CH 10 Pediatric Renal and Adrenal Flashcards
(109 cards)
1
Q
Kidneys
A
excretory organs that maintain the body’s chemical equilibrium through the excretion of urine. Kidneys originate in the pelvis and ascend into the upper abdomen. the ureters carry urine to the bladder and the urine is then excreted through the urethra.
urinary and genital systems are closely related, if anomalies are found in the genital system, check the kidneys and vice versa.
2
Q
Functions of the urinary system:
A
detoxification
blood pressure regulation
maintenance of the correct balance of PH, minerals, iron, and salt levels in the blood.
3
Q
Kidney location
A
kidneys and ureters are paired structures lying deep to the muscles of the back and are retroperitoneal. The right kidney is inferior to the left kidney due to the liver
4
Q
Adrenals location:
A
paired structures, superior to the kidneys and the diaphragm, psoas muscles and quadratus lumborum muscles are posterior aspect to the kidneys.
5
Q
renal parenchyma
A
consists of a cortex and medulla. The cortex is the outer portion from the renal sinus to the renal capsule. The medulla is the inner portion from the base of the pyramids to the center of the kidney. The renal pyramids are situated in the medulla, and are prominent in the neonate and pediatric patient. The renal sinus contains blood vessels, fat and lymph channels. The fibrous covering of the kidneys is called Gerota’s fascia
6
Q
Functional unit of the kidney:
A
Nephron. contains the renal corpuscle, proximal and distal convoluted tubule, descending and ascending limbs of the loop of Henle and the collecting tubules.
The renal corpuscle (malpighian body) consists of Bowman’s capsule and the glomerulus (knot of capillaries)
7
Q
Urinary bladder appearance
A
should appear anechoic and squared due to its relationship with the psoas muscles. The walls should be smooth and appear as a hyperechoic line when distened.
8
Q
Blood flow into kidney
A
Main renal artery > segmental arteries > Interlobar arteries > Arcuate arteries > Interlobular arteries
9
Q
Renal size in pediatric patients
A
0-12 months = median length 5 - 6.5 cm (+/- 1cm)
1 yr- 15 yrs = median length 6.5 - 11cm (+/- 1.75cm)
10
Q
Normal renal appearance:
A
premature infant= prominent cortex more echogenic than liver
Term infant = sinus echoes ot prominent due to lac of fat, renal cortex equals liver echogenicity, larger prominent medullary pyramids “chocolate chip cookie”
Young child = renal cortex is slightly less echogenic than liver and renal sinus central fat begins to develop.
Older child = normal cortex, hypoechoic pyramids and echogenic renal sinus
Teenager = normal renal echogenicity (same as adult)
11
Q
Renal agenesis
A
Bilateral renal agenesis, associated with Potter’s syndrome, also associated with oligohydramnios and pulmonary hypoplasia. Incompatible with life.
Unilateral renal agenesis may be an isolated congenital malformation or may be associated with chromosomal abnormalities.
Renal agenesis is more common in males.
12
Q
Renal agenesis associated abnormalities:
A
renal and urinary/genital abnormalities go together.
Bicornuate or didelphys uteri in females seminal vesicle agenesis in males congenital cardiac malformations VACTERL sydrome V-vertebral defects A-anal atresia C- cardovascular anomalies TE- tracheoesophgeal fistula R- renal anomalies L- limb defects MURS syndrome MU- mullerian agenesis R- renal agenesis CS- crvicothroracic somite abnormalities
13
Q
VACTERL sydrome
A
V-vertebral defects A-anal atresia C- cardovascular anomalies TE- tracheoesophgeal fistula R- renal anomalies L- limb defects
14
Q
MURS syndrome
A
MU- mullerian agenesis
R- renal agenesis
CS- crvicothroracic somite abnormalities
15
Q
Ectopic Kidneys:
A
one or both kidneys are in an abnormal position. The most common place for and ectopic kidney is the pelvis (pelvic kidney)
16
Q
Horseshoe kidney
A
The *lower poles of the kidney are fused.
The normal ascent of the kidney is prevented by the IMA. *There is a higher incidence of this anomaly in Turner’s syndrome. Horseshoe kidneys are the most common fusion anomaly.
17
Q
Crossed fused renal ectopia
A
Developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carrying the other one with it. More commonly the left is ectopic
18
Q
Crossed fused renal ectopia sonographically:
A
2 kidneys are visualized on one side of the abdomen with absence of a contra-lateral kidney.
The ureters connect on both sides of the bladder. There is an increase risk of VUR (vesicular ureteral reflux) with this anomaly.
*most commonly associated with VACTERL syndrome
19
Q
Dromedary Hump
A
- common variant of focal bulging on the lateral aspect of the left kidney due to splenic impression onto the superolateral left kidney.
20
Q
Junctionla parenchymal defect
A
extension of sinus fat into the cortex.
sono: triangular hyperechic area on the anterior aspect of the upper pole of the right kidney.
21
Q
Persistent fetal lobulation
A
normal variant seen occasionally in adult kidneys. Occurs when there is incomplete fusion of the developing renal lobules.
Embryologically, the kidneys originate as distinct lobules that fuse as they develop and grow.
Often seen as smooth indentations of the renal outline in between the renal pyramids.
22
Q
Column of Bertin (septal cortex)
A
- normal variation of prominent renal cortical parenchyma located between two medullary pyramids. This may give the appearance of a mass effect although the echogenicity is equal to the peripheral cortical tissue.
23
Q
Duplex Kidney
A
Duplication of the collecting system.
Complete: 2 ureters
Incomplete: 1 ureter
24
Q
Duplex Kidney (duplication of the collecting system) sonographically:
A
duplex kidney is typically longer than normal and has a complete central cortical break within the hyperechoic sinus.
- with complete double ureters, the ureter draining the upper pole typically inserts in an ectopic location on the bladder.
- a frequent complication of the ectopic ureter is a uterterocele (prolapse of the distal ureter into the bladder) this results in a hydroureter and hydronephrosis of the upper collecting system.
25
Weigert-Meyer law
describes the relationship of the upper and lower renal moieties in duplicated collecting systems to their drainage inferiorly.
with a duplex kidney and complete ureteral duplication, the upper renal and lower renal moiety have their own ureters with each ureter having its own reteral orifice in the bladder.
The upper renal moiety has an ectopic insertion medial and inferior to the lower pole moiety ureter and frequently ends in a ureterocele.
The lower renal moiety has an orthotopic (normal) insertion lateral and superior to the ureter draining the upper pole and reflux typically occurs.
26
Extrarenal pelvis
renal pelvis normally is located within the renal sinus. Extrarenal pelvis lies outside the renal sinus sonographically appearing as a cystic collection medial to the renal hilum.
27
Posterior urethral valve
Posterior urethral valve (PUV) most common cause of urninary obstruction in the MALE neonate.
This obstruction is due to a flap of mucosa that has a slit-like opening in the area of the prostatic urethra.
"keyhole" sign
PUV is associated with vesicoureteral reflux.
Sono: large bladder, urinoma, hydronephrosis, hydroureter
28
Multiclocular cystic nephroma
rare, non-herediatary, benign cystic neoplasm that is more common in males between 3 months and 2 years.
range in size from a few cm to 10 cm.
present with palpable abdominal mass. difficult to distinguish from a cystic renal cell carcinoma or cystic Wilm's tumor.
surgical excision required
29
Wilm's tumor (nephroblastoma)
most common childhood renal tumor. mean age for diagnosis 3.5 years. Present with large asymptomatic flank mass, can have hypertension, fever and hematuria.
mets can be to the lungs, liver, bone, lymph nodes, and retroperitoneum. with proper treatment 90% survival rate.
tumor extension can be into the renal vein and IVC.
wilm's tumor destroys renal contour. if normal contour, mass most likely and adrenal neuroblastoma.
30
Cystic Wilm's tumor
malignant tumor on the "favorable" end of the Wilm's tumors. occurs in children younger than 5.
Present with palpable abdominal mass, pain, hematuria or HTN.
associated with Beckwith-Wiedemann syndrome, drash syndrome, heihupertrophy, crytorchidism and sporadic aniridia (absence of the Iris)
5-10% have bilateral Wilm's tumors, majority are solid but a small percentage are cystic.
surgical excision is the preferred treatment
31
Mesoblastic Nephroma (fetal renal hamartoma)
benign renal tumor composed of connective tissue which is *most common in the neonatal period.
Presents as a palpable abdominal mass.
Sono: complex, well-defined mass with increased vascularity.
32
Rhabdoid tumor
rare, aggressive tumor associated with early onset of mets. chemo resistant. chemo and surgery are usual treatment. Poor prognosis.
mets invade lungs, liver, abdominal lymph nodes, brain, and bone.
presents as large complex renal mass.
sono: peripheral subcapsular crescent-shaped fluid collection is seen (due to hemorrhage or necrosis)
33
Hydronephrosis
* most common abdominal mass in neonates and infants.
3 most frequent causes of hydro:
PUV (posterior urethral valve)
UPJ (ureteropelvic junction) obstruction
UVJ (uereterovesical junction) obstruction
34
UPJ (ureteropelvic junction) obstruction
most frequent cause of sever hydronephrosis and the most common urinary obstruction in children.
Presents with palpable abdominal mass and abdominal distension. Hematuria is often present.
Hydro ends abruptly at the UPJ and is associated with a normal downstream ureter. if severe, pelvis is enlarged more compared to calyces.
35
UPJ (ureteropelvic junction) obstruction causes:
may be due to abnormal smooth muscle arrangement of the proximal ureter that impairs distensibility, abnormal innervation of the proximal ureter which impairs peristalsis or a crossing vessel/fibrous scar at the UPJ.
Pyeloplasty is the treatment (surgical reconstruction/revision of the renal pelvis to drain and decompress the kidney)
36
UPJ (ureteropelvic junction) obstruction associated anomalies include:
```
Multicystic dysplastic kidney
renal agenesis (contralateral)
duplicated collecting system
horseshoe Kidney
Ectopic kidney
```
37
UPJ (ureteropelvic junction) obstruction diagnosed:
often in utero. Initial u/s after birth should be done on day of life 7.
newborns are extremely dehydrated at birth so it is best to wait to evaluate this anomaly after birth.
sono: dilated collecting system and non-visualization of the distal ureter.
38
*UVJ (ureterovesical junction) obstruction
Megaureter is the most frequent type. renal collecting system and ureter are dilated due to functional aperistalsis of the distal ureter at the juxtavesicular ureteral segment.
*other causes may be a ureterocele and/or distal ureteral stricture
39
Vesicular ureteral reflux (VUR)
VUR is most commonly due to a congenital anomalous development of the UVJ (ureteral vesicular junction)
about 1/2 of males with PUV have VUR (reflux). Most children with prune belly syndrome have some form of VUR.
2 types: Primary VUR and secondary VUR
40
primary VUR
congenital defect in the urinary valve. the ureter did not grow long enough in utero and the bladder valve did not close properly. Improves with age.
41
Secondary VUR
due to a urinary tract blockage due to infection which causes ureter swelling due to PUV.
42
Multicystic Dysplastic Kidney
| non hereditary renal dysplasia
most common cause of an abdominal mass in neonates.
*a form of renal dysplasia characterized by multiple non-communicating cysts with the absence of renal parenchyma.
occurs as result of atresia of the ureteropelvic junction during fetal development. fatal if bilateral.
20-50% have contralateral vesicoureteral reflux, UPJ obstruction and primary megaureter. (unknown etiology)
43
Multicystic Dysplastic Kidney
(non hereditary renal dysplasia)
Sono:
associated with:
renal pelvis/sinus absent; multicystic masses of variable shape and size with absent/dysplastic renal parenchyma.
MCDK occurs in various syndromes such as: Beckwith-wiedemann, trisomy 18, and VACTERL
44
Autosomal recessive polycystic kidney disease:
| infantile
genetic disease which presents as generalized cystic dilatation of the renal collecting tubules. The kidneys are full of tiny cysts. hyperechoic.
45
Autosomal recessive (infantile) polycystic kidney disease (ARPCKD):
Sono:
enlarged kidneys are seen with a hyperechoic parenchyma and loss of cortical medullary distinction. it is also associated with renal dysfunction, pulmonary hypoplasia, congenital hepatic fibrosis and portal hypertension.
ARPCKD: can be detected in utero; oligohydramnios will be see.
46
Autosomal dominant (adult) polycystic kidney disease (ARPCKD):
bilateral renal enlargement due to the development of numerous cysts of varying sizes. associated with cysts in the liver, pancreas, and spleen.
multiple renal cysts may be identified as early as 20-30 years of age.
destruction of the residual renal tissue in advanced stages leads to renal failure and hypertension.
Also associated with arterial aneurysms, especially cerebral arterial (berry) aneurysms of the circle of willis.
47
Medullary sponge kidney:
congenital dysplastic cystic dilatation of the medullary pyramids due to tubular extasia/dysplasia in utero. Urinary stasis occurs and calcium deposits form in the dilated collecting tubules. It can progress to nephrocalcinosis (shadowing) and the formation of renal stones.
Sono: hyperechoic medullary pyramids
48
Angiomyolipomas(AML) (hamartoma)
common in children with Tuberous Sclerosis.
a hyperechoic benign renal tumor composed of blood vessels, fat cells and smooth muscle cells.
echogenicity is greater/equal to the renal sinus.
*AML may cause a propagation speed artifact.
49
Acute pyelonephritis
most renal infections occur via an ascending route from the bladder, and usually caused by gram-negative bacilli from the intestinal tract.
50
Acute pyelonephritis sono:
renal enlargement
hypoechoic parenchyma
absence of sinus echoes
when focal it is called: acute focal bacterial nephritis or lobar nephronia.
-appears as *focal hyper-echoic wedge-shaped area or a hypoechoic renal lobe.
must know history to differentiate from focal ischemia and infarct.
51
Emphysematous pyelonephritis
bacterial infection associated with renal ischemia. commonly occurring in diabetics (87-97%) imuno-suppressed and patients with urinary tract obstructions.
anaerobic bacteria produce intrarenal gas causing reverb or comet-tail artifacts.
Nephrectomy required to treat infection
52
Chronic pyelonephritis:
renal injury induced by recurrent renal infection due to:
anatomic anomalies
obstructive lesions
ureteral reflux
chronic pyelo leads to end-stage renal disease
sono: small hyperechoic kidney with cortical thinning.
53
Xanthogranulomatous Pyelonephritis (XGPN)
type of chronic pyelonephritis resulting from chronic infections due to a long term obstruction.
failure to depict a normal kidneu associated with a staghorn clculus suggest the diagnosis of XGPN
54
Xanthogranulomatous Pyelonephritis (XGPN) findings:
```
renal enlargement
parenchymal abscesses
**staghorn calculus *always
papillary necrosis
hydronephrosis
pyonephrosis
loss of cortical-medullary boundary
cortical thinning
```
55
Pyonephrosis
purulent material in the collection system of the kidney associated with an infection secondary to renal obstruction.
Percutaneous or surgical drainage is required for adequate treatment.
sono: hyperechoic debris in a dilated renal collecting system.
56
Mycetoma (fungal ball)
candidiasis is the most common renal fungal disease.
fungal infections result from hematogeneous seeding or ascend from the bladder.
fungus balls appear as hyperechoic, nonshadowing masses. can see movement when pressure from transducer.
57
Renal abscess
characterized by liquefactive necrosis with pus formation.
Most due to infections that are inadequately treated.
May occur from the direct spread of an infective process from other organs, trauma or surgery.
Immunocompromised patients are more prone to renal abscesses.
58
Hyperechoic renal masses:
```
mycetoma (fungal ball)
angiomyolipomas
blood clots
pyogenic debris
sloughed papilla
renal stones
```
59
Acute kidney injury (AKI)
| previously called acute renal failure (ARF)
abrupt decline in renal function, manifested by decreased urinary output and elevation in plasma blood urea nitrogen (BUN) and serum creatinine.
occurs within hours to weeks, usually reversible
*acute tubular necrosis (ATN) most common cause of acute kidney injury (AKI)
60
Acute kidney injury (AKI)
previously called acute renal failure (ARF)
Symptoms:
```
nausea and vomiting
increased blood pressure
dehydration
backache
confusion
edema
```
61
*3 primary causes of acute kidney injury (AKI)
Ischemia- due to prolonged hypotension
hypoxia - underperfusion due to volume depletion
nephrotoxicity- due to NSAIDS, cylcosporine, diuretic overuse
62
diagnoising the cause of acute kidney injury by U/S
hydronephrosis - indicates post-renal failure
abnormal resistive index - suggests intrinsic
**changes in serum creatinine, reflecting changes in glomerular filtration rate, is most accurate method pf determining AKI
63
Lab studies to evaluate acute kidney injury (AKI)
urine output
urinalysis
blood urea nitrogen
serum creatinine
64
Acute tubular necrosis (ATN)
*ATN most common cause of acute kidney injury (AKI)
results from prolonged ischemia or nephrotoxins (drugs/contrast) causing damage to the tubular epithelium of the nephron, leading to acute renal failure. can be reversible.
occurs more often in patients with h/o recent surgery, sepsis, or hypovolemia.
sono: renal enlargement, increased resistive index (RI)
65
Acute glomerulonephritis (GN)
inflammatory response resulting in glomerular damage caused by infectious and noninfectious causes.
most common- streptococcus species (due to upper respiratory and skin infections)
sono: renal enlargement, increased resistive index (RI)
66
Acute glomerulonephritis (GN) presenting symptoms:
sudden onset hematuria
proteinuria
red blood cell casts in urine
67
Nephrocalcinosis:
disorder of calcium metabolism (hypercalcemia and hypercalciuria) which results in the formation of calcium renal stones and deposition of calcium in the renal parenchyma. (increased calcium levels)
* *nephrocalcinosis = shadowing
* * medullary sponge kidney= no shadowing
68
Nephrocalcinosis causes:
```
primary hyperparathyroidism
renal tubular acidosis
medullary sponge kidney
chronic glomerulonephritis
renal cortical necrosis
```
in kidney transplant:
chronic rejection
papillary necrosis
69
Nephrolithiasis (renal stones)
arises in collecting system.
symptoms: acute back/flank pain often radiating down to ipsilateral groin. if severe can have fever, chills, dysuria, cloudy urine and hematuria.
70
"twinkle sign"
color doppler artifact that appears as a rapidly alternating mixture of red and blue doppler signals distal to a strongly reflective surface such as a renal stone.
71
Urinary bladder
located behind the pubic bone. The apex points anteriorly and is connected to the umbilicus by the median umbilical ligament. The ureters enter the bladder at the superolateral angle of the trigone and exit the bladder via the urethra.
72
Normal bladder wall thickness:
< 5 mm in a non-distended bladder
| < 3mm in a distended bladdr
73
Bladder diverticula
herniarions of the bladder mucosa through the bladder wall musculature. May be congenital or acquired.
most acquired bladder diverticula are associated with long-standing bladder outlet obstruction due to benign prostatic hypertrophy.
74
Urachus
remnant of a channel between the bladder and the umbilicus where urine initially drains in the fetus during the 1st trimester.
The channel of urachus usually seals off and obliterates around the 12th week of gestation and remains as a small fibrous cord between the bladder and umbilicus called the median umbilical ligament.
75
Urachal cyst
cystic dilatation of the fetal urachs. This is the median umbilical ligament connecting the bladder to the umbilicus.
Sono: cystic structure superior and anterior to the bladder.
can also have patent urachus or urachal sinus which will cause a discharge from the navel.
76
Ureters
exit the kidney posterior to the renal artery and vein. descend inferior, ureters lie on the anterior surface of the psoas.
In the pelvis, ureters cross anterior to the common iliac vessels to insert into the trigone of the bladder.
77
Bifid ureter:
results from duplication of the ureter. May be bifid in the renal pelvis or any place along the course of the ureter to bladder.
*occurs with duplex kidneys (duplicating system)
78
Ureteroceles
cyst-like enlargement of the lower end of the ureter which projects into the bladder lumen at the ureterovesical junction.
most commonly in association with complete ureteral duplication.
79
Megaureter:
a wide ureter, greater than 7 mm in diameter.
2 types:
obstructive primary megaureter
secondary megaureter
80
Obstructive primary megaureter
related to distal adynamic segement with proximal dilatation. ureter tapers to a short segment of narrowed distal ureter, usually just above vesicoureteric junction (VUJ)
associated hydro and active peristaltic waves can be seen.
bilateral involvement in about 20%. Male-to-female ratio 4:1
Left side more often than right.
81
Secondary megaureter
results from abnormalities that involve the bladder or urethra such as a neurogenic bladder, prune belly syndrome and posterior urethral valves.
82
Renal trauma
not uncommon due to lack of tissue surrounding kidney. may be from: blunt trauma from sports, falls, penetrating (stabbing) and deceleration/acceleration (MVA's)
83
Renal trauma complications:
subcapsular hematomas or hermatomas outside of kidney due to a laceration or urinary leak.
Color flow doppler (CFD) should always be used to evaluate flow in kidney. (hematoma won't light up)
84
Renal transplant acute rejection
kidney enlargement with swelling and hypoechoic pyramids. Hypoechoic foci may be seen in the renal cortex and an indistinct corticomeudllary junction will be seen.
High PI and RI values >.9 (normal .7)
serious cases may see reversed diastolic flow in renal artery.
85
Renal transplant chronic rejection
appearance not typical, ranging from normal to hyperechoic, along with cortical thinning, reduced number of intrarenal vessels and mild hydronephrossis and increased RI.
86
Renal vein thrombosis associated with:
```
extrinsic compression
nephrotic syndrome
renal tumors
renal transplants
trauma
```
87
Renal vein throbosis sono:
dilated thrombosed renal vein
absent intrarenal venous flow
enlarged hypoechoic kidney
high-resistive renal artery waveform (increased RI)
88
Resistive index (RI) of kidneys
< 0.7 = normal RI
0.7- 0.8 = questionable transplant dysfunction
> 0.8 = transplant dysfunction
89
Renal artery thrombosis
sudden cause of pre-renal failure that presents as:
acute flank pain
hematuria
sudden rise in blood pressure
90
Renal artery thrombosis sono:
focal hypoechoic areas of infarct
renal enlargement
absence of intrarenal arterial flow
acute tubular necrosis
91
Renal artery stenosis symptoms
sudden onset of hypertension and uncontrollable hypertension.
hemodynamically significant renal artery stenosis may produce a decreased renal size (<9 cm in length)
92
Renal dysfunction
caused by a variety of reasons, results in a loss of diastolic flow thus increased renal arterial resistance.
normal renal artery has continuous forward flow during diastole, typical of a low resistance perfusion.
93
Resistive index (value comparing the amount of diastole to that of the systole)
commonly used to evaluate renal transplant rejection, assess suspected hydronephrosis and evaluate medical renal disease.
RI = peak systolic freq - end diastolic freq / peak systolic freq
normal resistive index (RI) <0.7
94
Pediatric adrenals normal anatomy
adrenal glands are prominent and easily visualized superior to the kidney in the neonatal period due to very little peri-renal fat and their larger size.
Adrenal glands are in the peri-renal space. the crus of the diaphragm is medial to both adrenal glands.
** adrenal medulla has a thin echogenic core and the adrenal cortex appears hypoechoic
adrenals can be visualized up to age 3. decrease in size during the first 6 months of life.
shape varies. Right is pyramidal and Left is semi-lunar.
95
Measuring adrenal glands
should be from the apex of the gland to the midpint of the base of the gland in long.
96
Fetal zone of adrenal gland
neonate has a thick fetal zone in the adrenal cortex that occupies 80% of gland.
vascular congestion is present in the fetal zone and involution occurs due to hemorrhagic necrosis.
Fetal zone shrinks and is replaced by connective tissue by age 1.
97
Congenital Adrenal hyperplasia
inherited genetic condition in which the adrenal glands are enlarged.
have low blood pressure, low sodium and high potassium levels.
FEMALES: ambiguous genitalia at birth. milder forms at adolescence: masculine traits (hirsutism, acne, male-pattern baldness, menstrual abnormalities)
MALES: early puberty and short stature. may have female genitalia depending on severity. (25 different types)
98
Neonatal adrenal hemorrhages
occur due to: stress, birth trauma, anoxia, sepsis, dehydration, bleeding and diabetic mothers.
more common DOL 2-7, more common right adrenal.
left adrenal associated with renal vein thrombosis (RVT)
Present: abdominal mass, anemia, jaundice, hyperbilirubinemia and hypovolemic shock. gland may eventually calcify.
99
Neuroblastoma
*most common tumor of childhood.
median age 22 months; majority < 4 yrs
associated: beckwith-wiedemann syndrome, hirschprung's disease, DiGeorge syndrome and neurofibromatosis.
presents: abdominal mass, malaise, pain, anemia, weight loss, and SOB. Mets often present.
100
Neuroblastoma sono:
tumor rarely invades the kidney, but displaces it.
Solid mass appears with fine calcifications. Encasement of the AO, IVS, SMA, and SMV with no invasion.
hepatovenocclusive disease occures: PV reversal, increased hepatic artery RI (often a reversal in diastolic flow) and ascites is present.
101
Cystice neuroblastoma
rare. can arise from an adrenal gland or any neural crest of the abdomen.
sono: anechoic or complex with calcification's. Tumor does not change in size with follow-up, this differentiates it from an adrenal hemorrhage.
102
Ganglioneuroblastoma/ neuroma
incidental finding, usually seen on a chest x-ray.
may be malignant or benign. median age approx. 7 yrs
found in the posterior mediastinum, retroperitoneum, or adrenal gland.
103
Adrenocortical tumor
arise from the adrenal cortex and may be malignant or benign.
release hormones and occur more commonly in girls, in the over 5 yrs age group
present with precocious puberty, virilization, and cushings syndrome (hyperfunction).
104
Pheochromocytoma
rare tumor of adrenal gland tissue. release of too much epinephrine and norepinephrine (hormones that control heart rate, metabolism, and blood pressure)
usually develop in the center (medulla) of one or both adrenal glands.
Headaches are caused by the HTN from hormones released.
< 10% malignant
105
Wolman Disease
rare form of lipidosis, which results in an enlarged calcified adrenal gland and hepatosplenomegally (HSM).
Infants die early.
106
Myelolipoma
fatty adrenal mass composed of mature fat cells which ** cause a propagation speed artifact. due to the speed of sound being slower in fatty tissue. artifact seen as diaphragm projected deeper than what it is.
107
*Most common primary cancer associated with adrenal Mets
Lung cancer.
108
Addison's disease
adrenal HYPOfunction
109
Cushing's disease
adrenal HYPERfunction
