Ultrasound of the Urogenital Tract

Question 1

Indications for ultrasound of the Urinary Tract?

Answer 1

Hematuria
Dysuria
Palpable mass
Guided biopsy/cystocenteisis
Monitor Therapy

Question 2

*View ultrasound urogenital lecture; slide 3

Answer 2

Left kidney.
Long axis and short axis
*Looks like tomato

Question 3

*View ultrasound urogenital lecture; slide 5

Answer 3

Right kidney lives in the renal fossa of the liver.

*Observe mild pelvic dilation.

Question 4

Renal pelvis dilation..

Mild

Answer 4

Physiologic
Acute pyelonephritis
Early obstruction

Question 5

Renal pelvis dilation..

Moderate or severe dilation..

Answer 5

Pyelonephritis or obstructive nephropathy.

Question 6

Are the ureters normally seen on ultrasound?

Answer 6

NO

Question 7

*View ultrasound urogenital lecture; slide 7

Answer 7

Pyelectasia (dilation of the renal pelvis)

Question 8

*View ultrasound urogenital lecture; slide 9 + 10

Answer 8

Hydronephrosis

Question 9

If both of the ureters are dilated.. the problem is in the..

Answer 9

bladder!

Question 10

*View ultrasound urogenital lecture; slide 11

Answer 10

Severe hydronephrosis

Dilated pelvis of the right kidney.

Question 11

Renal disease can be… (3)

Answer 11

Focal, multifocal or diffuse.

Question 12

Diffuse disease of the kidney…

Hyperechoic renal cortex due to..

Answer 12

Hyperechoic renal cortex due to..
Lymphoscarcoma or Ethylene Glycol toxicity (acute tubular necrosis)
*View ultrasound urogenital lecture; slide 13

Question 13

Diffuse disease of the kidney…
Hyperechoic renal cortex due to..
Differentials?

Answer 13

Glomerulonephritis, 
Interstitial nephritis (leptospirosis)
Pyelonephritis
Acute tubular necrosis 
Toxic nephrosis (ethylene glycol, Easter lily)
End stage kidney
Nephrocalcinosis
Nephrosclerosis 
Amyloidosis
Leukemic infiltrate
Cats: Lymphoma, FIP + Fat deposits

Question 14

What are differentials for hypoechoic renal cortex?

Answer 14

Lymphoscarcoma
Congestion
Inflammation
*View ultrasound urogenital lecture; slide 15

Question 15

Indistinct corticomedullary junctions..

Answer 15

Difficult to assess..
Pyelonephritis 
Chronic renal disease (end stage)
May be seen normally in 5-6 year olds.
*View ultrasound urogenital lecture; slide 16

Question 16

Focal/multifocal kidney disease..

Answer 16

Nodules and cysts (nodules look the same as in the spleen/liver)
Neoplasia (may be hyper or hypo echoic)
Abscesses
Benign cortical cysts (insignificant) older patients

*View ultrasound urogenital lecture; slide 17

Question 17

*View ultrasound urogenital lecture; slide 18

Answer 17

Renal infarcts

Question 18

*View ultrasound urogenital lecture; slide 19

Answer 18

Polycystic kidneys

Question 19

Polycystic kidneys:

Answer 19

Autosomal dominant inheritable condition primarily in long haired cats (especially Persians)
Appearance from single to multiple cysts to foamy cortices
May not be symptomatic.

Question 20

*View ultrasound urogenital lecture; slide 20

Answer 20

Urinary bladder on ultrasound.

*Hard feces can shadow

Question 21

How to ultrasound the bladder

Answer 21

Evaluate the bladder including apex, body and trigone in both planes.
Moderate bladder filling is the best: need urine to interface with the wall and contents. Over distended difficult to manipulate.
*View ultrasound urogenital lecture; slide 21

Question 22

What can be in the lumen of the bladder?

Answer 22

Sand, mucus, calculi, blood clots and suspended debris.

Question 23

Ultrasound of bladder calculi

Answer 23

*View ultrasound urogenital lecture; slide 23

With ultrasound both mineral and soft tissue calculi are visible; may or may not be distinguishable from each other.

Question 24

*View ultrasound urogenital lecture; slide 24

Answer 24

Sand in the bladder

Question 25

*View ultrasound urogenital lecture; slide 25

Answer 25

View blood clots in the bladder, move the patient around to differentiate from a mass.

Question 26

*View ultrasound urogenital lecture; slide 26

Answer 26

Neoplasia and inflammatory polyps.

Question 27

What are focal and diffuse masses in the urinary bladder?

Answer 27

Neoplasia and inflammatory polyps. | May see normal ureteral papillae***

Question 28

Do you want to get samples of neoplasia with cystocenteiss?

Answer 28

NO

Question 29

******************* | Can you differentiate between neoplasia and cystitis of the bladder?

Answer 29

NO Both are equally, diffuse/focal, irregular, obstructive (non obstructive; cystitis). Neoplasia will cause lymphadenopathy.

Question 30

Normal wall thickness of the bladder?

Answer 30

<2 mm. Bladder must be adequately distended. Undistended bladder wall will appear thicker. *View ultrasound urogenital lecture; slide 28

Question 31

*View ultrasound urogenital lecture; slide 29

Answer 31

Diffuse thickening of the bladder.

Question 32

Prostate gland enlargement differentials:

Answer 32

``` BPH Cyst Prostatitis Abscess Neoplasia ```

Question 33

*View ultrasound urogenital lecture; slide 30

Answer 33

Prostate gland enlarged

Question 34

*View ultrasound urogenital lecture; slide 31

Answer 34

Prostate gland on ultrasound. | Likely to be cancer if mineralized.

Question 35

*View ultrasound urogenital lecture; slide 32

Answer 35

Uterine stump

Question 36

Uterine diseases:

Answer 36

Pyometra Endometrial hyperplasia Metritis

Question 37

Normal uterus thickness

Answer 37

20 mm max thickness.

Question 38

*View ultrasound urogenital lecture; slide 34

Answer 38

Large fluid filled uterus, lots of echoes, fluid pus mucus

Question 39

Pregnancy diagnosis on ultrasound..

Answer 39

Yes vs no | Number exact and at least, easier to count on radiograph.

Question 40

*View ultrasound urogenital lecture; slide 36

Answer 40

Pregnancy Gestational sac -20 days Gestational sac with embryo (23-25 days) Look for heartbeat with Doppler

Question 41

Pregnancy | Gestational sac at what day..

Answer 41

20 days

Question 42

Pregnancy | Gestational sac with embryo at what days:

Answer 42

23 to 25 days

Question 43

Normal fetal circulation..

Answer 43

``` The head of the fetus is to the left of the image. Umbilical vein (UV) and umbilical artery (UA) extended cranially to the liver (L). The heart (H) is visible cranial to the diaphragm. ```

Question 44

*View ultrasound urogenital lecture; slide 38

Answer 44

Pregnancy

Question 45

Pregnancy | Mandible and skull can be seen at what day..

Answer 45

46

Question 46

Pregnancy | Ribs can be seen at what day..

Answer 46

45-53

Question 47

Can ovaries be identified on ultrasound?

Answer 47

Ovaries are difficult but can be identified and evaluated caudal to the kidneys?