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Abdomen > Retroperitoneum/Adrenals/Renals > Flashcards

Retroperitoneum/Adrenals/Renals Flashcards

Including diffuse renal diseases and focal renal masses

1
Q

Where is the retroperitoneal space?

A

between the posterior parietal peritoneum and the posterior abdominal wall muscles
(extends from the diaphragm to the pelvis)

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2
Q

What categories is the retroperitoneum divided into?

A

anterior pararenal space, perirenal space, posterior pararenal space

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3
Q

Name the organs included in the anterior pararenal space.

A

pancreas, duedenum, ascending and transverse colon

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4
Q

Name the organs included in the perirenal space.

A

adrenal glands, kidneys, ureter, and great vessels

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5
Q

Name the organs included in the posterior pararenal space.

A

blood and lymph nodes

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6
Q

Name all the organs included within the retroperitoneum.

A

suprarenal glands, aorta/IVC, duodenum, pancreas, ureter, colon (ascending & descending), kidneys, esophagus, rectum
SAD PUCKER

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7
Q

Describe where the adrenals are located and what they look like in an adult.

A

located anterior, medial, and superior to the kidney
right: triangular and caps rt kidney
left: semilunar, medialr to upper pole of lt kidney
hypoechoic

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8
Q

List the normal dimensions of the adrenal glands.

A

3-6cm long
3-6mm thick
2-4cm wide

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9
Q

Describe the sonographic appearance of neonate adrenal glands.

A

thin/echogenic medula
thick hypoechoic rim
three times larger than an adult adrenal

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10
Q

What 3 types of steroids do the adrenals secrete?

A

sex hormones, mineralocorticoids, glucocorticoids

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11
Q

What is the function of each steriod that the adrenals secrete?

A

mineralocorticoids (aldosterone): regulates fluid volume in body
glucocorticoids (cortisone & hydrocortisone): controls blood sugar
sex hormones: secretes both male and female

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12
Q

Is the adrenal medulla essential for life?

A

no - can be removed

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13
Q

What is Addison’s Disease and who does it effect?

A

adrenocortical insufficiency
atrophy of adrenal cortex occurs with DECREASED production of CORTISOL(glucocorticoids) and sometimes ALDOSTERONE
affects men and women equally (not related to age)

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14
Q

What are the sypmtoms of Addison’s Disease?

A

hypotension, chronic fatique, loss of appetite, blotchy dark tanning and freckling of the skin

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15
Q

What are the primary causes of reduced adrenal cortical tissue?

A

autoimmune process (most common), TB, inflammatory process, primary neoplasm, metastases

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16
Q

What is adrenogenital syndrome?

A

adrenal virilism

results from the EXCESSIVE secretion of the sex hormones and adrenal androgens

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17
Q

What is adrenogenital syndrome caused by?

A

either an adrenal tumor or hyperplasia

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18
Q

What are the clinical symptoms of adrenogenital syndrome?

A

newborns: ambiguous genitalia with or without adrenal hyperplasia
adult women: masculinizing effects (deepening of voice, hirsutism, baldness, and acnes, atrophy of uterus, decreased breast size, clitoral hypertrophy)
prepubescent boys: masculine development (deepening of voice, increase body hair)

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19
Q

What is Conn Syndrome and who does it occur in?

A

caused by EXCESSIVE secretion of aldosterone (mineralocorticoids), usually because of a cortical adenoma of the glomerulosa cells

occurs in 0.5% of patients with sustained hypertension

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20
Q

List other causes of excessive secretion of aldosterone.

A

less frequent: adrenal hyperplasia (more common in males) and adrenal carcinoma (more common in women)

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21
Q

How is hypertension associated with Conn Syndrome?

A

increased aldonsterone leads to increased sodium levels within the blood, which causes increased volume of blood which is known as hypertension

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22
Q

What are the clinical signs of Conn Syndrome?

A

muscle weakness/cramps, hypertension, abnormal ECG

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23
Q

Describe Cushing Syndrome.

A

caused by EXCESSIVE secretion of cortisol

resulting from adrenal hyperplasia, cortical adenoma, adrenal carcinoma, or elevated ACTH from a pituitary adenoma

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24
Q

What can cause excessive secretion of cortisol?

A

adrenal hyperplasia, cortical adenoma, adrenal carcinoma, or elevated ACTH from a pituitary adenoma

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25
Q

What are the signs and symptoms of Cushing Syndrome?

A

truncal obesity and pencil thin extremities, “buffalo hump” or “moon face”, hypertension and renal stones, irregular menses, psychiatric disturbances

if adrenal tumor is present, the secretion of androgens may cause masculinizing effecrs in women

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26
Q

What is the average size of functioning adrenal adenomas in Cushing Syndrome?

A

small, 2-5cm

hypoechoic

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27
Q

What is Waterhouse-Friderichsen Syndrome?

A

caused by infection with meningococcal bacteria

bacteria attacked adrenals and shut them down

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28
Q

Describe the symptoms of Waterhouse-Friderichsen Syndrome.

A

fulminant bacterial sepsis, shock, and necropsy bilateral adrenal hemorrhage
meningococcal bacteria will be in blood

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29
Q

What may Waterhouse-Friderichsen Syndrome be complicated with?

A

acute adrenocortical insufficiency

in up to 25% of severely traumatized patients

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30
Q

Sonographically, what does Waterhouse-Friderichsen Syndrome look like?

A

depending on hemorrhage stage - hyperechoic to anechoic

overtime, the mass may shrink and calcifications may appear

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31
Q

Why is sonography used to image adrenal masses?

A

to…
characterize an adrenal mass as cystic or solid
evaluate the position and patency of the IVC and draining veins
evaluate tumor invasion into an adjacent structure
determine the origin of a large retroperitoneal mass
follow an adrenal mass that in not surgically removed

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32
Q

Describe adrenal cysts.

A

uncommon
3x more likely in females than males
typically unilateral and asymptomatic

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33
Q

Describe adrenal hemorrhage and what causes it.

A

rare in adults
caused by severe trauma or infection
usually unilateral - no major clinical problem
sonographically is variable and complex

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34
Q

If adrenal hemorrhage is bilateral, what could happen?

A

adrenal insufficiency

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35
Q

In whom is adrenal hemorrhage more common in?

A

neonates who experience traumatic delivery

adrenals in neonates are very vascular

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36
Q

Adrenal nodules are usually what size?

A

less than 2.5cm

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37
Q

Who has a higher incidence of adrenal adenoma?

A

older patients with diabetes or hypertension

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38
Q

What is the most common primary adrenal tumor?

A

benign functioning adenoma

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39
Q

What is the sonographic findings for non-functioning adrenal adenoma?

A

well-defined, round, slightly hypoechoic, homogeneous mass
incidental
may be so large it compresses adjacent structures

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40
Q

What are the classifications of malignant adrenal tumors?

A

hyperfunctional and nonfunctional

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41
Q

What is a hyperfunctional tumor?

A

it will be found faster clinically (than a nonfunctional tumor) because the patient will have symptoms

hyperfunctional tumors are more common in women

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42
Q

What diseases may adrenal malignant tumors cause?

A

cushing syndrome, conn’s syndrome, or adrenogenital syndrome

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43
Q

What do adrenal malignant tumors look like sonographically?

A

homogeneous with the same echogenicity as the renal cortex
larger tumors tend to be nonfunctional and heterogeneous with a central area of necrosis and hemorrhage and calcification
tumor is hypervascular with high inidence of invasion of the adrenal or renal vein, IVC, hepatic veins, and lymph nodes

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44
Q

Where does pheochromocytoma arise from?

A

the chromaffin cells in the adrenal medulla

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45
Q

What does this (pheochromocytoma) secrete?

A

epinephrine and norepinephrine in excessive quantities

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46
Q

List the clinical symptoms of pheochromocytoma.

A

intermittent hypertension, severe headaches, heart palpitations and excessive perspiration

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47
Q

What are the sonographic findings for such a tumor?

phenochromocytoma

A

homogeneous pattern, weak posterior wall, poor through-transmission, unilateral, may be large and bulky, variable (cystic, solid, calcified)

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48
Q

What is the most common malignancy of the adrenal glands in childhood?

A

adrenal neuroblastoma

30% of all neonatal tumors

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49
Q

What is am adrenal neuroblastoma?

A

a well-encapsulated tumor that displaces the kidney inferiorly and laterally and elevates levels of the vanillylmandelic acid (VMA) and homovanillic acid (HVA)

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50
Q

What percentage of fetal neuroblastoms occur in the adrenals?

A

more than 90%

50% have cystic components

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51
Q

Where does the adrenal neuroblastoma arrise from?

A

the adrenal medulla

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52
Q

What are the symptoms for adrenal neuroblastomas?

A

usually children are asymptomatic

some have palpable abdominal mass (must be differntiated between hydro and hemorrhage)

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53
Q

Is spontaneous regression normal for adrenal neuroblastomas?

A

yes, before 1 year old

otherwise prognosis is poor (tumor not being responsive to chemo or radiation)

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54
Q

What is the sonographic look for adrenal neuroblastomas?

A

heterogeneously echogenic with poorly defined margins, some have interal califications with cystic areas
the ultrasound lobule (increased area of echogenicity in the tumor) is characteristic
capsular color flow - low resistance

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55
Q

What are the differentials for a large, solid upper abdominal mass found in children?

A

neuroblastoma, wilms tumor (nephroblastoma), hepatoblastoma

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56
Q

List the four most common sites for metastasis.

A

lung, liver, bone, adrenals

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57
Q

For adrenal mets, how common is it for both glands to be involved?

A

occurs in more that half of patients

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58
Q

What is the sonographic findings for adrenal mets?

A

nonspecific

may contain areas of necrosis and hemorrhage

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59
Q

What is the normal AP dimension for lymph nodes?

A

less than 1cm

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60
Q

When do lymph nodes enlarge?

A

with infection

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61
Q

What are the major lymph areas in the retroperitoneum?

A

iliac and hypogastric nodes and paraaortic nodes

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62
Q

Describe the sonographic appearace of paraaortic lymph nodes.

A 
mantle of nodes in the paraspinal location
floating or anteriorly displaced aorta, secondary to the enlarged nodes
sandwich sign (anterior vessel, node, posterior vessel)

homogeneous and transmit sound easily

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63
Q

What is the best patient position to view the paraaortic lymph nodes?

A

patient in supine or decubitus position

left coronal view using left kidney as window

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64
Q

What is the most common primary retroperitoneal tumor?

A

lymphoma

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65
Q

Where are the primary areas to evaluate for lymphadenopathy?

A

hepatic and splenic hilum, origin of celiac, SMA, and paraaortic and renal hilar areas

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66
Q

Describe the typical sonographic appearance of lymphoma.

A

round, hypoechoic masses, anechoic masses with good posterior enhancement, increased intranodal vascularity

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67
Q

What is the second most common primary retroperitoneal tumor?

A

leiomyosarcoma

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68
Q

Where can this tumor originate?

leiomyosarcoma

A

smooth muscles of small blood vessels or within the GI tract and extend into the retroperitoneum

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69
Q

Sonographically, what do leiomyosarcomas look like?

A

large, complex mass with areas of necrosis and cystic degeneration

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70
Q

What tumors are invasive and infiltrate widely into muscles and adjoining soft tissue and sonographically are highly reflective?

A

fibrosarcoma and rhabdomyosarcoma

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71
Q

Where do teratoma’s arrise?

A

within the upper retroperitoneum and pelvis

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72
Q

In childhood, where are teratomas commonly located?

A

upper pole of left kidney

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73
Q

List the four most common sites of germ cell tumors.

A

ovaries, testes, anterior mediastinum, and retroperitoneum

most common origin is in pelvis

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74
Q

What do germ cell tumors look like sonographically?

A

heterogeneous with solid areas, calcifications, and cystic spaces

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75
Q

What are the most common primary malignancies that spread into the retroperitoneum?

A

breast, lung, testes, recurrence of previously resected urologic or gynecologic tumors

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76
Q

What indicates seeding or invasion of the perioneal surface?

A

asitic fluid along with retroperitoneal tumor

from bad to worse: tumor; tumor with ascites; tumor with echoes in ascites

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77
Q

What is another name for retroperitoneal fibrosis?

A

Ormond’s Disease

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78
Q

What is ormond’s disease?

A

idopathic condition characterized by thick sheets of fibrous tissue in the retroperitoneal cavity

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79
Q

What is retroperitoneal fibrosis associated with?

A

infiltrating neoplasms, acute immune diseases (Crohn disease), ulcerative colitis, sclerosing cholangitis, and other conditions

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80
Q

What are the clincal signs for ormond’s disease?

A

abdominal pain, hypertension, and oligonuria

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81
Q

Sonographically, what will ormond’s disease look like?

A

abnormal hypoechoic tissue surrounding the anterolateral aspect of the aorta and/or the IVC

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82
Q

What are the functions of the urinary system?

A

A WET BED
maintaining ACID base balance, maintaining WATER balance, ELECTROLYTE balance, TOXIN removal, BLOOD pressure control, making ERYTHROPOIETIN, vitamin D metabolism

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83
Q

Where is the glomerulus located?

A

the cortex

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84
Q

What part of the nephron is located in the medulla?

A

the loop of Henle

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85
Q

What are the normal urine pH values?
What happens if urine is too acidic?
Too basic/alkaline?

A

4.6-8.0
stones and bacterium
acidosis and CRF

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86
Q

What is specific gravity and what are the normal vaulues?

A

kidneys ability to concentrate urine

1.002-1.030

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87
Q

What does protein in the urine signify? Albumin?

A

glomerular damage

albuminuria can signify neoplasm, calculi, or infection

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88
Q

What does blood in the urinie mean?

A

trauma, neoplasm, calculi, glomerular or vascular inflammation

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89
Q

List the normal levels for creatinine in the urine.

A

males: 97-137 mL/min
females: 88-128 mL/min
a deacrease is abnormal

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90
Q

What are the normal values of hematocrit?

A

male: 40.7-50.3%
females: 36.1-44.3%

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91
Q

What does BUN stand for?

State the normal values.

A

blood urea nitrogen
6-20 mg/dL
develops if kidneys can’t excrete urea properly

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92
Q

What are the normal serum creatinine levels?

A

males: .7-1.3 mg/dL
females: .6-1.1 mg/dL
elevation is abnormal

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93
Q

What is the normal thickness of the bladder walls?

A

3-6mm

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94
Q

What is the most common renal anomaly?

A

horseshoe kidney

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95
Q

List obstructive causes of hydronephrosis.

A

calculi, bladder tumors, carcinoma of cervix, stricture, UPJ obstruction, ureterocele, normal pregnancy, pelvic mass, prostatic enlargement, congenital

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96
Q

List non-obstructive causes of hydronephrosis.

A

neurogenic bladder, inflammation, pyelonephritis

97
Q

Describe the different stages of hydronephrosis.

A

Grade 1: small, fluid-filled speration of the renal pelvis
Grade 2: dilation of some, but not all calyces, renal sinus orientation still concave
Grade 3: complete pelvocaliectasis; calyx presentation is changed in convex
Grade 4: prominenet dilation of collecting system; thinning renal parenchyma, no differentiation between the collecting system and renal parenchyma

98
Q

Pyonephrosis occurs secondary to ___.

What it it associtated with?

A

long-standing ureteral obstruction

associated with severe urosepsis

99
Q

What are the symptoms of pyonephrosis?

A

fever, elevated WBC count, flank pain

100
Q

How is pyonephrosis treated?

A

with antibiotics or percutaneous drainage

101
Q

Sonographic findings of pyonephrosis:

A

low level echoes with a fluid debris, which dilate the renal pelvis

102
Q

What causes emphysematous pyonephritis?

How is it treated?

A

E. Coli

sometimes treated with emergent nephrectomy

103
Q

Sonographic appearance of emphysematous pyonephritis:

A

enlarged, hypoechoic kidneys with echogenic air pockets within the renal pelvis, giving off a dirty shadow posteriorly
generally unilateral

104
Q

What is xanthogranulomatous pyonephrosis?

A

when normal renal parenchyma is destroyed by the body’s immune system and replaced with lipid-laden foamy macrophages

105
Q

What causes xanthogranulomatous pyonephrosis, what is it’s potential, and how is it treated?

A

its a rare sequela to chronic obstruction or infection
XGP can invade adjacent organs
XGP is treated with nephrectomy

106
Q

What is the incidence for xanthogranulomatous pyonephrosis?

A

xanthogranulomatous pyonephrosis is more common in middle aged - elderly females

107
Q

Describe the sonographic appearance of xanthogranulomatous pyonephrosis.

A

renal heypertrophy, cystic replacement of renal parenchyma, possible presence of a staghorn calculus

108
Q

What categories can diffuse renal diseases be put in?

A

inflammatory, necrotic disease, and renal failure

109
Q

List the diffuse renal diseases that have increased collagen and fibrous tissue, thus having increased cortical echogenicity?

A

acute glomerulonephritis, insterstitial nephritis, acute tubular necrosis, amyloidosis, diabetic nephropathy, lupus erythematosus, myeloma

110
Q

List the diffuse renal diseases that have a loss of normal anatomic detail, thus having a loss of corticomedullary differentiation.

A

chronic pyelonephritis, renal tubular ectasia, acute bacterial nephritis

111
Q

What are the symptoms of acute glomerulonephritis?

A

facial puffiness, hematuria, or anuria

112
Q

Sonographically, what does acute glomerulonephritis look like?

A

renal hypertrophy, and increased echogenicity of renal parenchyma

113
Q

Where does acute interstitial nephritis take place within the kidney?

A

occurs in medulla

114
Q

What can cause acute interstitial nephritis?

A

often an allergic response to medication
sometimes can result from long term use of Tylenol or NSAIDS
sometimes a side effect of antibiotics

115
Q

What are the symptoms of acute interstitial nephritis?

A

uremia, hematuria or proteinuria, rash, fever and eosinophilia

116
Q

What does acute interstitial nephritis look like sonographically?

A

renaly hypertrophy, heterogeneous echotexture, increased cortical echogenicity

117
Q

Who has an increased incidence with lupus nephritis?

A

more women than med get systemic lupus erythematosus. Peak age is between 20-40 years old

118
Q

Symptoms of lupus nephritis include:

A

hematuria, proteinuria, hypertension, renal vein thrombosis and renal insufficiency

119
Q

Sonographically, lupus nephritis appears how?

A

renal atrophy, increased cortical echogenicity

120
Q

What other diseases can AIDS cause?

A

acute tubular necrosis, nephrocalcinosis, interstitial nephritis, and focal segmental glomerulosclerosis

121
Q

What can AIDS look like sonographically?

A

normal or hypertrophic renal size and increased cortical echogenicity

122
Q

What renal diseases can sickle cell disease cause?

A

glomerulonephritis, renal vein thrombosis, papillary necrosis

123
Q

What is a common symptom with sickle cell disease?

A

hematuria

124
Q

What is the sonographic appearence with sickle cell disease?

A

variable based on underlying pathology

125
Q

List causes of papillary necrosis.

A

analgesic abuse, sickle cell disease, diabetes, obstruction, pyelonephritis, renal transplant

126
Q

Causes of papillary necrosis are:

A

pyelonephrosis, obstruction, sickle cell disease, TB, cirrhosis, alcohol abuse, renal vein thrombosis, diabetes, systemic vasculitis

127
Q

Clinical symptoms of papillary necrosis include:

A

back/flank pain, bloody/cloudy/dark urine, tissue pieces in urine,
fever, chills, painfull urination, frequent urination, urgancy to urinate, uriary hesitancy, urinary incontinence, urinating large amounts, urinating often at night

128
Q

Sonographic findings of papillary necrosis include:

A

one or more fluid spaces at the pyramidal side of the corticomedullary junction and increased visualization of arcuate vessels

129
Q

Is acute tubular necrosis reversible?

A

Yes

and bilateral

130
Q

Acute tubular necrosis has several causes, including:

A

hypotension, blood transfusion reaction, medications, dye reaction, trauma, surgery, septic shock

131
Q

Where is acute tubular necrosis common?

A

in the renal transplant population

132
Q

Sonographic findings of acute tubular necrosis include:

A

bilateral renal hypertrophy, hyperechoic renal pyramids, and nephrocalcinosis

133
Q

Nephrocalcinosis occurs secondary to other chronic conditions, such as:

A

glomerulonephritis, hypercalemic states, sickle cell disease, and renal transplant rejection

134
Q

Where does nephrocalcinosis occur in the kidney?

A

typically in the medulla but may affect the cortex

135
Q

What does nephrocalcinosis look like sonographically?

A

depending on where the condition is localized
cortical: increased echogenicity of the cortex
medulla: increased echogenicity of pyramids
occurs bilaterally

136
Q

What are causes of renal infarction?

A

thrombus, tumor infiltration, obstruction, and iatrogenic injury
(when they obstruct arterial flow)

137
Q

Sonographic findings of renal infarction include:

A

irregular, echogenic areas somewhat triangular in shape along the periphery of the kidney and nodular or bumpy kidney border

138
Q

What types of renal failure are there?

A

prerenal, renal, and postrenal

139
Q

Prerenal causes of renal failure include

A

hypoperfusion, hyperperfusion, and CHF

140
Q

What does prerenal renal failure affect?

A

affecting inflow/blood

141
Q

What are renal causes of renal failure? Where do they occur?

A

infection, nephrotoxicity, renal artery occulusion, renal mass/cyst
occurs within the kidney

142
Q

What are postrenal causes of renal failure? Where does this occur?

A

lower urinary tract obstruction and retroperitoneal fibrosis

occurs when things mess with ureters and bladder

143
Q

Renal failure can also be divided into…

A

acute and chronic

144
Q

What is the sonographic appearance of renal failure?

A

acute: enlarged kidney, possible hydronephrosis, hypoechoic parenchyma
chronic: small kidney, increased echogenicity, thinning cortex

145
Q

What are the ureters made of?

A

smooth muscle tissue
the distal 1/3 of the ureter are lined with transitional epithelium and extra smooth muscle for the purposes of peristalsis

146
Q

What is the point in which the ureters exit the kidney called?

A

UPJ or ureteropelvic junction

147
Q

What is the point at which the ureters enter the bladder called?

A

UVJ or ureterovesical junction

148
Q

What can be causes of ureteral stricture?

A

congenital fibrosis, inflammatory disease, TB, localized periureteral fibrosis, impacted stone, schistostomiasis, iatrogenic injury, and radiation therapy

149
Q

Sonographic findings of a ureteral stricture are:

A

dilated ureter, tapering to a termination point and hydronephrosis

150
Q

Where do ureteropelvic obstructions take place?

A

at the level of the proximal insertion of the ureter into the kidney

151
Q

UPJ obstructions can be caused by what?

A

ATYPICAL COURSE OF BLOOD VESSELS, scar tissue from surgery, infection, and kidney stones

152
Q

UPJ obstruction, sonographically, looks like:

A

hydronephrosis AND dilated renal pelvis

the ureter is not seen

153
Q

Where does the UVJ obstruction take place?

A

at the level of the distal insertion of the ureter into the bladder

154
Q

UVJ obstructions can be caused by what?

A

congenital fibrosis, scar tissue from surgery, infection, and kidney stones

155
Q

When do UVJ obstructions usually occur?

A

in fetal development and are detected on prenatal ultrasound

156
Q

What do UVJ obstructions look like sonographically?

A

hydronephrosis and dilated ureter, tapering near or at the unsertion of the ureter into the bladder

157
Q

What can ureteroceles cause? What are they treated with?

A

reflux to the kidney

treated with antibiotics (if an inflammatory condition) and/or surgery (if congenital malformation)

158
Q

Sonographically, a ureterocele appears as:

A

a well-circumscribed cystic area at the posterior wall of the bladder

159
Q

What tissue is the bladder lined with?

A

transitional epithelium

160
Q

How much can the bladder hold?

A

between 500 and 1000 mL

161
Q

How is bladder volume assessed?

A

L x W x H x 0.52

162
Q

What is a sign of chronic cystitis?

A

increased WBC count in urine

163
Q

What can cause cystitis?

A

parasites, fungus, radiation, drug induced, catheter induced

164
Q

Sonographically, cystitis appears as:

A

visible debris within the bladder, irregular and thickened bladder wall
abnormalities can be diffuse or localized depending on the cause of severity

165
Q

What is a neurogenic bladder?

A

incontinence is secondary to brain, spinal, or nervous pathology

166
Q

What causes a neurogenic bladder?

A

alzheimer’s, birth defects, cerebral palsy, encephalitis, multiple sclerosis, parkinson’s, and stroke

167
Q

What is the peak incidence of bladder diverticulas?

A

around ages 10 and 70

168
Q

What complications can bladder diverticula result in?

A

TCC, bladder stones, bladder rupture

169
Q

What is the sonographic findings of a bladder diverticula?

A

cystic lobulations extending from the outer surface of the bladder wall and no vascular flow

170
Q

What are the categories for Bosniak classification for complex renal cysts?

A 
I simply benign
II cystic lesion
IIF minimally complicated cyst
III indeterminate cystic masses 
IV suspicious complex lesions
171
Q

Where do parapelvic cysts originate?

A

from the renal sinus (not communicating with renal collecting system)
most likely lymphatic in origin

172
Q

What are the symptoms of parapelvic cysts?

A

they are asymptomatic, but may eventually lead to obstruction

173
Q

What renal cystic conditions are associated with neoplasms?

A

von Hippel-Lindau, tuberous sclerosis, asquired cystsic kidney disease, polycystic kidney disease, multicyctic kidney disease

174
Q

What is von hippel-lindau?

A

an autosomal dominant disorder

(if one parent has it, it can be passed down

175
Q

What is von hippel-lindau characterized by?

A

retinal angioma, cerebellar hemangioblastoma, and abdominal cysts and tumors

176
Q

What is the sonographic appearance of von hippel-lindau?

A

multiple mixed lesions contained within the kidney

simple cysts, complex cysts, solid lesions

177
Q

What is tuberous sclerosis?

A

an autosomal dominant GENETIC disorder

178
Q

Tuberous sclerosis is characterized by:

A

mental retardation, seizures, adenoma sebacecum, retinal or cerebral hamartomas, multiple varied renal lesions

179
Q

Sonographic appearance of tuberous sclerosis is:

A

multiple mixed lesions within the kidney

simple cysts, complex cysts, solid lesions, ANGIOMYOLIPOMAS

180
Q

Are polycystic kidney diseases unilateral or bilateral?

A

bilateral

genetic in origin and will thus have bilateral manifestations

181
Q

What is autosomal-dominant polycystic kidney disease?

A

adult autosomal dominant form, common disorder, severity varies depending upon the genotype

182
Q

What is autosomal-recessive polycystic kidney disease?

A

infantile polycystic disease, rare disorder, chromosome 6

183
Q

When does ADPKD manifest?

A

does not usually clinically manifest until the fourth or fifth decade when hypertension or hematuria develops
by age 60, about 50% of the patients have end stage renal disease

184
Q

What are the symptoms for ADPKD?

A

pain, hypertension, palpable mass, hematuria, headache, UTI, renal insufficiency

185
Q

What are complications of ADPKD?

A

infection, hemorrhage, stone formation, rupture of cyst, renal obstruction

186
Q

The sonographic findings of ADPKD are:

A

many focal cystic lesions of varying size replacing renal cortex, hypertrophic kidney size, and obliteration of renal shape

187
Q

What are the four types of ARPKD?

A

perinatal, neonatal, infantile, juvenile

188
Q

What are the clinical signs of juvenile ARPKD?

A

hypertension, renal insufficiency, nephromegaly, hepatic cysts, bile duct proliferation, caroli’s disease of the liver, periportal fibrosis

189
Q

What are the clinical signs of prenatal ARPKD?

A

pulmonary hypoplasia, oligohydramnios, massively enlarged echogenic kidneys

190
Q

Sonographically, ARPKD shows:

A

enlarged echogenic kidneys, decreased corticomedullary differentiation, and small medullary cysts

191
Q

What is multicystic dysplastic disease caused by?

A

in utero UTI

it is the most common cystic disease in neonates

192
Q

Sonographically, multicystic dysplastic disease appears:

A

enlarged kidney and multiple cystic lesions throughout renal cortex

193
Q

What is medullary cystic disease?

A

cystic of fusiform dilation of the distal collecting ducts

resultins stasis of urine leads to stone formation

194
Q

What is the sonographic appearance of medullary cystic disease?

A

echogenic renal pyramids

195
Q

What is considered a malignant cystic mass?

A

wall thickness greater than 1mm, irregularity at the base of the cyst, septations evident, calcifications evident, and/or vascularity present in the septa and/or cystic wall

196
Q

What is the most common benign renal tumor?

A

angiomyolipoma

197
Q

What is the most common cystic disease in neonates?

A

mulcystic displastic disease

198
Q

What is the sonographic appearance of renal adenomatous tumors?

A

appear as solid masses, hyper/hypoechoic, hypovascular on color Doppler, may be indistinguishable from RCC

199
Q

When is the increased incidence of oncocytoma?

A

middle aged and older patients

200
Q

What is the sonographic appearance of oncocytoma?

A

hypoechoic in most cases, spoke wheel patterns of enhancement evident with a central scar
extremely difficult to differentiate from RCC

201
Q

What is the incidence with renal lipomas?

A

more often found in females than males and are typically asymptomatic

202
Q

What is the most common abdominal malignancy?

A

Wilm’s tumor

203
Q

What is the most common solid renal tumor in pediatric patients?

A

nephroblastoma

204
Q

What is the peak incidence of Wilm’s tumor?

A

2.5-3 years of age

205
Q

Nephroblastoma is more common in who?

A

2-8 times more common in patients with horseshoe kidney

206
Q

What are clinical signs of Wilm’s tumor?

A

abdominal/flank mass, hematuria, fever, anorexia

207
Q

Sonographic findings of nephroblastoma include:

A

hypoechoic-echogenic, most unilateral, up to 40% have renal vein thrombosis and/or IVC or atrial thrombosus at time of diagnosis

208
Q

What is the most common of all renal neoplasms?

A

Grawitz tumor

209
Q

What is the incidence of hypernephroma?

A

twice as common in men

develops in the 6th to 7th decade of life

210
Q

Clinical signs of RCC include:

A

hematuria, flank pain, palpable mass

211
Q

Sonographic findings of RCC are:

A

unilateral, singular, solid or complex isoechoic or hyperechoic lesion, the larger the more heterogeneous
tumors <3cm are hyperechoic,
hypoechoic rim (vascular pseudocapsule), presence of intratumoral calcifications are specific for RCC, low resistive index

212
Q

What cells compose TCC?

A

flat(high grade malignancy) or papillary (low grade malignancy)
papillary is most common

213
Q

What percentage of of bladder tumors are TCC?

A

95%

214
Q

Sonographic findings of TCC include:

A

hypoechoic mass in the collecting system, with low vascularity on color Doppler, calcifications are rare, may invade adjacent renal parenchyma and form an infiltrating mass

215
Q

Clinical findings of squamous cell carcinoma are:

A

history of chronic irritation, gross hematuria, palpable kidney secondary to severe hydronephrosis

216
Q

What is the prognosis of squamous cell carcinoma?

A

rare, highly invasive tumor with a poor prognosis

217
Q

What is the sonographic appearance of squamous cell carcinoma?

A

large mass is evident in renal pelvis, obstruction from kidney stones may also be present

218
Q

What is the sonographic finding for renal lymphoma?

A

enlarged, hypoechoic kidneys, very hyperechoic renal tumors with poorly defined margins without enhancement

219
Q

List the common primary malignancies to metastasize to the kidneys.

A

lung, breast, RCC of contralateral kidney

220
Q

What is the sonographic appearance of renal mets?

A

multiple, poorly marginated, hypoechoic masses
renal enlargement without a discrete mass may occur, tumor may be multifocal (uncommon), may spread beyond renal capsule and invade the venous channel

221
Q

A 55 year-old male presents to the ultrasound department for a renal sonogram. The ordering diagnosis states that the patient has uremia. The patient reports taking antibiotics for a staph infection on his leg. Imaging demonstrates bilaterally enlarged echogenic kidneys with heterogeneous cortical tissue. Which is most likely?

A

Acute interstitial nephritis

222
Q

A 25 year old female presents for a renal sonogram with an ordering diagnosis of recurrent UTI. Initial imaging demonstrates a normal left kidney, but the right kidney is not easily identified in the right renal fossa. Assuming the reason for this difficulty is an ectopic kidney, where would be to most likely place for the unidentified kidney to be located?

A

pelvis

223
Q

A 75 year-old female inpatient is transported to the ultrasound department for a renal sonogram. The patient has a history of chronic recurrent nephritis and now presents with acute renal failure. Imaging demonstrates the presence of a staghorn calculus and cystic replacement of renal parenchyma. Which is most likely?

A

Xanthogranulomatous pyonephrosis

224
Q

A patient presents with flank pain x 4 days and 2 episodes of gross hematuria in the last 6 hours. A urinalysis reveals acidic urine. Which is the most likely diagnosis?

A

renal stones

225
Q

A patient presents for renal sonogram with recurrent UTI as the ordering diagnosis. Imaging demonstrates grade I hydronephrosis on the right side. Bilateral ureteral jets are obtained at the trigone of the bladder. The left jet is unremarkable. There is a well-circumscribed cystic outpouching within the bladder, posterior to the right jet. What is this most likely indicative of?

A

ureterocele

226
Q

A patient presents with hematuria and receives a renal sonogram. Ultrasound shows a large, vascular, irregular mass in the posterior wall of the bladder at the insertion of the ureter. This mass is most likely:

A

TCC

227
Q

Sonographic examination of a 4 year-old boy reveals a solid renal mass and presence of ipsilateral hydronephrosis. What is the most likely finding?

A

Wilm’s tumor

228
Q

An adult patient presents for sonographic evaluation of the retroperitoneum. Imaging demonstrates thrombus within the left renal vein and IVC. Which condition would be a typical concurrent finding?

A

RCC

229
Q

A 45 year-old diabetic female presents for a renal sonogram. An incidental finding is noted as a 1.8 cm hypoechoic well-circumscribed mass, superior and medial to the left kidney. The patient’s labs are drawn and no abnormality is noted. Which of the following is most likely?

A

benign non-functioning adenoma

230
Q

Sonographic examination of the kidneys and bladder of a 42 year old male reveals a central cystic region in the renal sinus that extends beyond the medial renal border. What is the term for the anatomic variant?

A

extrarenal pelvis

231
Q

An African-American woman presents with abnormal renal labs and a history of sickle-cell anemia. In addition to surveying the kidneys for gross abnormality, the sonographer should also look for:

A

renal vein thrombosis

232
Q

A 27 year-old female presents to the ultrasound department for a renal sonogram. The ordering diagnosis is hematuria. The patient denies use of any prescription medications, stating that she has only been taking Ibuprofen for a shoulder injury that occurred 6 weeks previous. Imaging demonstrates right and left renal hypertrophy and increased cortical echogenicity. Which is most likely?

A

acute interstitial nephritis

233
Q

A patient presents with acute renal failure after a CT angiogram in which contrast was used. Sonographic imaging demonstrates bilateral renal hypertrophy with very hyperechoic renal pyramids. One month later the repeat imaging reveals normal renal size and echogenicity. Which of the following is most likely?

A

acute tubular necrosis

234
Q

A right upper quadrant sonogram is ordered on a 75 year-old man for elevated liver enzymes. An incidental finding of a large, unilateral hypoechoic renal cortical mass prompts a biopsy, which returns benign. What is the most likely finding?

A

oncocytoma

235
Q

What is the most common neonatal tumor?

A

mesoblastic nephroma

generally a benign renal tumor

236
Q

What is the incidence of mesoblastic nephroma?

A

diagnosis usually made antenatally or shortly after birth

90% of cases discovered before age 1

237
Q

What are clinical symptoms of mesoblastic nephroma?

A

palpable abdominal mass

hematuria occuring less often

238
Q

Sonographically, what does mesoblastic nephroma look like?

A

well-defined with low level homogeneous echoes, increased vascularity
classical type: concentric echogenic and hypoechoic rings
cellular: complex due to hemorrhage, cyst formation, and necrosis
neonatally, polyhydramnios may be noted

Abdomen (4 decks)

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