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Flashcards in Urinary Pathology Week 10 Deck (86)
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1

Obstructive Nephropathy

Ureteral necrosis
Abscess
Lymphocele
Fungus ball
Retroperitoneal fibrosis
Stricture at the ureterovesical junction
Ureteral calculus
Hemorrhage into the collecting system with obstruction from clots

2

Renovascular impedance specificity

If high renovascular impedance develops immediately after surgery, patency of the renal vein must be tested.
With the use of color and pulsed Doppler imaging, renal thrombosis displays distinctive spectral pattern with a plateaulike reversal of diastolic flow (accentuated at end diastole).
Renal artery stenosis (RAS) exhibits a high-velocity jet with distal turbulence.

3

Hydronephroisis

Grading system

4

Grade 1 hydronephrosis

Small, fluid-filled separation of the renal pelvis

5

Grade 2 hydronephrosis

Dilation of some but not all calyces; renal sinus orientation still concave

6

Grade 3 hydronephrosis

Complete pelvocaliectasis; calyx presentation is changed in convex.

7

Grade 4 hydronephrosis

: Prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma

8

With severe hydronephrosis

Parenchyma differentiaon is not seen

9

While scanning hdronephrosis

Post void residual and recheck the kidneys
May have effect on collecting system

10

Acquired causes of hydronephrosis

Bladder tumors
Carcinoma of the cervix
Calculi
Neurogenic bladder
Normal pregnancy
Pelvic mass
Prostatic enlargement
Retroperitoneal fibrosis

11

Obstruction is not

Synonymous with dilation

12

Intrinsic causes

Calculus
Stricture (Ureter)
Inflammation
Pyelonephritis
Congenital
Bladder neck obstruction
Posterior urethral valves
Ureterocele
Ureteropelvic junction (UPJ) obstruction

13

Obstructive findings

Renal insufficiency
Decreased urine output
Hypertension

14

Obstructive hydronephrosis sono findings

Fluid filled renal collecting system
thin parenchyma
hydroureter
decreased or absent ureteral jets

15

twinkle can help to

Locate stones

16

Milly distended collecting system

Overhydration

17

nonobstructive hydronephrosis

Reflux
Infection
Large extra renal pelvis
High floww tstate
distended bladder
Atrophy after obstruction
Pregnancy dilation

18

Pregnancy

Uterus can compress urters, third trimester, more common on right side

19

False positive Hydronephrosis

Arteriovenous malformation
Congenital megacalyces
Extrarenal pelvis
Papillary necrosis
Parapelvic cysts
Persistent diuresis
Reflux
Renal artery aneurysm

20

Localized hydronephrosis

Duplex
strictures
In females, may insert lower which can cause dribbling

21

False negative hydronephrosis

Retroperitoneal fibrosis or necrosis
Distal calculi “newly” lodged
Staghorn calculus
PCKD and multicystic KD
Parapelvic cysts

22

Staghorn

Fills the collecting system

23

Pyonephrosis

Pus within the collecting system
Severe urosepsis

24

Pyonephrosis is

A true urologic emergency that requires IV antibiotics

25

When does pyonephrosis occur

Long-standing ureteral obstruction from calculus disease, stircture or congenital anomaly

26

Most renal infections

Stay in the kidneys

27

Perirenal abscess

Direct extension

28

Sono findings of pyonephritis

Low level echoes with a fluid debris level
May find an anechoic dilated

29

Pyonephrosis Clinical

Renal insufficiency
Hematuria

30

Emphysemtous pyelonephritis

Occurs when air is in the parenchyma
May be caused by E-Coli
Dirty shadowing

31

Emphysematous is unilateral/bilateral

Unilateral

32

Sono findindings of emphysematous pyeloniptitus

Enlarged kidneys are hypoechoic and inflamed
Avascular
Area in the kidney that does not perfuse like the rest

33

Xanthogranulomatous Pyelonephritis

Uncommon renal disease associated with chronic obstruction and infection
Involves the destruction of renal parenchyma and the infiltration of lipid-laden histiocytes
Presenting symptoms include a large, nonfunctioning kidney, staghorn calculus, and multiple infections.
More common in females

34

Xanthogranulomatous Pyelonephritis clincial findings

Multiple infections
Nonfunctioning kidneys
`

35

Xanthogranulomatous Pyelonephritis sono appearance

“Staghorn appearance” which can cause echogenicity
Destruction of renal parenchyma ↑ (Cystic spaces)
Echogenicity ↑
Renal size is increased
Dilated calyces
Disease may be diffuse or segmental

36

Renal calcifications Localized parenchymal

scar tissue by bacterial infection, abscess, infected hematoma, urinoma, lymphocele, TB, infarction, post-percutaneous procedures
Seen in cystic and solid masses
Seen in vascular components

37

Renal calcifications intraluminal calcifcations

Renal calculi
Milk of calcium Diveticulum

38

Benign renal masses

May calcify

39

Nephrocalcinosis

Parenchymal calcification occurs
Affects both kidneys
Diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex.

40

Cortical nephrocalcinosis

most commonly seen with chronic glomerulonephritis, chronic hypercalemic states, sickle cell disease, and rejected renal transplants.

41

MSK

Anatomic, causes stasis and stone formation, shadowing within them
Anatomic, not metabolic (Therefore may be unilateral or segmental)

42

Nephrocalinosis calcification may be

dystrophic from devitalized tissues, ischemia and/or necrosis, or from hypercalemic states, hyperparathyroidism, renal tubular acidosis, and renal failure.

43

sonographic findings nephrocalcinosis

Cortical nephrocalcinosis appears as increased cortical echogenicity with spared pyramids.
Medullary nephrocalcinosis pyramids become more echogenic than the adjacent cortex.

44

Cortical nephrocalcinosis appearance

appears as increased cortical echogenicity with spared pyramids.

45

Medullary nephrocalcinosis appearance

pyramids become more echogenic than the adjacent cortex.

46

Urolithiasis

stone in urinary system
Majority of stones formed in the kidney and course down the urinary tract

47

Stones

Made up of a comnination f chemical from urine

48

Chemicals in kidney stones

Uric acid, calcium, systene, zanthene

49

Kidney stone size

Most are small and can travel through the urinary system with increased hydration and without treatment.
Large stones that fill the renal collecting system, called staghorn calculi
Some kidney stones may obstruct the ureter in the constricted areas.

50

Where do urolithasis

Can develop anywhere in urinary tract

51

Kidney stones are more common in

Men
Ppl who have a hx of kidney stones

52

When do kidney stones form

Excessive amounts of solutes in filtrate
Insufficient fluid intake – major factor for calculi formation
Urinary tract infection

53

Stones are associated with

Acidosis

54

Stones clinically

Extreme pain, cramping on side (flank pain), may be lower in the plevis

55

Manifestations only occur with obstruction of urine flow

May lead to infection
Hydronephrosis with dilation of calyces
If located in kidney or ureter and atrophy

56

Tx of stones

Lithotripsy (breaks apart stone)
Pertucutanous nephrlithotomy
Scope removal of stone (Mid or lower urinary tract stones)

57

Early treatment of stones

Can reverse the damage done by stones

58

Sono findings of kidney stone

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.

59

Blockage for long time

Thinning of parenchyma

60

When looking for urolithasis

Turn off compound imaging to optimize posterior acoustic shadowing

61

Colour and power doppler

Can cause twinkling artifact
Rapidly changing mix of colours behind the stone

62

Urinary bladder

US is not the imaging modality of choice
Cystoscopy

63

TA sonography

Bladder lesions greater than 5mm

64

Bladder normal

should be smooth and uniform
3-6mm
evaluate residual volume

65

Normal post void residual bladder

<20ml

66

Bladder diverticulum

Hernination/outpouching of the bladder wall
My be single or multiple
Can be acquired or congenital

67

Acquired

No muscle
Neck
From increased pressure
Diverticulum lacks a muscular layer and is narrow
Associated with calculi, chronic bladder outlet or neurogenic bladder

68

Congenital bladder diveriulum

Rare
Posterior angle of bladder trigone
All components of bladder wall

69

When patients empty bladder

Diverticulum may or may not empty post void

70

Sono finding

Fluid filled sac with neck, can still be filled after void, may lead to stone formation due to stasis of the bladder

71

Uterocele

Cyst like enlargemet of distal end of ureter
Usually small and aysmptomatic but may cause obstruction or bladder outlet
More often in adults
May be bilateral or unilateral

72

Uterocele

Cobra head appearance
May change in size with urine

73

Candle stick

Continuous ureteral jet

74

Uterocele may mimic

diverticula

75

Ectopic uterocele

More common in females
Extravesical (ectopic)
May be associated with hydronephrosis
Round, thin walled cystic strcuture, may cause debris protuding into bladder

76

Inflammation of the bladder

Cystitis is usually secondary other to satistis

Cause by a number of different causes

Sonon: early: wall may appear to be normal, as duration increases, smooth bladder wall becomes diffuse or nonfiffuse with hypoechoic thickening
As progresses: fibrosis, will get more echogenic bladder

77

Bladder tumors

Mostly transitional cell carcinomas
Usually not dteetced until large

78

Bladder tumors clinical findings

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

79

bladder mass may be

Secondary
Prostate, ovarian, rectum,

80

Bladder tumors sonographic findings

Appearance of bladder masses vary.
Commonly appear as a focal bladder wall thickness
Intravesical lesions are as small as 3 to 4 mm.
Sonography unable to detect a perivesical extension and pelvic wall involvement.
Transrectal approach can be used to detect intravesicular involvement.

81

Most bladder tumors

Most bladder tumors are malignant and commonly arise from transitional epithelium of the bladder.
Often develops as multiple tumors
Diagnosed by urine cytology and biopsy

82

Bladder tumor is

invasive through wall to adjacent structures.
Metastasizes to pelvic lymph nodes, liver, and bone

83

Benign bladder tumors

Hypoechoic comapred to malignant bladder tumors but may have echogenciity as maliganancy

84

All primary bladder tumors

tumors have the same sonographic appearance: an irregular echogenic mass that projects into the lumen of the bladder.
Any bladder mass may cause outflow obstruction; the kidneys should be evaluated for hydronephrosis.

85

Primary bladder tumors

squamous cell carcinoma, adenocarcinoma, and rhabdomyosarcoma in children.

86

If something is found in bladder

Scan the kidneys