Retroperitoneum/Adrenals/Renals Flashcards
Including diffuse renal diseases and focal renal masses (238 cards)
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)
2
Q
What categories is the retroperitoneum divided into?
A
anterior pararenal space, perirenal space, posterior pararenal space
3
Q
Name the organs included in the anterior pararenal space.
A
pancreas, duedenum, ascending and transverse colon
4
Q
Name the organs included in the perirenal space.
A
adrenal glands, kidneys, ureter, and great vessels
5
Q
Name the organs included in the posterior pararenal space.
A
blood and lymph nodes
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
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
8
Q
List the normal dimensions of the adrenal glands.
A
3-6cm long
3-6mm thick
2-4cm wide
9
Q
Describe the sonographic appearance of neonate adrenal glands.
A
thin/echogenic medula
thick hypoechoic rim
three times larger than an adult adrenal
10
Q
What 3 types of steroids do the adrenals secrete?
A
sex hormones, mineralocorticoids, glucocorticoids
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
12
Q
Is the adrenal medulla essential for life?
A
no - can be removed
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)
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
15
Q
What are the primary causes of reduced adrenal cortical tissue?
A
autoimmune process (most common), TB, inflammatory process, primary neoplasm, metastases
16
Q
What is adrenogenital syndrome?
A
adrenal virilism
results from the EXCESSIVE secretion of the sex hormones and adrenal androgens
17
Q
What is adrenogenital syndrome caused by?
A
either an adrenal tumor or hyperplasia
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)
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
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)
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
22
Q
What are the clinical signs of Conn Syndrome?
A
muscle weakness/cramps, hypertension, abnormal ECG
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
24
Q
What can cause excessive secretion of cortisol?
A
adrenal hyperplasia, cortical adenoma, adrenal carcinoma, or elevated ACTH from a pituitary adenoma
25
What are the signs and symptoms of Cushing Syndrome?
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
26
What is the average size of functioning adrenal adenomas in Cushing Syndrome?
small, 2-5cm
| hypoechoic
27
What is Waterhouse-Friderichsen Syndrome?
caused by infection with meningococcal bacteria
| bacteria attacked adrenals and shut them down
28
Describe the symptoms of Waterhouse-Friderichsen Syndrome.
fulminant bacterial sepsis, shock, and necropsy bilateral adrenal hemorrhage
meningococcal bacteria will be in blood
29
What may Waterhouse-Friderichsen Syndrome be complicated with?
acute adrenocortical insufficiency
| in up to 25% of severely traumatized patients
30
Sonographically, what does Waterhouse-Friderichsen Syndrome look like?
depending on hemorrhage stage - hyperechoic to anechoic
| overtime, the mass may shrink and calcifications may appear
31
Why is sonography used to image adrenal masses?
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
32
Describe adrenal cysts.
uncommon
3x more likely in females than males
typically unilateral and asymptomatic
33
Describe adrenal hemorrhage and what causes it.
rare in adults
caused by severe trauma or infection
usually unilateral - no major clinical problem
sonographically is variable and complex
34
If adrenal hemorrhage is bilateral, what could happen?
adrenal insufficiency
35
In whom is adrenal hemorrhage more common in?
neonates who experience traumatic delivery
| adrenals in neonates are very vascular
36
Adrenal nodules are usually what size?
less than 2.5cm
37
Who has a higher incidence of adrenal adenoma?
older patients with diabetes or hypertension
38
What is the most common primary adrenal tumor?
benign functioning adenoma
39
What is the sonographic findings for non-functioning adrenal adenoma?
well-defined, round, slightly hypoechoic, homogeneous mass
incidental
may be so large it compresses adjacent structures
40
What are the classifications of malignant adrenal tumors?
hyperfunctional and nonfunctional
41
What is a hyperfunctional tumor?
it will be found faster clinically (than a nonfunctional tumor) because the patient will have symptoms
hyperfunctional tumors are more common in women
42
What diseases may adrenal malignant tumors cause?
cushing syndrome, conn's syndrome, or adrenogenital syndrome
43
What do adrenal malignant tumors look like sonographically?
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
44
Where does pheochromocytoma arise from?
the chromaffin cells in the adrenal medulla
45
What does this (pheochromocytoma) secrete?
epinephrine and norepinephrine in excessive quantities
46
List the clinical symptoms of pheochromocytoma.
intermittent hypertension, severe headaches, heart palpitations and excessive perspiration
47
What are the sonographic findings for such a tumor?
| phenochromocytoma
homogeneous pattern, weak posterior wall, poor through-transmission, unilateral, may be large and bulky, variable (cystic, solid, calcified)
48
What is the most common malignancy of the adrenal glands in childhood?
adrenal neuroblastoma
| 30% of all neonatal tumors
49
What is am adrenal neuroblastoma?
a well-encapsulated tumor that displaces the kidney inferiorly and laterally and elevates levels of the vanillylmandelic acid (VMA) and homovanillic acid (HVA)
50
What percentage of fetal neuroblastoms occur in the adrenals?
more than 90%
| 50% have cystic components
51
Where does the adrenal neuroblastoma arrise from?
the adrenal medulla
52
What are the symptoms for adrenal neuroblastomas?
usually children are asymptomatic
| some have palpable abdominal mass (must be differntiated between hydro and hemorrhage)
53
Is spontaneous regression normal for adrenal neuroblastomas?
yes, before 1 year old
| otherwise prognosis is poor (tumor not being responsive to chemo or radiation)
54
What is the sonographic look for adrenal neuroblastomas?
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
55
What are the differentials for a large, solid upper abdominal mass found in children?
neuroblastoma, wilms tumor (nephroblastoma), hepatoblastoma
56
List the four most common sites for metastasis.
lung, liver, bone, adrenals
57
For adrenal mets, how common is it for both glands to be involved?
occurs in more that half of patients
58
What is the sonographic findings for adrenal mets?
nonspecific
| may contain areas of necrosis and hemorrhage
59
What is the normal AP dimension for lymph nodes?
less than 1cm
60
When do lymph nodes enlarge?
with infection
61
What are the major lymph areas in the retroperitoneum?
iliac and hypogastric nodes and paraaortic nodes
62
Describe the sonographic appearace of paraaortic lymph nodes.
```
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
63
What is the best patient position to view the paraaortic lymph nodes?
patient in supine or decubitus position
| left coronal view using left kidney as window
64
What is the most common primary retroperitoneal tumor?
lymphoma
65
Where are the primary areas to evaluate for lymphadenopathy?
hepatic and splenic hilum, origin of celiac, SMA, and paraaortic and renal hilar areas
66
Describe the typical sonographic appearance of lymphoma.
round, hypoechoic masses, anechoic masses with good posterior enhancement, increased intranodal vascularity
67
What is the second most common primary retroperitoneal tumor?
leiomyosarcoma
68
Where can this tumor originate?
| leiomyosarcoma
smooth muscles of small blood vessels or within the GI tract and extend into the retroperitoneum
69
Sonographically, what do leiomyosarcomas look like?
large, complex mass with areas of necrosis and cystic degeneration
70
What tumors are invasive and infiltrate widely into muscles and adjoining soft tissue and sonographically are highly reflective?
fibrosarcoma and rhabdomyosarcoma
71
Where do teratoma's arrise?
within the upper retroperitoneum and pelvis
72
In childhood, where are teratomas commonly located?
upper pole of left kidney
73
List the four most common sites of germ cell tumors.
ovaries, testes, anterior mediastinum, and retroperitoneum
| most common origin is in pelvis
74
What do germ cell tumors look like sonographically?
heterogeneous with solid areas, calcifications, and cystic spaces
75
What are the most common primary malignancies that spread into the retroperitoneum?
breast, lung, testes, recurrence of previously resected urologic or gynecologic tumors
76
What indicates seeding or invasion of the perioneal surface?
asitic fluid along with retroperitoneal tumor
| from bad to worse: tumor; tumor with ascites; tumor with echoes in ascites
77
What is another name for retroperitoneal fibrosis?
Ormond's Disease
78
What is ormond's disease?
idopathic condition characterized by thick sheets of fibrous tissue in the retroperitoneal cavity
79
What is retroperitoneal fibrosis associated with?
infiltrating neoplasms, acute immune diseases (Crohn disease), ulcerative colitis, sclerosing cholangitis, and other conditions
80
What are the clincal signs for ormond's disease?
abdominal pain, hypertension, and oligonuria
81
Sonographically, what will ormond's disease look like?
abnormal hypoechoic tissue surrounding the anterolateral aspect of the aorta and/or the IVC
82
What are the functions of the urinary system?
A WET BED
maintaining ACID base balance, maintaining WATER balance, ELECTROLYTE balance, TOXIN removal, BLOOD pressure control, making ERYTHROPOIETIN, vitamin D metabolism
83
Where is the glomerulus located?
the cortex
84
What part of the nephron is located in the medulla?
the loop of Henle
85
What are the normal urine pH values?
What happens if urine is too acidic?
Too basic/alkaline?
4.6-8.0
stones and bacterium
acidosis and CRF
86
What is specific gravity and what are the normal vaulues?
kidneys ability to concentrate urine
| 1.002-1.030
87
What does protein in the urine signify? Albumin?
glomerular damage
| albuminuria can signify neoplasm, calculi, or infection
88
What does blood in the urinie mean?
trauma, neoplasm, calculi, glomerular or vascular inflammation
89
List the normal levels for creatinine in the urine.
males: 97-137 mL/min
females: 88-128 mL/min
a deacrease is abnormal
90
What are the normal values of hematocrit?
male: 40.7-50.3%
females: 36.1-44.3%
91
What does BUN stand for?
| State the normal values.
blood urea nitrogen
6-20 mg/dL
develops if kidneys can't excrete urea properly
92
What are the normal serum creatinine levels?
males: .7-1.3 mg/dL
females: .6-1.1 mg/dL
elevation is abnormal
93
What is the normal thickness of the bladder walls?
3-6mm
94
What is the most common renal anomaly?
horseshoe kidney
95
List obstructive causes of hydronephrosis.
calculi, bladder tumors, carcinoma of cervix, stricture, UPJ obstruction, ureterocele, normal pregnancy, pelvic mass, prostatic enlargement, congenital
96
List non-obstructive causes of hydronephrosis.
neurogenic bladder, inflammation, pyelonephritis
97
Describe the different stages of hydronephrosis.
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
Pyonephrosis occurs secondary to ___.
| What it it associtated with?
long-standing ureteral obstruction
| associated with severe urosepsis
99
What are the symptoms of pyonephrosis?
fever, elevated WBC count, flank pain
100
How is pyonephrosis treated?
with antibiotics or percutaneous drainage
101
Sonographic findings of pyonephrosis:
low level echoes with a fluid debris, which dilate the renal pelvis
102
What causes emphysematous pyonephritis?
| How is it treated?
E. Coli
| sometimes treated with emergent nephrectomy
103
Sonographic appearance of emphysematous pyonephritis:
enlarged, hypoechoic kidneys with echogenic air pockets within the renal pelvis, giving off a dirty shadow posteriorly
generally unilateral
104
What is xanthogranulomatous pyonephrosis?
when normal renal parenchyma is destroyed by the body's immune system and replaced with lipid-laden foamy macrophages
105
What causes xanthogranulomatous pyonephrosis, what is it's potential, and how is it treated?
its a rare sequela to chronic obstruction or infection
XGP can invade adjacent organs
XGP is treated with nephrectomy
106
What is the incidence for xanthogranulomatous pyonephrosis?
xanthogranulomatous pyonephrosis is more common in middle aged - elderly females
107
Describe the sonographic appearance of xanthogranulomatous pyonephrosis.
renal heypertrophy, cystic replacement of renal parenchyma, possible presence of a staghorn calculus
108
What categories can diffuse renal diseases be put in?
inflammatory, necrotic disease, and renal failure
109
List the diffuse renal diseases that have increased collagen and fibrous tissue, thus having increased cortical echogenicity?
acute glomerulonephritis, insterstitial nephritis, acute tubular necrosis, amyloidosis, diabetic nephropathy, lupus erythematosus, myeloma
110
List the diffuse renal diseases that have a loss of normal anatomic detail, thus having a loss of corticomedullary differentiation.
chronic pyelonephritis, renal tubular ectasia, acute bacterial nephritis
111
What are the symptoms of acute glomerulonephritis?
facial puffiness, hematuria, or anuria
112
Sonographically, what does acute glomerulonephritis look like?
renal hypertrophy, and increased echogenicity of renal parenchyma
113
Where does acute interstitial nephritis take place within the kidney?
occurs in medulla
114
What can cause acute interstitial nephritis?
often an allergic response to medication
sometimes can result from long term use of Tylenol or NSAIDS
sometimes a side effect of antibiotics
115
What are the symptoms of acute interstitial nephritis?
uremia, hematuria or proteinuria, rash, fever and eosinophilia
116
What does acute interstitial nephritis look like sonographically?
renaly hypertrophy, heterogeneous echotexture, increased cortical echogenicity
117
Who has an increased incidence with lupus nephritis?
more women than med get systemic lupus erythematosus. Peak age is between 20-40 years old
118
Symptoms of lupus nephritis include:
hematuria, proteinuria, hypertension, renal vein thrombosis and renal insufficiency
119
Sonographically, lupus nephritis appears how?
renal atrophy, increased cortical echogenicity
120
What other diseases can AIDS cause?
acute tubular necrosis, nephrocalcinosis, interstitial nephritis, and focal segmental glomerulosclerosis
121
What can AIDS look like sonographically?
normal or hypertrophic renal size and increased cortical echogenicity
122
What renal diseases can sickle cell disease cause?
glomerulonephritis, renal vein thrombosis, papillary necrosis
123
What is a common symptom with sickle cell disease?
hematuria
124
What is the sonographic appearence with sickle cell disease?
variable based on underlying pathology
125
List causes of papillary necrosis.
analgesic abuse, sickle cell disease, diabetes, obstruction, pyelonephritis, renal transplant
126
Causes of papillary necrosis are:
pyelonephrosis, obstruction, sickle cell disease, TB, cirrhosis, alcohol abuse, renal vein thrombosis, diabetes, systemic vasculitis
127
Clinical symptoms of papillary necrosis include:
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
Sonographic findings of papillary necrosis include:
one or more fluid spaces at the pyramidal side of the corticomedullary junction and increased visualization of arcuate vessels
129
Is acute tubular necrosis reversible?
Yes
| and bilateral
130
Acute tubular necrosis has several causes, including:
hypotension, blood transfusion reaction, medications, dye reaction, trauma, surgery, septic shock
131
Where is acute tubular necrosis common?
in the renal transplant population
132
Sonographic findings of acute tubular necrosis include:
bilateral renal hypertrophy, hyperechoic renal pyramids, and nephrocalcinosis
133
Nephrocalcinosis occurs secondary to other chronic conditions, such as:
glomerulonephritis, hypercalemic states, sickle cell disease, and renal transplant rejection
134
Where does nephrocalcinosis occur in the kidney?
typically in the medulla but may affect the cortex
135
What does nephrocalcinosis look like sonographically?
depending on where the condition is localized
cortical: increased echogenicity of the cortex
medulla: increased echogenicity of pyramids
occurs bilaterally
136
What are causes of renal infarction?
thrombus, tumor infiltration, obstruction, and iatrogenic injury
(when they obstruct arterial flow)
137
Sonographic findings of renal infarction include:
irregular, echogenic areas somewhat triangular in shape along the periphery of the kidney and nodular or bumpy kidney border
138
What types of renal failure are there?
prerenal, renal, and postrenal
139
Prerenal causes of renal failure include
hypoperfusion, hyperperfusion, and CHF
140
What does prerenal renal failure affect?
affecting inflow/blood
141
What are renal causes of renal failure? Where do they occur?
infection, nephrotoxicity, renal artery occulusion, renal mass/cyst
occurs within the kidney
142
What are postrenal causes of renal failure? Where does this occur?
lower urinary tract obstruction and retroperitoneal fibrosis
| occurs when things mess with ureters and bladder
143
Renal failure can also be divided into...
acute and chronic
144
What is the sonographic appearance of renal failure?
acute: enlarged kidney, possible hydronephrosis, hypoechoic parenchyma
chronic: small kidney, increased echogenicity, thinning cortex
145
What are the ureters made of?
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
What is the point in which the ureters exit the kidney called?
UPJ or ureteropelvic junction
147
What is the point at which the ureters enter the bladder called?
UVJ or ureterovesical junction
148
What can be causes of ureteral stricture?
congenital fibrosis, inflammatory disease, TB, localized periureteral fibrosis, impacted stone, schistostomiasis, iatrogenic injury, and radiation therapy
149
Sonographic findings of a ureteral stricture are:
dilated ureter, tapering to a termination point and hydronephrosis
150
Where do ureteropelvic obstructions take place?
at the level of the proximal insertion of the ureter into the kidney
151
UPJ obstructions can be caused by what?
ATYPICAL COURSE OF BLOOD VESSELS, scar tissue from surgery, infection, and kidney stones
152
UPJ obstruction, sonographically, looks like:
hydronephrosis AND dilated renal pelvis
| the ureter is not seen
153
Where does the UVJ obstruction take place?
at the level of the distal insertion of the ureter into the bladder
154
UVJ obstructions can be caused by what?
congenital fibrosis, scar tissue from surgery, infection, and kidney stones
155
When do UVJ obstructions usually occur?
in fetal development and are detected on prenatal ultrasound
156
What do UVJ obstructions look like sonographically?
hydronephrosis and dilated ureter, tapering near or at the unsertion of the ureter into the bladder
157
What can ureteroceles cause? What are they treated with?
reflux to the kidney
| treated with antibiotics (if an inflammatory condition) and/or surgery (if congenital malformation)
158
Sonographically, a ureterocele appears as:
a well-circumscribed cystic area at the posterior wall of the bladder
159
What tissue is the bladder lined with?
transitional epithelium
160
How much can the bladder hold?
between 500 and 1000 mL
161
How is bladder volume assessed?
L x W x H x 0.52
162
What is a sign of chronic cystitis?
increased WBC count in urine
163
What can cause cystitis?
parasites, fungus, radiation, drug induced, catheter induced
164
Sonographically, cystitis appears as:
visible debris within the bladder, irregular and thickened bladder wall
abnormalities can be diffuse or localized depending on the cause of severity
165
What is a neurogenic bladder?
incontinence is secondary to brain, spinal, or nervous pathology
166
What causes a neurogenic bladder?
alzheimer's, birth defects, cerebral palsy, encephalitis, multiple sclerosis, parkinson's, and stroke
167
What is the peak incidence of bladder diverticulas?
around ages 10 and 70
168
What complications can bladder diverticula result in?
TCC, bladder stones, bladder rupture
169
What is the sonographic findings of a bladder diverticula?
cystic lobulations extending from the outer surface of the bladder wall and no vascular flow
170
What are the categories for Bosniak classification for complex renal cysts?
```
I simply benign
II cystic lesion
IIF minimally complicated cyst
III indeterminate cystic masses
IV suspicious complex lesions
```
171
Where do parapelvic cysts originate?
from the renal sinus (not communicating with renal collecting system)
most likely lymphatic in origin
172
What are the symptoms of parapelvic cysts?
they are asymptomatic, but may eventually lead to obstruction
173
What renal cystic conditions are associated with neoplasms?
von Hippel-Lindau, tuberous sclerosis, asquired cystsic kidney disease, polycystic kidney disease, multicyctic kidney disease
174
What is von hippel-lindau?
an autosomal dominant disorder
| (if one parent has it, it can be passed down
175
What is von hippel-lindau characterized by?
retinal angioma, cerebellar hemangioblastoma, and abdominal cysts and tumors
176
What is the sonographic appearance of von hippel-lindau?
multiple mixed lesions contained within the kidney
| simple cysts, complex cysts, solid lesions
177
What is tuberous sclerosis?
an autosomal dominant GENETIC disorder
178
Tuberous sclerosis is characterized by:
mental retardation, seizures, adenoma sebacecum, retinal or cerebral hamartomas, multiple varied renal lesions
179
Sonographic appearance of tuberous sclerosis is:
multiple mixed lesions within the kidney
| simple cysts, complex cysts, solid lesions, ANGIOMYOLIPOMAS
180
Are polycystic kidney diseases unilateral or bilateral?
bilateral
| genetic in origin and will thus have bilateral manifestations
181
What is autosomal-dominant polycystic kidney disease?
adult autosomal dominant form, common disorder, severity varies depending upon the genotype
182
What is autosomal-recessive polycystic kidney disease?
infantile polycystic disease, rare disorder, chromosome 6
183
When does ADPKD manifest?
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
What are the symptoms for ADPKD?
pain, hypertension, palpable mass, hematuria, headache, UTI, renal insufficiency
185
What are complications of ADPKD?
infection, hemorrhage, stone formation, rupture of cyst, renal obstruction
186
The sonographic findings of ADPKD are:
many focal cystic lesions of varying size replacing renal cortex, hypertrophic kidney size, and obliteration of renal shape
187
What are the four types of ARPKD?
perinatal, neonatal, infantile, juvenile
188
What are the clinical signs of juvenile ARPKD?
hypertension, renal insufficiency, nephromegaly, hepatic cysts, bile duct proliferation, caroli's disease of the liver, periportal fibrosis
189
What are the clinical signs of prenatal ARPKD?
pulmonary hypoplasia, oligohydramnios, massively enlarged echogenic kidneys
190
Sonographically, ARPKD shows:
enlarged echogenic kidneys, decreased corticomedullary differentiation, and small medullary cysts
191
What is multicystic dysplastic disease caused by?
in utero UTI
| it is the most common cystic disease in neonates
192
Sonographically, multicystic dysplastic disease appears:
enlarged kidney and multiple cystic lesions throughout renal cortex
193
What is medullary cystic disease?
cystic of fusiform dilation of the distal collecting ducts
| resultins stasis of urine leads to stone formation
194
What is the sonographic appearance of medullary cystic disease?
echogenic renal pyramids
195
What is considered a malignant cystic mass?
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
What is the most common benign renal tumor?
angiomyolipoma
197
What is the most common cystic disease in neonates?
mulcystic displastic disease
198
What is the sonographic appearance of renal adenomatous tumors?
appear as solid masses, hyper/hypoechoic, hypovascular on color Doppler, may be indistinguishable from RCC
199
When is the increased incidence of oncocytoma?
middle aged and older patients
200
What is the sonographic appearance of oncocytoma?
hypoechoic in most cases, spoke wheel patterns of enhancement evident with a central scar
extremely difficult to differentiate from RCC
201
What is the incidence with renal lipomas?
more often found in females than males and are typically asymptomatic
202
What is the most common abdominal malignancy?
Wilm's tumor
203
What is the most common solid renal tumor in pediatric patients?
nephroblastoma
204
What is the peak incidence of Wilm's tumor?
2.5-3 years of age
205
Nephroblastoma is more common in who?
2-8 times more common in patients with horseshoe kidney
206
What are clinical signs of Wilm's tumor?
abdominal/flank mass, hematuria, fever, anorexia
207
Sonographic findings of nephroblastoma include:
hypoechoic-echogenic, most unilateral, up to 40% have renal vein thrombosis and/or IVC or atrial thrombosus at time of diagnosis
208
What is the most common of all renal neoplasms?
Grawitz tumor
209
What is the incidence of hypernephroma?
twice as common in men
| develops in the 6th to 7th decade of life
210
Clinical signs of RCC include:
hematuria, flank pain, palpable mass
211
Sonographic findings of RCC are:
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
What cells compose TCC?
flat(high grade malignancy) or papillary (low grade malignancy)
papillary is most common
213
What percentage of of bladder tumors are TCC?
95%
214
Sonographic findings of TCC include:
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
Clinical findings of squamous cell carcinoma are:
history of chronic irritation, gross hematuria, palpable kidney secondary to severe hydronephrosis
216
What is the prognosis of squamous cell carcinoma?
rare, highly invasive tumor with a poor prognosis
217
What is the sonographic appearance of squamous cell carcinoma?
large mass is evident in renal pelvis, obstruction from kidney stones may also be present
218
What is the sonographic finding for renal lymphoma?
enlarged, hypoechoic kidneys, very hyperechoic renal tumors with poorly defined margins without enhancement
219
List the common primary malignancies to metastasize to the kidneys.
lung, breast, RCC of contralateral kidney
220
What is the sonographic appearance of renal mets?
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
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?
Acute interstitial nephritis
222
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?
pelvis
223
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?
Xanthogranulomatous pyonephrosis
224
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?
renal stones
225
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?
ureterocele
226
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:
TCC
227
Sonographic examination of a 4 year-old boy reveals a solid renal mass and presence of ipsilateral hydronephrosis. What is the most likely finding?
Wilm's tumor
228
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?
RCC
229
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?
benign non-functioning adenoma
230
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?
extrarenal pelvis
231
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:
renal vein thrombosis
232
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?
acute interstitial nephritis
233
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?
acute tubular necrosis
234
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?
oncocytoma
235
What is the most common neonatal tumor?
mesoblastic nephroma
| generally a benign renal tumor
236
What is the incidence of mesoblastic nephroma?
diagnosis usually made antenatally or shortly after birth
| 90% of cases discovered before age 1
237
What are clinical symptoms of mesoblastic nephroma?
palpable abdominal mass
| hematuria occuring less often
238
Sonographically, what does mesoblastic nephroma look like?
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
