URINARY PATHOLOGY

Question 1

tuberous sclerosis looks like adult polycystic kidney disease

Answer 1

(ADPKD) adult polycystic kidney disease

Question 2

In cases of_______, calcium deposits are usually located in the medulla

Answer 2

nephrocalcinosis

Question 3

pyelonephritis or chronic renal disease appearance

Answer 3

the kidneys appear diffusely enlarged with a loss of normal anatomy.

Question 4

____ ___ ___may demonstrate renal vein thrombosis or tumor extension into the renal vein

Answer 4

Renal cell carcinoma

Question 5

_____ is in urine when major damage or destruction of (RBC) erythrocytes occurs. This condition injures the kidney and can cause acute renal failure

Answer 5

Hemoglobin

Question 6

_____ can invade the renal vein and IVC w/ tumor or thrombosis

Answer 6

Renal cell carcinoma

Question 7

_____ occurs when pus is in obstructed renal system

Answer 7

Pyonephrosis

Question 8

Autosomal dominant polycystic kidney characteristics:

Answer 8

1 latent until the fourth or fifth decade of life. 2 The severity varies, depending on the genotype. 3 may have cysts in the liver, pancreas, and spleen. 4 kidneys are small and extremely echogenic.

Question 9

most common renal ectopia:

Answer 9

The pelvic kidney (sacral kidney), (looks like pelvic tumor)

Question 10

true or false? An extrarenal pelvis appears as a central cystic region that may extend beyond the confines of the renal sinus.

Answer 10

true

Question 11

____ ___ are one of the most common kidney problems that can occur, may cause obstruction that is very painful

Answer 11

kidney stones (nephrolithiasia)

Question 12

stones that are large and fill the collecting system are called:

Answer 12

staghorn calculi

Question 13

urolithiasis

Answer 13

calculous of urinary system

Question 14

nephrolithiasis

Answer 14

calc of the kidney

Question 15

Most ___ are formed in kidney, course down urinary tract and are made of chemicals that precipitate out of urine

Answer 15

kidney stones -urolithiasis

Question 16

true or false? Most urolithiasis are small and can travel through the urinary system with increased hydration and without treatment, but some may obstruct the ureter in the constricted areas

Answer 16

true

Question 17

sonographic findings urolithiasis:

Answer 17

• Very echogenic foci with posterior acoustic shadowing
• Scanning is done along the lines of the renal fat; stones less than 3 mm may not shadow.
• Prominent renal sinus fat, mesenteric fat, and bowel have high attenuation; they may appear as an indistinct echogenic focus with questionable posterior acoustic shadowing, making it difficult to differentiate from stones

Question 18

describe what you see:

a midpole echogenic foci w/ posterior shadowing

(clean shadowing from a midpole right kidney stone (nephrolithiasis)

Answer 18

describe what you see:

a midpole echogenic foci w/ posterior shadowing

(clean shadowing from a midpole right kidney stone (nephrolithiasis)

Question 19

Majority (95%) of bladder tumors in adults are ______.

Usually not detected until they have become advanced

Patients typically have gross hematuria, dysuria, urinary frequency, or urinary urgency.

Answer 19

TCC Transisitional cell carcinoma

Question 20

Sonographic findings of bladder tumors (masses):

• Appearance varies
• Commonly appear as a focal bladder wall thickness
• Intravesical lesions are as small as 3 to 4 mm.
• US can NOT see a perivesical extension and pelvic wall involvement.
• Transrectal approach to detect intravesicular involvement.

Question 21

_____ tumors are typically hypoechoic compared with malignant bladder tumors but may have the same echogenicity.

Answer 21

benign

Question 22

true or false?

Any bladder mass may cause outflow obstruction; the kidneys should be evaluated for hydronephrosis.

Answer 22

true

Question 23

____bladder tumors include squamous cell carcinoma, adenocarcinoma, and rhabdomyosarcoma in children.

This just depends on what cells turn cancerous

Answer 23

primary

Question 24

bladder tumor

carcinoma of the urinary bladder with blood flow seen within the mass

Question 25

normal renal blood flow ## Footnote Low resistance Flow to vital organs

Answer 25

Low resistance Flow to vital organs

Question 26

All \_\_\_\_\_bladder tumors have the same sonographic appearance: an irregular echogenic mass that projects into the lumen of the bladder.

Answer 26

primary

Question 27

normal intrarenal vessels with vascular flow throughout the renal cortex

Answer 27

normal arcuate arteries a rapid systolic rise w/ RI of 0.56. gradual decrease into dystole.

Question 28

diagram of normal renal artery spectral waveform with early systolic peak (ESP) and rapd systolic upstroke followed by peak systole (PS) and gradual decrease into diastole

Answer 28

abnormal renal artery spectral waveform w/ absence of early systolic peak and a long systolic upstroke

Question 29

The most common correctable cause of hypertension.

Answer 29

(RAS) renal artey stenosis

Question 31

Most common causes of the renal artery stenosis:

Answer 31

atherosclerosis and fibromuscular dysplasia

Question 32

sonographic characteristics RAS (renal artery stenosis)

Answer 32

Overall waveform shape: “tardus” and “parvus” waveform Resistive index: RI = (S-D) ≥ 0.70 S

Question 33

what occurs when part of the tissue undergoes necrosis after the cessation of the blood supply (usually arterial occlusion), and renal function is usually normal

Answer 33

renal infarction

Question 34

renal infarction may result from:

Answer 34

* thrombus * tumor infiltration * obstruction * or be iatrogenic

Question 35

renal infarction sonographic findings:

Answer 35

* irregular areas, somewhat triangular in shape, and along the periphery of the renal border. * Irregular area may be more echogenic than renal parenchyma. * Renal contour “lumpy-bumpy.”

Question 36

renal failure:

Answer 36

* failure of the kidneys to remove metabolites from blood. * can be acute or chronic * chronic- long term disease, shrunken kidney w/ increased echogenicity

Question 37

end stage renal disease may not even be able to id kidneys because they blend in w/ sinus fat and are so shrunken

Question 38

Arteriovenous Fistula and Pseudoaneurysm

Answer 38

Question 39

bladder imaging:

Answer 39

* U.S. not modality of choice, masses of approx. 5 mm. can be seen * Bladder should always be examined with upper urinary system * Bladder must be distended to examine walls for tumors, diverticulum, thickening * Cystoscopy diagnoses early neoplasms

Question 40

bladder imaging:

Answer 40

Cystoscopy is usually used to examine the bladder because it can diagnose early neoplasms. Transabdominal sonography will allow visualization of most lesions greater than 5 mm. Transurethral intravesicular sonographic approach has been used to evaluate bladder tumors.

Question 41

bladder US technique:

Answer 41

* Bladder is distended. * Right or left lateral decubitus position is recommended. * TGC is adjusted to reduce anterior wall artifacts. * Bladder wall should be smooth and measure 3 to 6 mm. * Look for asymmetry in the walls. * Evaluate residual volume. * Ureteral jets

Question 42

Ureters: Congenital Anomalies: stricture * **Ureteral narrowing a result of fibrosis is a common form of ureteral stricture.**

Answer 42

* **Ureteral narrowing a result of fibrosis is a common form of ureteral stricture.** * Ureteral strictures may also result from inflammatory disease, tuberculosis, localized periureteral fibrosis, impacted ureteral stone, schistostomiasis, iatrogenic ureteral injury, or radiation therapy. * Other causes include amyloidosis, adjacent malignancies, metastases, extrinsic compression caused by primary retroperitoneal tumors, enlarged lymph nodes, and medial lower pole renal masses.

Question 43

sonographic evaluation of transplant (allograft)

Answer 43

Sonographic evaluation: * Renal size * hydronephrosis * perirenal fluid collections * Hematomas * Urinomas * Lymphoceles * Adequate perfusion: Doppler RI \> .7 may indicate rejection

Question 44

double ureter jet

Answer 44

single ureteral jet

Question 45

what pathology is shown? where is this bladder calc located?

Answer 45

nephrolithiasis **calc at base of bladder - ureterovesicle junction** ureter dialates all the way up to the bladder

Question 46

Ureters: Congenital Anomalies: ureterocele * **Cystlike enlargement of the lower end of the ureter** * Caused by congenital or acquired stenosis of the distal end of the ureter

Answer 46

* Cystlike enlargement of the lower end of the ureter * Caused by congenital or acquired stenosis of the distal end of the ureter * Ectopic ureteroceles are rare; are usually associated with complete ureteral duplication.

Question 47

\*\*\*ureterocele\*\*\*

Answer 47

Question 48

true or false? the most sensitive and specific way to evaluate the presence of stones is the intravenous urogram and the helical CT scan

Answer 48

true

Question 49

bladder diverticula 2 bladder diverticula; one on each side of the bladder

Answer 49

Question 50

T or F? flank pain caused by urolithiasis is a common prob. in pt. coming to ER

Answer 50

true

Question 51

what do you see? 2 stones causing hydronephrosis 2 echogenic foci wth posterior shadowing

Answer 51