Ch. 25 &26 Flashcards
(215 cards)
1
Q
Transducer for general pediatric
A
Highest frequency
Linear, curved, or sector
For better resolution, use sequential focusing and zoom instead of decreasing depth
2
Q
Abdominal prep
A
0-2yr: NPO 4hr
3-5yr: NPO 5hr
6+yr: NPO 6hr
3
Q
Pelvic prep
A
0-9yr: plenty of juice or water 30 minutes before exam and no urinating
10+ yr: 32 oz water 1 hour before exam, no voiding
4
Q
Right hepatic lobe should not extend more than __ below costal margin in young infant w/o pulmonary hyperaeration; should not extend below right __ in older infants and children
A
1cm
Costal margin
5
Q
Echogenicity of pediatric liver
A
Normally low to medium homogenicity with clear definition of portal venous vasculature
6
Q
Us of biliary system to exclude
A
Ductal dilation
7
Q
CBD measurements
A
<1mm in neonates
<2 mm in infants up to 1 year old
<4mm in older children
<6-7mmin adolescent and adults
8
Q
Right hepatic lobe should not extend more than _____below costal margin in young infant without pulmonary hyperaeration
A
1cm
9
Q
Right hepatic lobe should not extend below ___ in older infants and children.
A
Right costal margin
10
Q
Liver echogenicity
A
Normally low to medium homogenicity with clear definition of portal venous vasculature
11
Q
GB measurements
A
Infants <1 year of age: 1.5-3cm;
in older children 3 to 7 cm
12
Q
Length of GB should not exceed length of
A
The kidney
13
Q
Sonographic appearance of GB
A
Smooth walled anechoic structure w/o internal echoes, pericholecystic fluid should not be present
14
Q
If pericholecystic fluid is present
A
Cholecystitis
15
Q
Panc measurements
A
Head:1-2.2cm
Body: 0.4-1cm
Tail: 0.8-1.8cm
16
Q
Pancreatic duct should not exceed
A
1-2mm
17
Q
Size of panc should _ with age
A
Increase
18
Q
Sono appearance of panc
A
Hypoechoic compared with normal liver texture as little fatty tissue has invaded islets of Langerhans.
19
Q
Spleen: Upper limits of normal length ranges from ___
A
6cm in infants <3 months to 12cm in children >12 years
20
Q
Portal vein diameter is helpful in determining
A
presence of portal HTN
21
Q
Mean PV measurement
A
8.5 mm in children <10 years of age
10 mm in patients 10 to 20 years old
13mm in adults
22
Q
Color doppler should be used on PV to
A
determine flow direction and patency
23
Q
Jaundice
A
Extrahepatic or intrahepatic obstruction to bile flow
24
Q
Extrahepatic obstruction in neonates may be caused by
A
Choledochal cyst, biliary atresia, or spontaneous perforation of bile ducts
25
Intrahepatic causes of neonatal jaundice
hepatitis and metabolic disease
26
Systemic diseases that cause cholestasis
Heart failure, shock, sepsis, neonatal lupus, histiocytosis, severe hemolytic disease
27
If neonate has jaundice that persists beyond ___________after delivery, sonography may be ordered to differentiate among common causes for jaundice
2 weeks
28
With jaundice liver appears
coarse and echogenic
29
With jaundice sonography very useful in demonstrating
GB with inspissated bile and biliary duct stones
30
Jaundice in infants and children may be due to
cirrhosis, benign structures, or neoplastic processes
31
Three most common causes of jaundice in neonatal period
hepatitis
biliary atresia
choledochal cyst
32
Infection of the liver occurs within
3 months of birth
33
Causes of neonatal hepatitis
Infections, metabolic disorders, familial recurrent cholestasis, metabolism errors, or idiopathic causes
34
Neonatal hepatitis
An infection of the liver that reaches liver through placenta, via vagina from infected maternal secretions, or through catheters or blood transfusions
35
With hepatitis, transplacental infection occurs during ___, most common agents are __
3rd trimester, syphilis, toxoplasma, rubella, cytomegalovirus
36
Neonatal hepatitis, During delivery, direct contact with _____ may lead to hepatitis
herpes viruses, CMV, human immunodeficiency (HIV) virus, Listeria
37
Blood transfusions may contain
hepatitis, epstein-barr virus, HIV
38
Bacterial hepatitis or abscess formation may be obtained from ___ after delivery.
Umbilical vein catheter
39
Sono findings with neonatal hepatitis
Normal or enlarged, parnechyma pattern is echogenic with decreased visualization of peripheral portal venous structures, biliary ducts and GB are not enlarged.
40
With neonatal hepatitis, if hepatocellular dysfunction is severe
GB may be small because of decreased volume of bile
41
Biliary atresia
Narrowingor underdevelopment of biliary ductal system
42
Biliary atresia is more common in
Males
43
Biliary atresia may result from
inflammation of hepatobiliary system
44
Biliary atresia may affect
intra or extrahepatic ducts and may or may not involve GB, although latter is most common form with absence of GB
45
Clinical features of biliary atresia in neonates
Persistent jaundice, acholic stools, dark urine, distended abdomen from hepatomegaly
46
With biliary atresia, early surgical intervention may prevent
serious complications like cirrhosis and liver failure
47
Sono findings of biliary atresia
Liver size may be normal or enlarged
Echogenicity of liver parenchyma may be normal or increased with slight decrease in visualization of peripheral portal venous vasculature (indicative of fibrosis)
Intrahepatic ducts not dilated; but remnant duct may be identified with some types of atresia.
Small triangular structure may be seen superior to porta hepatis, which is hypoplastic remnant of biliary structure.
48
With biliary atresia, normal size GB may be seen when
atretic (narrow) CBD is distal to insertion of cystic duct
49
Finding of a small (<1.5cm) GB
non-specific b/c may be seen with either hepatitis of biliary atresia
50
Decrease in the GB after milk feeding suggest
normal patency of CH and CB ducts and would suggest neonatal hepatitis instead of biliary atresia`
51
Presence of _ should determine if biliary atresia is suspected, because there is high association of this abnormality
polysplenia
52
End stage liver disease
ascites, hepatofugal flow, collateral venous channels
53
3rd most common cause of biliary atresia
Choledochal cyst
54
Choledochal cysts
abnormal cystic dilation of the biliary tree that most frequently affects CBD
55
5 types of choledochal cysts
1. Fusiform dilation of CBD
2. 1 or more diverticula of CBD
3. Dilation of intraduodenal portion of CBD (choledochocele)
4. Dilation of intra and extrahepatic ducts
5. Carolis disease w/ dilation of intrahepatic ducts
56
Clinical presentation of choledochal cysts
jaundice and pain, palpable mass may be felt in RUQ
57
When choledochal cysts are present, it is usually
fusiform dilation of CBD w/ assoc. intrahepatic ductal dilation
58
Two most common neoplasms in pediatric population are
Hemangioendthelioma (benign)
| Hepatoblastoma (malignant)
59
Most common benign liver tumor
Hemangioendothelioma
60
Hemangioendothelioma
Infantile hepatic vascular tumors
61
Most common us appearance w/ hemangiendothelioma
Hepatomegaly
62
Hemangioma
Benign, vascular, mesenchymal mass characterized by active endothelial growth that may cause arteriovenous shunting, which causes high output heart failure in infants
63
With hemangiomas, vessel growth ___ as tumor matures; however, existing vessles may form ___ within lesion w/ little blood flow
Slows down
| Lakes
64
Adenoma
Benign liver tumor
Not commonly seen in infants unless liver disease is present.
Normal AFP
65
Sonographic appearance of adenoma
ranges from hyper to hypo and non specific
66
Most common malignant tumors in childhood are
Hepatoblastoma
| HCC
67
Mets to liver may arise from
neuroblastoma
wilms
leukemia
lymphoma
68
Hepatoblastoma
Most common primary malignant disease of liver.
Occurs most freq. in children younger than 4yrs w/ majority occurring in children less than 1yr.
May be familial
assoc. w/ beckwith0wiedeman, hemihypertrophy, familial adenomatous polyposis, and precocious puberty
69
Third most common abdominal malignancy in children after nephroblastoma and neuroblastoma
Hepatoblastoma
70
Most common abdominal malignancies in children
Nephroblastoma (wilms)
Neuroblastoma
Hepatoblastoma
71
Sometimes considered infantile from of HCC
Hepatoblastoma
72
Sono appearance of hepatoblastoma
Hepatomegaly w/ solitary mass that may show some calcifications
Heterogeneous mass predominantly solid, may he hypoechoic areas w/ necrosis and/or hemorrhage
Portal vein thrombosis may be present, doppler flow pattern in lesion shows high velocity low resistance flow pattern
73
With hepatoblastoma, it is important to identify
hepatic vessles and hepatic veins
74
HCC
Second most common malig. tumor in childhood
AKA hepatoma
1/2 of children affected have preexisting liver disease
liver is multicentric solid mass, usually w/o calcs, variable echogen.
color doppler should be used to eval portal venous structures to look for thrombus or tumor invasion
75
3 common conditions that may prompt the pediatric patient to appear in general us lab on an emergent basis for extreme abdominal pain
Hypertrophic pyloris stenosis
Appendicitis
Intussusception
76
Pyloric canal is located
between stomach and duodenum
77
In some infants, pyloric muscle can become hypertrophied, resulting in
significantly delayed gastric emptying
78
Hypertrophy of circular muscle of pylorus is acquired condition that __________ pyloric canal
Narrows
79
With hypertrophic pyloric stenosis, Pyloric canal itself not intrinsically stenotic or narrowed; however, ____
functions as if it were result of abnormally thickened surrounding muscle
80
Hypertrophic pyloric stenosis (HPS)appears most commonly in ______ infants between 3 and 12 weeks of age.
male
81
Most frequent clinical sign of HPS
bile free vomiting in otherwise healthy infant. often reported as projectile vomiting, dehydration and weight loss may ensue
82
with HPS, pyloric muscle __ and ___, stomach outlet obstruction __ and vomiting becomes more constant and projectile
thickens and elongates, increases and vomiting becomes more constant and projectile
83
With HPS, ____ crossing upper abdomen may be observed during or after feeding as stomach attempts to force its contents through abnormal canal (projectile vomiting).
Peristaltic waves and reverse peristaltic waves
84
Palpation of ___shaped mass in RUQ is diagnostic and treated by surgical pyloromyotomy.
olive
85
Sono appearance of HPS in trans
Bagel or target appearance of hypertrophied pyloric muscles and echogenic canal in seen
Cervix sign
86
Cervix sign (HPS)
if the muscle is thickened and enlogated, the mucosa extends into the antrum
87
Sonographic measurement of ___ enables diagnosis of HPS
pyloric muscle thickness
88
Pyloric muscle measurements can be made in __, if image is oblique
both long and trans
| measurement may be overestimated
89
Sono appearance of HPS
Diagnosis of hypertrophic pyloric stenosis depends on:
Visualization of hypertrophied pyloric muscle with a canal length measuring 15-16 mm or greater
Individual pyloric muscle wall thickness of 3mm or greater
Additional significant finding is presence of active antegrade and reverse gastric peristalsis.
90
Appendicitis
Most common causse of emergent sugrical abdominal pain in children
91
Appednicitis occurs when
appendiceal lumen becomes obstructed and subsequently infected
92
Progression of acute appendicitis is ___ in infants and young children
more rapid
93
With appendicitis, classical physical and lab findings may be
absent of confusing
94
Common clinical presentation of appendicitis
RLQ pain and vomiting
95
Diagnostic considerations of appendicitis
enteritis
inflammatory bowel disease
lymphoma
In girls, differential broadens to include gynecologic processes, such as ovarian cysts, neoplasms, ovarian torsion.
96
Appendicitis, assess
upper abdomen, kidneys, and bladder
In girls, adnexal areas should be examined with patient having distended urinary bladder.
Bladder should then be emptied to allow gradual graded compression over area of appendix with linear or curved array transducer.
97
Technique for appendicitis
Right flank and RLQ are reexamined using 5-to 17-MHz linear array transducer.
Transducer moved slowly over abdomen using graded compression technique. Technique allows sonographer to carefully apply gentle pressure with transducer over region of appendix.
98
Nonvisualization of appendix may occur for
multiple reasons and is not definite indication of normal appendix.
99
Causes of appendicealnonvisualization
Being obscured by overlying bowel
Retrocecal position of appendix
Overdistentionor nondistention of urinary bladder
Lack of sonographer experience
100
Sono appearance of appendicitis
Peristalsis not seen in appendix, allowing differentiation of normal appendix and small bowel.
Appendix may be tortuous and difficult to visualize in its entirety.
Walls not thickened; normal appendix compresses easily
Increase in echogenicity shown in surrounding mesentery secondary to inflammation
long, tubular structure in the longitudinal plane and as a bull’s-eye or target in the transverse plane.
Free peritoneal fluid or loculated fluid collection in lower abdomen
101
Appendix measures in
trans across short axis, using maximum diameter
102
Outer diameter >___ mm with compression consistent with appendicitis both in children and adults.
6-7mm
103
McBurneys sign
Localized pain produced by overlying transducer pressure is additional finding consistent with appendicitis
104
with appendicitis, color Doppler useful to document
hyperemia
105
With appendicitis, Confirmation of ___ in symptomatic patient virtually diagnostic
appendicolith
106
Appendicolith
Hyperechoic; produces classic acoustic shadow, single or multiple, intraluminal or surrounded by periappendiceal phlegmon or abscess
107
With appendicitis, the right kidney
may be hydronephrotic because of ureteralinflammation
108
With appendicitis, perforated appendix
may or may not be visualized
109
With appendicitis, if decompressed, abnormally
thick bowel wall may be apparent
110
With ___, localized, well defined RLQ phlegmon or abscess w/ or w/o appendicolith may be present
Appendicitis
111
Most common acute abdominal disorder in early childhood
Intussusception
112
Intussusception occurs when
bowel prolapses into more distal bowel and propelled in antegrade fashion
113
Telescoping of bowel causes
obstruction
114
Telescoping of bowel is associated with
Intussusception
115
With intussusecption, Ileum may
Invaginate into more distal ileum, causing ileoileal intussusception
116
With intussusception, children may present
with colicky abdominal pain, vomiting, and bloody (currant jelly) stools
Abdominal distention or palpable mass
117
Failure to reduce an intussusception mandates
immediate surgical intervention
118
Preliminary abdominal radiographs followed by barium or air enema are rapidly undertaken for both diagnostic confirmation and therapeutic reduction,
if patient has no peritoneal symptoms or fever.
119
Sono findings with intussusception
Alternating hypo and hyperechoic rings surrounding echogenic center as seen in short-axis view of involved area
Known as target sign or donut
Cinnamon roll sign
120
Intussusception, Long axis view
Hypoechoic layers on each side of echogenic center result in “pseudokidney” or “sandwich” sign appearance
121
Surgical conditions
```
Appendicitis
Intussusception
Mesenteric or omental cysts (often large in size)
Duplication cysts of bowel
Duodenal atresia ‘Double Bubble Sign’
Meconium peritonitis
```
122
Gastric bezoars
movable intraluminal masses of congealed ingested materials that are seen on upper gastrointestinal radiographs.
123
Trichobezoars
Hair ball
124
Phytobezoars
Vegetable matter
125
Lactobezoars
Incompletely dissolved powdered formula
126
Concrections (bezoars)
Inorganic material (sand, asphalt, and shellac)
127
Clinical presentation of bezoars
nausea, vomiting, and pain
128
Indications for neonatal and pediatric adrenal and urinary US
```
➢Hydronephrosis
➢Palpable mass
➢Abdominal distention
➢Anuria
➢Hematuria
➢Sepsis or urinary tract infection
➢Myelomeningocele
➢Chromosomal or VACTERLanomalies
➢Abnormal external genitalia
➢Prune-belly syndrome
```
129
Transducer used for neonatal and pediatric adrenal/urinary US
10-MHz curved array (slightly more curved than an adult footprint) is ideal for neonates and infants.
7.5-MHz transducer with a similar footprint for a young child (toddler/preschooler) or thin, older (school aged) child
9-to 12-MHz linear array in a premature infant or to provide better detail resolution when pathology is suspected
3-to 5-MHz curved array is typical for an adolescent.
130
Neonatal adrenal/urinary US, start at the __ region
suprapubic
131
Neonatal adrenal/urinary US, obtain a
pre-void bladder wall thickness measurement (with full bladder).
132
Neonatal adrenal/urinary US, with the bladder still full,
a preliminary view of the kidneys and perirenal areas are scanned via the anterior abdomen or flanks.
133
Long images of the kidneys obtained to document
any fluid in the kidney with the bladder full, & to document the echogenicity comparative to the liver and spleen
134
In the potty-trained child or older child, the patient is instructed to urinate fully. The bladder is then re-examined in long and trans views,
including a post-void bladder wall thickness.
135
Infant and young child: renal views are obtained from a ________ position
Prone
136
Older children and adolescents: scanned in the __ position.
Decubitus
137
Renal length may be slightly shorter from a ___ position as well as position dependent _ may occur
Prone
| pelviectasia (dilation of renal pelvis
138
Medullary pyramids are
large and hypo
| could be confused w/ cysts or dilation
139
Renal cortex is
thin; echogenicity similar to or slightly greater than normal liver parenchyma
140
Renal cortical echogenicity normally
decreases to less than liver parenchyma, usually by 4 to 6 months of age.
141
Kidneys: Children & adolescents appear
Similar to adult kidneys
142
Normal renal cortex produces
low level, back scattered echoes
143
Hypoechoic pyramids are situated around
the central echogenic renal sinus
144
The normal renal length __ of the neonate or pediatric patient.
varies w/ the age
145
__ kidney is somewhat longer
Left
146
a kidney measurement greater than __side to side should be monitored closely, and may indicate__
1cm
| Infection, scarring, or congenital abnormalities, such as hypotrophy or duplicated renal system
147
The normal adrenal glands are __ and more __ in the neonate than in the older infant or young child
Larger
| easily identified
148
The left adrenal gland extends slightly more __ than does the right
medial
149
Sonographically the adrenal gland has an
inverted “V” or “Y” shape in the longitudinal plane.
150
The central adrenal medulla in the neonate is relatively
Thin, distinct echogenic stripe surrounded by the more prominent and less echogenic adrenal cortex
151
When the kidney is absent or ectopic
the ipsilateral adrenal gland remains in the renal fossa, but as a result it may have an altered configuration.
152
he normal urinary bladder is
Thin-walled in the distended state and should measure <3mm in AP dimension
153
When empty, the bladder wall thickness
increases but remains <5mm
154
Kidneys: anomalies of position, form, and orientation
➢Pelvic kidney
➢Horseshoe kidney
➢Crossed ectopy
➢Renal duplication
155
Congenital Urinary Tract Anomalies
➢Hydronephrosis
➢Patent urachus
➢Multicystic dysplastic kidney disease (MCDK)
156
Congenital Hydronephrosis
Dilation of urinary collecting system
Most common urinary tract anomaly in children
Causes of dilation of collecting system: obstruction, reflux, abnormal muscle development
157
Congenital hydronephrosis:
| Sonography very sensitive in
detecting small amounts of fluid in renal pelvis
158
Sono features on hydronephrosis
visible renal parenchyma surrounding central cystic component
➢small peripheral cysts (dilated calyces) budding off large central cyst (renal pelvis)
➢visualization of dilated urete
159
Vesicoureteral reflux (VUR)
Common nonobstructive cause of hydronephrosis and is indicated in up to 33% of prenatally diagnosed hydronephrosis
160
VUR is the abnormal
refluxing of urine from the urinary bladder through the ureters and into the kidney
161
Grades of VUR
I= least severe
(limited to ureters)
V= most severe (dilation of ureters and kidneys w/ loss of papillary impressions
162
With VUR, ___ hydronephrosis may occur and different sides may have different levels of reflux.
Unilateral or bilateral
163
Sono findings of VUR
➢may or may not include hydronephrosis
➢pelvic or ureteral wall thickening
➢intermittent dilation of the collecting system
➢displaced ureteral jet in the bladder
164
Ureteropelvic Junction Obstruction (UPJ)
Most common type of obstruction causing hydrohephrosis of upper urinary tract in peds
Most often results from intrinsic narrowing or extrinsic vascular compression at level of ureteropelvic junction
165
UPJ obstruction produces
proximal dilation of collecting system; ureter is normal in caliber, increased incidence of abnormalities in the contralateral kidney
166
Sono finding on UPJ
Pelvocalyceal dilation w/o ureteral dilation
When obstruction pronounced, dilated renal pelvis extends inferiorly and medially
If vesicoureteral reflux or primary megaureter is present, ureter may be dilated.
167
Ureter may be obstructed __
anywhere along its course or at ureterovesical junction.
168
Causes on ureteral obstruction
Abscess, lymphoma, & urolithiasis
Presence of primary megaureter (7mm)
➢Atresia
➢Ectopic ureter
169
Sonography shows hydronephrosis and hydroureter with
arrow segment of distal ureter behind bladder
Increased peristalsis in ureter distal to obstruction
Diminished ureteral jets may be seen at lower margin of bladder with color Doppler on side of obstruction
170
Ectopic Ureterocele (and the Duplex Kidney) occurs more commonly in
females and more common on the left side
171
Ectopic Ureterocele (and the Duplex Kidney) results from
an ectopic bladder insertion and cystic dilation of the distal ureter of a completely duplicated renal collecting system
172
Ectopic Ureterocele commonly referred to as
a duplex or double kidney
173
Sono findings for ectopic ureterocele and the duplex kidney
➢Seen as a fluid mass within the UB
➢Located inferomedially to the ureteral insertion of the lower pole ureter.
➢An upper pole fluid mass, in continuity with a dilated ureter and ureterocele
174
Bladder Outlet Obstruction
Bilateral hydronephrosis frequently caused by obstruction at level of bladder or bladder outlet
175
BOO:
| Bladder may be obstructed by
neurogenic bladder
pelvic mass
congenital anomaly such as posterior urethral valves (PUV’s)
176
Most common cause of bladder outlet obstruction in male neonates, __ may be cause, __ is also a possible cause of dilated renal pelvis
Posterior urethral valves
pelvic mass or tumor
vesicoureteral reflux
177
Sono findings on BOO
Wall of urinary bladder appears thickened and trabeculated with PUV’s
Midline sagittal imaging with caudal angulation through bladder may allow visualization of distended posterior urethra.
Posterior urethra can be imaged directly from perineal approach.
178
Prune belly syndrome
Rare congenital anomaly of unknown etiology
Males 96% of cases
Includes a triad of hypoplasia or deficiency of the abdominal musculature, cryptorchidism, and urinary tract anomalies
179
Prune belly syndrome includes
congenital absence or deficiency of the abdominal musculature, large hypotonic dilated tortuous ureters, a large bladder, a patent urachus, bilateral cryptorchidism, and a dilated prostatic urethra.
85% have associated VUR (vesicoureteral reflux)
180
Urachus
a long, tubular structure, which connects the dome of the bladder to the umbilicus
Normally it closes during the fourth and fifth months of gestation
Sometimes remains patent –either at bladder or umbilical end
181
Patent urachus
A hypoechoic tract tracing to the umbilicus at the superior bladder
Fluid may be present on either end.
In case the urachal remnant is patent at the bladder end and closed at the umbilicus, a cyst will form appearing as a hypoechoic mass seen just posterior to the umbilicus
182
Multicystic dysplastic kidney
Most common cause of renal cystic disease in neonates
183
When hydronephrosis is excluded, __ is the most common cause of abdominal mass in newboens
Multicystic dysplastic kidney
184
MCDK is __, thought to be secondary to severe, generalized __
congenital
| interference w/ ureteral bud function during 1st trimester
185
with MCDK, collecting tubules __
enlarge, becoming cystic, grossly distorting shape of kidney
186
With MCDK, remaining renal parenchyma becomes
virtually non functioning
187
Nearly half cases of MCDK have
contralateral abnormalities
188
Sono findings of MCDK
Unilateral mass, “cluster of grapes” represent multiple discrete noncommunicating cysts; the largest are peripheral.
No identifiable renal pelvis
If bilateral, usually fatal
189
Autosomal recessive polycystic kidney disease (ARPKD)
Diffuse enlargement, cystic diverticula of medullary portions of kidneys
Most severe form seen in neonatal stage
Least severe form seen in infantile to juvenile stage
190
Sono findings on ARPKD
Bilateral renal enlargement with diffuse increased echogenicity and loss of definition of renal sinus, medulla, cortex.
Hypoechoic outer rim (cortex compressed by expanded pyramids)
Less severe cases: hepatosplenomegaly and portal hypertension, with renal parenchyma normal to echogenic
191
Autosomal dominant polycystic kidney disease (ADPKD)
usually appears during middle age.
Rarely reported in young infants
Cerebral berry aneurysms known to occur in 10% to 15% of patients
Increased incidence of RCC
192
Sono findings of ADPKD
Findings similar to ARPKD, Bilateral well-defined cysts Cysts are macroscopic of varying size; can also form in liver, spleen, pancreas
193
Renal cysts may appear in the kidney and may be associated with various syndromes like
Tuberous Sclerosis and von Hippel-Lindau Disease
194
Patients with the autosomal disease of tuberous sclerosis have a 40% incidence of having __, which may resemble polycystic renal disease
Renal cysts
195
Angiomyolipoma may occur and may be
multiple; their echogenicity is determined by the amount of fatty tissue within the lesion
196
In patients with von Hippel-Lindau disease, there are
Multiple cysts
197
Both tuberous sclerosis and von Hippel-Lindau disease are associated with an increased incidence of
RCC
198
Clinical symptoms of acute pyelonephritis
Sudden fever, flank pain, tenderness
199
With acute pyelonephritis, infection usually beigns
in the bladder and ascends ureter into renal pelvis
200
With acute pyelonephritis, renal size may be
slightly enlarged with altered renal parenchymal echogenicity secondary to edema
201
With acute pyelonephritis, as infection spreads into the renal pelvis, there may be
Increased echogencity in this triangular area.
| Renal pelvis and ureter may show some thickening secondary to inflammation. Infection may be diffuse or localized
202
Chronic pyelonephritis
Repeated episodes of acute pyelonephritis cause the kidney to become scarred and decreased in size.
➢The outline of the kidney may be irregular as the parenchyma becomes scarred.
➢The renal cortex becomes increasingly more echogenic than the liver parenchyma.
➢The renal pyramids become difficult to separate from the renal parenchyma.
203
Nephrocalcinosis
Most common neonatal adrenal mass
Calcification of the renal parenchyma, often in the medulla and rarely in the cortex
Many underlying causes including infants receiving long-term furosemide for lung or heart disease, among other medications, as well as medullary sponge disease kidney
204
Predispositions for adrenal hemorrhage
Difficult delivery, large size, infants of diabetic mothers, stress, hypoxia at delivery, septicemia, shock
205
With adrenal hemorrhage, hemorrhage is usually found secondary to
other complications like uncontrolled bleeding, jaundice, intestinal obstruction, hypertension, adrenal abscess, impaired renal function
206
Sono findings of adrenal hemorrhage
Ovoid enlargement of gland or portion of gland
Appearance can range from anechoic to hyperechoic, or may be mixture of echogenicities, depending on extent, age, severity of process
207
Most common neonatal adrenal mass
Adrenal hemorrhage
208
Nephroblastoma
Most common intraabdominal malignant renal tumor in young children, incidence peaks between 2-5 years of age.
Usually unilateral, small % occurs b/l
Large solid mass expands within renal parenchyma
Distorts renal sinus, pyramids, cortex, contour of kidney.
May protrude into hepatic capsule.
Resultant hydronephrosis may be present.
209
Sono finding of nephroblastoma
Appearance: variable, homogeneous to complex texture
Areas of echogenicity and may have calcifications within
Borders sharply marginated and well-defined; bulky, with hypoechoic to hyperechoic rim surrounding mass Adjacent renal tissue becomes compressed with growth of mass
210
Congenital mesoblastic nephroma
Most common renal tumor of neonate
Rare, benign tumor; indistinguishable from wilms tumor by any method of imaging
Tumor may invade adjacent structures
211
Neuroblastoma
Malignant tumor arises in adrenal medulla; may be detected on antenatal sonography or at birth
*Most common malignancy in children under one year
Second most common abdominal tumor of childhood, occurring between age of 2 months to 2 years
212
Sono findings of neuroblastoma
Usually highly echogenic
Intrinsic calcification may be identified.
Smaller tumors may appear homogeneous and hyperechoic; large tumors more complex in appearance
213
With neuroblastoma, adjacent kidney is displaced
Inferiorly and at times laterally
214
With neuroblastoma, doppler eval may help
differentiate tumor from adrenal hemorrhage because of increased vascularity within neoplastic growth
215
Other malignant retroperitoneal tumors
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RCC
Rhabdomyosarcoma
Adrenal malignant tumors
pheochromocytoma
adrenocortical carcinomas
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