URINARY Section 6: PERFUSION/VASCULAR Flashcards
Subcapsular hematoma = renal compression + complex fuckery with the renin-angiotensin system.
Page Kidney
Page Kidney
Subcapsular hematoma + HTN =
Page kidney
Page Kidney
The capsule is the real issue here.
Hematoma in subcapsule = tough capsule = wont’ expand = hematoma squeezes the “meat of the kidney
Hypertension post biopsy, lithotripsy, or trauma
Page kidney
Delayed Nephrogram
One kidney enhances and the other doesn’t (or does to a lesser degree).
Basically this is happening from pressure on the kidney, either extrinsic from a Page kidney situation, or intrinsic from an obstructing stone.
Persistent Nephrogram
hypotension/shock and ATN.
Persistent nephrogram
The tip offs are going to be that they tell you the time (3 hours etc…) and it’s gonna be bilateral.
So wedge shaped hypodensities in the kidney can be seen with lots of stuff (infarct, tumor, infection, etc…).
Renal Infarct
Renal infarcts are most easily identified on what phase?
Post contrast imaging in the CORTICAL Phase
Renal infarct
“Cortical Rim sign”
absent immediately after the insult, but is seen 8 hours to days later. You have a dual blood supply, which allows the cortex to stay perfused.
Renal Infarct
“Flip-flop enhancement”
a region of hypodensity / poor enhancement on early phases becomes relatively hyperdense on delayed imaging.
causes of Renal vein thrombosis
dehydration
indwelling umbilical venous catheters (most common in neonates)
nephrotic syndrome (most common in adults)
Renal vein thrombosis can mimic __ in presentation
Renal stone
- Flank pain
- Enlarged kidney
- Delayed nephrogram
Renal vein thrombosis on Doppler
Reversed arterial diastolic flow
Absent venous flow
Acute Cortical Necrosis
“Reverse Rim Sign”
non- enhancing dark cortex with normal enhancement of the renal medulla.
A veeeery thin rim of contrast enhancement (cortical rim sign) can persist and this should not be mistaken for sufficient perfusion.
