Chapter 16- Retroperitoneum Flashcards
What are the three subdivisions of the retroperitoneum
anterior pararenal, perirenal, and posterior pararenal spaces.
List three structures in the anterior pararenal space
Pancreas, ascending and transverse colon
The perirenal space is surrounded by Gerota’s fascia. List the 5 structures inside the space.
Adrenal glands, kidney, ureter, Aorta, IVC
Blood vessels and lymph nodes are found in which retroperitoneal space?
The posterior pararenal space.
What directional terms apply to the adrena glands in relation to the kidney?
The adrenal glands are superior, medial, and anterior to the kidney
What is different about the right adrenal gland?
The right adrenal gland is more superior to the kidney and is more triangular
What is different about the left adrenal gland?
The left is more medial and is more of a cap or crescent shaped.
Normal adrenal glands are difficult to see on ultrasound. How do they appear?
Hypoechoic and less than 3 cm. Sometimes, echogenic fat surrounds the gland
The pediatric adrenal gland is proportionally larger than the adult. What are the proportions?
The neonatal adrenal gland is 1/3 the size of the kidney. The adult adrenal gland is 1/13 the size.
The lymphatic chain follows the course of which organ?
Thoracic and abdominal aorta
Lymph nodes are rarely seen on ultrasound unless infected and enlarged. How large are normal lymph nodes?
Less than 1 cm
List the =retroperitoneal structures.
Suprarenal/adrenal glands, Aorta/IVC, duodenum, pancreas, ureters, colon/cervix, kidneys, esophagus, rectum
What is the crura of the diaphragm? Which one is longer
A “tether” to the spine. The right side is longer
What 3 arteries supply each adrenal gland?
Superior suprarenal branch of the inferior phrenic, Middle suprarenal branch of the aorta, inferior suprarenal branch of the renal artery
Which adrenal gland drains directly into the IVC? Where does the other gland drain into?
The right drains into the IVC, The left drains into the left renal vein
The adrenal gland is made of two endocrine glands, the outer cortex and the medulla. Which is larger?
The outer cortex is larger
What does the cortex secrete?
mineralocorticoids, glucocorticoids, sex hormones
The main mineralocorticoid is aldosterone. What does it do?
It regulates the water content of tissue and maintains the electrolyte balance
What is the effect of insufficient aldosterone?
decreased soduim, chloride, and water in the blood and an increase of these in urine. This lowers pH and blood pressure
What do glucocorticoids do?
They are responsible for carbohydrate and protein metabolism. This increases blood sugar level.
Cortisol is the main glucocorticoid. What does it do
Cortisol converts to cortisone. With hydrocortisone it diminishes allergic reactions and inflammation
What sex hormone does the adrenal gland secrete in men? Women?
The adrenal gland secretes small amounts of both androgen and estrogen regardless of gender.
What controls the Adrenal cortex?
The pitutiary gland secretes ACTH
What does the medulla secrete?
Epinephrine and Norepinephrine
Epinephrine and Norepinephrine are part of the sympathetic nervous system. What does this mean?
They control the “fight or flight” response by elevating blood pressure and heart rate and constricting blood vessels.
With Addison disease, Cortisol and aldosterone decrease. What are some symptoms?
Atrophy of cortex, loss of appetite, skin tanning, renal failure
With Adrenogenital disease, sex hormones increase. What are some symptoms?
Ambiguous genitalia, masculinizing effects on women, early puberty in boys
With Conn Syndrome, aldosterone increases. What are some symptoms?
Adrenal adenomas, abormal ECG
With Cushing Disease, glucocorticoids increase. What are some symptoms.
Truncal obesity with thin arms, renal stones, psychiatric disturbances
What is Waterhouse-Friedrichsen Syndrome?
Bilateral adrenal hemorrhage
What is lymphadenopathy?
a diseased lymph node
What is the best method for determining if a tumor is fixed or invading? Why?
Ultrasound because you can use multiple planes and positions.
Adrenal cysts are uncommon and asymptomatic lesions. Who do they affect and what do they look like?
The affect women more commonly than men 3:1. They are typically cystic with no internal echos. May be unilateral and locular.
Adrenal Hemorrhage is rare in adults. In what demographic is it more common?
Neonates after traumatic delivery
What is the most common tumor found primarily in the adrenal gland?
Benign and nonfunctioning adrenal adenoma
Adrenal adenoma is commonly found in diabetic patients with hypertension or as a result of metastasis. How do they appear?
well defined, homogeneous, large and compressing
Hyperfunctional malignant adrenal tumors are rare but more common in women and may cause which syndromes?
Cushing’s, Conn’s, or adrenogenital syndromes
Are nonfunctional adrenal malignant tumors larger or smaller? How early are they diagnosed?
Nonfunctional tumors are usually larger and diagnosed later
How do adrenal malignant tumors appear on ultrasound?
They are hypervascular. If small they are well defined, if large they often have necrosis and calcifications.
Adrenal glands are the fourth most common site in the body for which disease?
Metastasis
How does adrenal metastasis appear? Are they bilateral or unilateral
More than 50% are bilateral. They vary in size and appearance.
What are the symptoms of a Pheochromocytoma? Are they benign or malignant?
Symptoms include increased heart palpatations, perspiration, hypertension and headaches. around 10% are malignant.
A tumor that secretes epinepherine and norepinephrine in excessive quantities is called..?
pheochromocytoma
How does pheochromocytoma appear on ultrasound?
Homogenous, unilateral, large and bulky, can have any texture
What is the most common malignancy of the adrenal glands in childhood?
Adrenal Neuroblastoma
What is the most common tumor of infancy (30% of all neonatal tumors)
Adrenal Neuroblastoma
What is adrenal neuroblastoma
A tumor that develops in the medulla and displaces the kidney inferiorly and laterally.
How does adrenal neuroblastoma appear sonographically
heterogeneous with areas of increased echogenicity
What is the most common primary retroperitoneal tumor
Lymphoma
How does lymphoma appear sonographically?
Round and hypoechoic to anechoic with enhancement
What is the second most common primary retroperitoneal tumor
Leiomyosarcoma
Where does Leiomyosarcoma originate?
May originate from small blood
vessels or within the gastrointestinal tract.
how does Leiomyosarcoma appear sonographically?
It appears as a complex mass with areas of necrosis.
What are fibrosarcoma and rhabdomyosarcoma? How do they appear?
Tumors that originate in the muscle and are invasive to other tissues. They appear highly reflective.
What is the fourth most common site for a germ cell tumor? Are they benign or malignant
The retroperitoneal space. They can be either benign or malignant
What is the sonographic appearance of a retroperitoneal hemorrhage?
New bleeds will appear hyperechoic, old bleeds will be hypoechoic. They may be complex or calcified.
