QUIZ 4 Flashcards
1
Q
What are the normal measurements for the kidneys?
A
9-12 CM X 5 CM X 2.5CM
2
Q
Where do the left renal vein and right renal artery travel in relation to other structures?
A
LRV posterior to SMA and anterior to aorta, RRA posterior to IVC
3
Q
What is the normal echotexture of the renal medulla?
A
Anechoic or hypoechoic
4
Q
What is the normal echotexture of the renal cortex?
A
Medium echogenicity; more hypoechoic than liver or spleen
5
Q
What happens to the kidneys when a patient takes a deep breath?
A
They move about an inch inferior
6
Q
What is the functional unit of the kidney?
A
Nephron
7
Q
What is another name for Gerota’s fascia?
A
Perinephric fascia
8
Q
What does Gerota’s fascia surround?
A
TRUE CAPSULE, PERINEPHRIC FAT, ADRENALS
9
Q
What are the three functions of the kidneys?
A
*Filtration (glomerulus)
*Reabsorption
*Secretion (tubules)
10
Q
What is excretion?
A
Body removing old waste
11
Q
What is a junctional parenchymal defect?
A
Appears as an echogenic triangle in the anterior right upper pole
12
Q
What is a dromedary hump?
A
A variant that can appear as a pseudo tumor
13
Q
What is the hypertrophied column of Bertin?
A
Looks like an extension of the cortex into the kidney
14
Q
What is the term for fusion of the lower poles of the kidneys?
A
Horse shoe kidney
15
Q
What is a ureterocele?
A
Caused by congenital or acquired stenosis of distal end of ureter; may cause obstruction if large and/or infectious
16
Q
What does a ureterocele look like?
A
Round, cystic structures that project into the bladder lumen at the UV junction
17
Q
What lab values are associated with renal failure?
A
*Elevated BUN
*Elevated creatinine
18
Q
Is BUN or creatinine more sensitive in detecting renal issues?
A
Creatinine
19
Q
Can we evaluate renal function on ultrasound?
A
Cannot evaluate renal function on US
20
Q
What does chronic renal failure look like?
A
*Gradual decrease in renal function
*Small, echogenic kidney
21
Q
What pathology is common for adults over 50?
A
Cystic disease
22
Q
Where is a parapelvic cyst located?
A
Kidney hilum
23
Q
What can be a complication of a parapelvic cyst?
A
*Obstruction
*Pain
*Hypertension
24
Q
Do simple renal cysts affect the function of the kidney?
A
No
25
What characteristics would make a cyst more likely to be malignant?
*Septations thicker than 1 mm with vascularity
*All are assumed malignant until proven benign
*Multiple thick septations
*Irregular walls
*Large solid components
26
What genetic disorder is associated with bilateral angiomyolipomas?
Tuberous sclerosis
27
What does ARPKD stand for?
Autosomal recessive polycystic kidney disease
28
What does ADPKD stand for?
Autosomal dominant polycystic kidney disease
29
Which type of polycystic kidney disease is related to children?
ARPKD
30
Which type of polycystic kidney disease is related to adults?
ADPKD
31
Which type of PKD is echogenic and which is hypoechoic?
*ARPKD - Massively enlarged, echogenic kidneys
*ADPKD - Enlarged kidneys with multiple asymmetrical cysts
32
Are the kidneys small or enlarged with PKD?
ENLARGED with PKD
33
Which type of PKD is associated with cysts in the liver, pancreas, and spleen?
ADPKD
34
What is the most common palpable mass in neonates?
Multicystic dysplastic kidney (MCDK)
35
Is multicystic dysplastic kidney usually unilateral or bilateral?
Usually unilateral, if bilateral incompatible with life
36
Is the kidney functioning properly in MCDK?
No, nonfunctional kidney
37
What is the sonographic appearance of MCDK in neonates and children?
*Multicystic, absence of renal parenchyma, renal sinus, and atretic renal artery
38
What is the sonographic appearance of MCDK in adults?
*Small (atrophic and calcified) and echogenic
39
What is MCKD?
Medullary cystic kidney disease, genetic unlike MCDK
40
What does MCKD lead to?
Leads to renal failure
41
What does a medullary sponge kidney look like?
*Dysplastic cystic dilatation of the collecting tubules
*Stone formation due to calcium deposits and infection
42
Is medullary sponge kidney malignant or benign?
Benign
43
What is calcium deposition in the renal parenchyma called?
Nephrocalcinosis
44
What does nephrocalcinosis look like?
Similar to staghorn calculus or air
45
What is the most common primary malignancy in adults?
RCC - renal cell carcinoma
46
What are other names for renal cell carcinoma?
*Hypernephroma
*Von Grawitz tumor
47
What is the patient presentation for renal cell carcinoma?
*Pain
*Hematuria
*Palpable mass
48
Where is renal cell carcinoma located in the kidney?
Parenchymal tumor
49
Who is more likely to get renal cell carcinoma?
Men 60-70 years old
50
What cancer is in the collecting system?
TCC - transitional cell carcinoma
51
What are potential locations for transitional cell carcinoma?
*Collecting system
*Renal pelvis
*Ureter
*Bladder
52
What is the most common location for TCC?
Collecting system
53
What symptom does the patient usually present with if they have TCC?
*Painless hematuria
*Hydronephrosis
54
What is the sonographic appearance of TCC?
Isoechoic or hypoechoic mass within collecting system
55
What is the most common solid renal tumor in preschool children?
Wilm’s tumor
56
What is Wilms tumor also known as?
Nephroblastoma
57
What are the signs and symptoms of a Wilms tumor?
*Fever
*Gross hematuria
*Pain
*Palpable mass
*Nausea/vomiting
58
What is the sonographic appearance of Wilms tumor?
*Homogeneous and echogenic
*May extend into IVC, right atrium
59
What is a common benign renal tumor?
Angiomyolipoma
60
What is the most common benign renal tumor?
Angiomyolipoma
61
What artifact is associated with angiomyolipoma?
Prop speed artifact
62
What is the sonographic appearance of angiomyolipoma?
*Fat, blood vessels, and smooth muscle
*Solitary, small lesion – hyperechoic
63
What is the sonographic appearance of an adenoma?
*Well-defined, hyperechoic
*Incidentaloma
64
What is the sonographic appearance of an oncocytoma?
*Well encapsulated
*Spokewheel in color
*Central scar
65
What is the most common renal disease to produce acute renal failure?
Acute tubular necrosis (ATN)
66
What is hydronephrosis?
*Dilation of renal pelvis and calyces
*Obstructed outflow
67
What is the term for a ureter filled with urine?
Hydroureters
68
What can cause hydronephrosis?
*Pelvic mass
*Pregnancy
*Obstruction/stone
*BPH
*Stricture
*Bladder tumor
*UPJ block
69
What is the most common obstruction of patients with acute flank pain?
Renal calculi
70
What is the medical term for kidney stones?
Urolithiasis
71
What are the most common locations for kidney stones?
*UPJ
*UPV
*Pelvic brim
72
What artifacts confirm the presence of stones on ultrasound?
*Posterior shadow
*Twinkle artifact
73
What is a staghorn calculi?
Large, fill renal collecting system
74
What is lithotripsy?
Therapeutic US to breakdown stones
75
What is pyonephrosis?
Pus in obstructed renal system (infection)
76
What is the term for inflammation of the bladder?
Cystitis
77
What are the five sonographic signs of renal artery stenosis?
*Kidney size less than 9 cm in length
*Peak main RA velocity > 180 cm/s
*RA/aorta ratio > 3.5
*Intrarenal tardus parvus waveform
*Absence of early systolic peak
78
What is the most common symptom of renal artery stenosis?
Most common correctable cause of hypertension
79
What is a normal resistive index in renal transplants?
RI of .7 or less = WNL
80
What is the appearance of a renal transplant kidney?
Normal appearance but in pelvis
81
What is oliguria?
Abrupt, transient decrease in function (part of ARF)
82
What are the sonographic signs of kidney rejection?
*↓ echogenicity of some pyramids
*↑ Echogenicity of cortex
*Localized anechoic area of parenchyma
*Distortion of renal outline
*Patchy sonolucent areas
*Increased renal size
83
What are the sonographic signs of renal vein thrombosis?
*Dilated thrombosed renal vein
*Absence of venous flow within the kidney
*Enlarged hypoechoic kidney
*Elevated RI in renal artery
84
What is it called when we have herniation of the bladder wall?
Bladder diverticulum
85
Where is the spleen located?
Intraperitoneal
86
What is the vascular supply to the spleen?
Splenic artery and vein
87
What is the normal size for the spleen?
*8 - 13 CM in length
*7 CM wide
*3-4 CM thick
88
What size is considered splenomegaly?
>13cm
89
What vessels join to form the MPV?
*SMV
*SV
*IMV
90
What does fresh hemorrhage in the spleen look like?
Hypoechoic appearance
91
What does a healed infarction in the spleen look like?
Echogenic, peripheral wedge-shaped hypoechoic lesions
92
What are the four functions of the spleen?
*Breakdown of hemoglobin
*Formation of bile pigment
*Formation of antibodies
*Reservoir for blood
93
What does the spleen do during fetal life?
Hematopoiesis
94
What is culling?
Removal of abnormal
95
What appearance does a healed infarction have in the spleen?
Echogenic, peripheral wedge-shaped hypoechoic lesions with their base toward the subcapsular surface of the spleen
## Footnote
Healed infarctions may change in appearance over time.
96
What are the four functions of the spleen?
* Breakdown of hemoglobin
* Formation of bile pigment
* Formation of antibodies
* Reservoir for blood
97
Define culling in relation to the spleen.
Removal of abnormal RBC’s from blood
98
Define pitting in relation to the spleen.
Removal of nuclei from RBC’s
99
What labs are associated with splenic pathology?
* Hct - % RBC’s/volume
* Bacteremia – bacteria in blood
* Leukocytosis - ↑ WBC’s
* Leukopenia - ↓ WBC’s
* Thrombocytopenia- ↓ platelets
100
Where is an accessory spleen most commonly located?
Usually near hilum; can be found from diaphragm to scrotum
101
What is amyloidosis?
Starch deposits in the spleen
102
What does amyloidosis look like in the spleen?
Nodular, enlarged, heterogeneous spleen
103
What is Gaucher’s disease?
Fat and proteins abnormally deposited in the body; Jewish; enlarged spleen; auto-recessive
104
What is Niemann-Pick Disease?
Lipid storage disorder; rapidly fatal; splenomegaly; affects female infants
105
What is sickle cell anemia?
Hereditary; abnormal hemoglobin shape; autosplenectomy (adults); late stages – small spleen
106
What can sickle cell anemia cause?
A small spleen with progressive infarction and fibrosis as seen in autosplenectomy
107
What is polycythemia vera?
Excess RBCs, sometimes WBCs and platelets also; splenomegaly, firm; bone marrow
108
What is Thalassemia?
Hereditary; abnormal form of hemoglobin; fewer RBCs due to high rate of destruction; very enlarged spleen; may need regular blood transfusions
109
What is Wilson’s Disease?
Build-up of copper; enlarged spleen; Kayser-Fleisher ring – copper ring around eye
110
What is Felty’s syndrome?
Chronic rheumatoid arthritis; enlarged spleen
111
What is associated with infectious mononucleosis?
Splenomegaly
112
What is associated with AIDS/HIV and the spleen?
Splenomegaly; Tuberculosis; Kaposi’s sarcoma; opportunistic infections
113
What is the clinical presentation of a splenic abscess?
Fever, LUQ tenderness, abdominal pain, left shoulder pain, flank pain, splenomegaly
114
What is the most common appearance of splenic infection?
Most prominent feature is splenomegaly; many immuno-compromised patients also have multiple nodules
115
What is a parasitic infection that can occur in the spleen?
Echinococcus: anechoic with possible daughter cysts or solid
116
True splenic cysts are associated with what?
Congenital, PKD
117
What is the most common benign tumor of the spleen?
Hemangioma: usually an isolated, inhomogeneous, echogenic mass with multiple small hypoechoic areas
118
What are the two primary malignancies of the spleen?
* Hemangiosarcoma
* Lymphoma (common) – focal hypoechoic
119
What is the most common metastasis to the spleen?
Melanoma
120
Which organs are in the anterior pararenal space?
* Pancreas
* Duodenum
* Ascending and transverse colon
121
What is the largest of the three spaces in the retroperitoneum?
Perirenal space
122
What does Gerota’s fascia surround?
Kidneys, adrenals, and surrounding fat
123
What is in the posterior renal space?
* Blood
* Lymph nodes, lymphatic vessels
* Fat
* Vessels
* No organs
124
What are the two major lymph node bearing areas in the retroperitoneal cavity?
* Iliac and hypogastric nodes within the pelvis
* Paraaortic group in the upper retroperitoneum
125
Which organ should be evaluated with lymphadenopathy?
Spleen for splenomegaly
126
What is the mantle sign?
Mesenteric sandwich sign: anterior and posterior nodes surround vessels, layered appearance
127
How do lymph nodes appear with infection?
Smooth and ovular
128
How do lymph nodes appear with malignancy?
Irregular and round
129
What is the appearance of the right vs left adrenal gland?
* Right: more superior to kidney, posterior to IVC, anterior to crus
* Left: more medial, posterior to pancreas tail, anterior to crus
130
How big is the adrenal gland in an infant?
Proportionally larger than adult (1/3 size of kidney; 1/13th in adult)
131
What is the outer portion of the adrenal gland called and what does it produce?
Cortex; produces mineralocorticoids, glucocorticoids, and sex hormones
132
What does the medullary part of the adrenal gland produce?
Epinephrine and norepinephrine
133
Where does the left suprarenal vein drain to?
Left renal vein (LRV)
134
In which patient population is adrenal hemorrhage more common and why?
More common in neonates due to traumatic delivery with stress, asphyxia, and septicemia
135
What is Addison's disease?
↓ adrenal function; ↑ serum potassium; atrophy of cortex; hypotension, weakness, loss of appetite and weight
136
What is Waterhouse-Friderichsen syndrome?
Bilateral hemorrhage into adrenals due to acute infectious process (meningitis, sepsis)
137
What is adrenogenital syndrome?
↑ sex hormones due to congenital adrenal hyperplasia
138
What is Conn's syndrome?
↑ aldosterone; affects fluid balance regulation and carbohydrate metabolism
139
What is Cushing syndrome?
Hypersecretion of cortisol causing excessive glucose production and ↓ serum potassium
140
What is the most common benign primary adrenal tumor?
Benign nonfunctioning adenoma
141
What type of patients are more likely to have an adrenal adenoma?
Older patients with diabetes or hypertension
142
What do we see propagation speed artifact with?
A mass containing fatty tissue; adrenal myelolipoma
143
What is a pheochromocytoma?
Adrenal medulla tumor that secretes excessive dopamine, epinephrine, and norepinephrine
144
What symptoms are associated with pheochromocytoma?
* Hypertension
* Severe headaches
* Heart palpitations
* Tachycardia
* Excessive perspiration
145
What is significant about the organ of Zuckerkandl?
Pheochromocytoma can be found there
146
What is the most common tumor of infancy?
Neuroblastoma
147
What is the most common primary retroperitoneal tumor?
Liposarcoma
148
What is Ormond’s disease?
Idiopathic condition characterized by thick sheets of fibrous tissue in the retroperitoneal cavity
