgesic abuse Sickle cell disease
86
What does papillary necrosis look like on US?
Echogenic material in collecting system Triangular cystic collections Bright echoes
87
What is renal sinus lipomatosis?
Increase renal sinus fat that replaces normal renal parenchyma
88
How does renal sinus lipomatosis appear on US?
Increase in central sinus echo complex with cortical thinning
89
How is the urinary bladder connected to the umbilicus?
Median umbilical ligament (urachus)
90
What is a normal bladder wall thickness?
<3 mm when distended
91
What is a bladder diverticula?
Herniations of the bladder mucosa through the bladder wall musculature
92
What is a urachal cyst?
Cystic dilatation of fetal urachus
93
How do the ureters travel in the body?
Exit kidney posterior to renal artery and vein, anterior to psoas, anterior to common iliac vessels to insert upon the trigone of bladder
94
What is a ureterocele?
Cyst-like enlargement of the lower end of the ureter that projects into the bladder lumen
95
What is a transitional cell carcinoma?
Most common bladder neoplasm
96
What type of cells line the urinary tract?
Transitional cells
97
What is the most common clinical presentation of transitional cell carcinoma?
Hematuria
98
What is resistive index commonly used for?
Evaluate renal transplant rejection Assess suspected hydronephrosis Evaluate medical renal disease
99
What does renal dysfunction result in?
Loss of diastolic flow thus increased renal arterial resistance
100
How is RI measured?
RI = (peak systolic freq - end diastolic freq)/ peak systolic freq
101
What are sxs of renal artery stenosis?
Sudden onset of HTN | Uncontrollable HTN
102
What are renal artery stenosis diagnostic criteria?
``` Direct eval (renal artery velocities) = renal artery/aorta ratio (RAR) >3.5 Indirect eval (intrarenal waveform eval) - Parvus Tardus, Absent early systolic peak ```
103
Which kidney is typically harvested and why?
Left kidney for longer renal vein
104
How is US used in renal transplant?
Assess immediate surgical complications Location for renal biopsy Vascular status in acute rejection
105
What are post-transplant complications?
Fluid collections Renal artery kinking or thrombosis Renal vein thrombosis
106
What are sonographic findings of acute transplant rejection?
Renal enlargement (increased length) Decreased kidney echogenicity Loss of cortical medullary boundary Increasing flow resistance (RI)
107
What is crossed fused renal ectopia?
Developing kidneys fuse in pelvis and one kidney ascends to its normal position carrying the other one with it across the midline
108
What is a discoid or pancake kidney?
Fused pelvic kidney
109
What is a Dromedary hump?
Common variant of cortical thickening on lateral aspect of left kidney
110
What is a junctional parenchymal defect?
Triangular hyperechoic area on anterior aspect of upper pole of the right kidney
111
What is fetal lobulation?
Partial fusion of the renunculi

Abdominal Sonography (12 decks)

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