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SON131-Abd 2 > Chapter 27 > Flashcards

Chapter 27 Flashcards

1
Q

What are some neonatal indications?

A 
Abnormal prenatal ultrasound
Flank masses
Abdominal distention
Anuria-no urination
Oliguria-little urination
Hematuria-blood in urine
Sepsis or UTI
Meningomyelocele-Spinal bifida
VATER and VACTERL anomalies
Abnormal external genitalia
Prune belly syndrome
Skin tags (usually near ear and associated with cardiac anomalies)
Two-vessel umbilical cord
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2
Q

What are normal kidneys characterized by?

A

Characterized by a distinct demarcation of cortex and medullary pyramids

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3
Q

Sonographic appearance of medullary pyramids

A

Medullary pyramids are large and hypoechoic

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4
Q

sonographic appearance of cortex

A

Cortex is thin with echogenicity similar to or slightly greater than the liver (cortical echogenicity usually decreases to less than that of the liver by 4-6 months)

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5
Q

Sonographic appearance of renal sinus

A

Renal sinus is hypoechoic and indistinct (lack of fat in renal sinus)

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6
Q

sonographic appearance of arcuate arteries

A

Arcuate arteries- echogenic structures at the base of the pyramid

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7
Q

What is the contour of the neonatal kidney?

A

Contour is usually lobulated from residual fetal lobulations

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8
Q

List normal anatomy for adrenal glands

A

Larger in a neonate than in an older infant or young child
Superior to the upper pole of the kidney
Lt. is slightly more medial than Rt.
In long it has an inverted “V” or “Y” shape
In transverse a portion is seen as a linear or curvilinear outline
Medulla in a neonate is a thin echogenic line surrounded by a more prominent and less echogenic cortex
When the kidney is absent or ectopic, the ipsilateral adrenal gland remains in the renal fossa, but may have an altered configuration.

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9
Q

Normal anatomy of the bladder

A

Bladder wall should be thin-walled
When distended it should be less than 3 mm
When empty wall should be less than 5 mm
Distal ureters may bee seen at bladder base on a well hydrated child.

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10
Q

What do sonographers evaluate for hydro?

A 
Sonographers evaluates for:
Severity of hydro
Unilateral vs. bilateral
If ureters and bladder are dilated
Status of renal parenchyma
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11
Q

What are common causes of hydro?

A

Common causes:
Obstruction
Reflux
Abnormal muscle development

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12
Q

What do you have to make sure of when evaluating hydro?

A

Make sure you can connect small peripheral cyst (dilated calyces) to central cyst (renal pelvis) to determine hydro vs. cyst

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13
Q

Most common cause of obstruction of the upper urinary tract

A

UPJ

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14
Q

What is the most often result of UPJ?

A

Most often result of an intrinsic narrowing or extrinsic vascular compression at the level of UPJ

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15
Q

Charactericis of UPJ

A

May be bilateral with contralateral multicystic dysplastic kidney or vesicoureteral reflux

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16
Q

When does proximal dilation occur?

A

Proximal dilation occurs and the ureter remains normal size

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17
Q

Ultrasound findings of UPJ

A

Pelvocalyceal dilation without ureteral dilation
When the obstruction is pronounced the renal pelvis extends inferiorly and medially
If vesicoureteral reflux or primary megaureter is present the ureter may be dilated
The best way to image the ureter at the UPJ is with a coronal scan plane

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18
Q

Where can ureteral obstruction be obstructed?

A

May be obstructed anywhere along its course or at ureterovesical junction

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19
Q

What are potential causes of ureteral obstruction?

A 
Potential causes:
Abscess or lymphoma
Primary megaureter
Atresia 
Ectopic ureter
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20
Q

What can cause a megaureter and define it?

A

Ureteral obstruction

Primary megaureter- hydronephrosis and hydroureter with a narrow segment of the distal ureter behind the bladder

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21
Q

Where is bilateral hydro usually found?

A

Bilateral hydronephrosis is frequently caused by obstruction at the level of the bladder or bladder outlet

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22
Q

What are some causes of bladder outlet obstruction?

A

Possible causes of obstruction:
Neurogenic bladder
Pelvic mass
Congenital anomaly such as posterior urethral valves

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23
Q

What is the most common cause of bladder outlet obstruction in male neonates?

A

Posterior urethral valves are the most common cause of bladder outlet obstruction in a male neonate

24
Q

Ultrasound findings of bladder outlet obstruction?

A

Ultrasound Findings:
Thick bladder wall
ML sagittal imaging angling caudally may demonstrate the distended posterior urethra
The resultant hydronephrosis and hydroureter are usually bilateral
Urinary ascites or perirenal urinoma can result from high-pressure vesicoureteral reflux, rupturing a calyceal fornix or tearing the renal parenchyma
Perirenal urinoma is usually anechoic, but could have septations

25
Q

Where is a n ectopic ureterocele more common?

A

More common in females

More common on the left side

26
Q

What does ectopic ureterocele results from?

A

Results from an ectopic insertion and cystic dilation of the distal ureter of the upper moiety in a completely duplicated collecting system

27
Q

US findings of ectopic ureterocele

A

Ultrasound findings:
Ectopic ureterocele, seen as a fluid mass within the urinary bladder’
Located inferomedially to the ureteral insertion of the lower pole ureter
Weigert-Meyer Rule

28
Q

describe prune belly syndrome

A

Triad of hypoplasia or deficiency of abdominal musculature, cryptorchidism, and urinary tract anomalies
Severely affected patients have urethral atresia and bilateral cystic renal dysplasia secondary to the obstruction
Resultant pulmonary hypoplasia is fatal
Less severely affected neonates have a bladder with poor contractility without obstruction; however, ureters may be ectatic and dilated
Reflux is a common finding with prune belly syndrome

29
Q

Us findings of prune belly syndrome

A

Most severely affected neonates-dysplastic echogenic kidneys
Less severely affected, nonhydronephrotic kidneys with dilated ureters and a huge bladder
Physically a wrinkled “prune like” abdomen aids in clinical diagnosis

30
Q

What is the Most common cause of renal cystic disease in the neonate?

A

MCDK

31
Q

describe MCDK

A

When hydronephrosis is excluded it is the most common cause of an abdominal mass in a newborn
Congenital
Caused by an obstruction, collecting tubules enlarge, becoming cystic and distorting the shape of the kidney.
Renal parenchyma becomes virtually nonfunctioning

32
Q

US findings of MCDK

A

Unilateral multicystic mass “cluster of grapes”
Noncommunicating cysts
No identifiable renal pelvis
Bilateral MCDK is fatal
Association with contralateral ureteropelvic junction obstruction has been noted

33
Q

What is Most severe form is seen in the neonatal stage, least severe form is seen in the infantile and juvenile stage

A

ARPKD

34
Q

describe ARPKD

A

Polycystic renal disease seen in the neonate is most often ARPKD also known as infantile polycystic disease
Not common
Female predominance 2:1

35
Q

US findings of ARPKD

A

Ultrasound findings
Bilateral renal enlargement
Increased echogenicity with loss of definition of the renal sinus, medulla, and cortex
The cystlike appearance reflects dilated renal tubules, the innumerable acoustic interfaces cause the increase in echogenicity

36
Q

What is Adult form usually appears during middle age

A

ADPKD

37
Q

describe ADPKD

A

Rarely it has been reported in a young infant
Typically presents in the fourth decade with hypertension, hematuria, and enlarged kidneys
Cyst are macroscopic and vary in size, may also be seen in the liver, spleen and pancreas
Cerebral berry aneurysm seen in 10-15% of patients with ADPKD
Patients are at increased risk of renal cell carcinoma (RCC)

38
Q

US findings ADPKD

A

Similar to ARPKD
Lack of significant renal impairment, normal amniotic fluid (in utero), family hx., and histologic sampling allows for differentiation
Cysts of varying sizes can be seen in adults-tubular and ductal cells become engorged

39
Q

US findings of acute pyelonephritis

A

sudden fever, flank pain, and tenderness
Typically begins in the bladder and ascends the ureter to the renal pelvis
May be slightly enlarged and hypoechoic
If infection spreads to the pyramids may see increased echogenicity there
Renal pelvis and ureter may show thickening
Infection can be focal or diffuse, and it may develop into an abscess

40
Q

US findings of chronic pyelonephritis

A

Repeated episodes of acute pyelonephritis
Kidneys become scarred and decreased in size
Outline of the parenchyma may be irregular
Kidneys have increased echogenicity
Difficult to separate pyramids from renal parenchyma

41
Q

describe common things for renal vein thrombosis

A

Most likely to occur in a septic/dehydrated infant
More prevalent in infants of diabetic mothers
One or both kidneys may be involved
Renal enlargement
Hematuria, proteinuria, and low platelet count

42
Q

Us findings of renal vein thrombosis

A

Starts in the small intrarenal venous branches-heterogeneous parenchyma
If it reaches the renal vein and IVC it can be seen
May have coexistent adrenal hemorrhage, particularly on the left where adrenal vein drains into the left renal vein
Calcifications may be seen in involved veins

43
Q

Most common abdominal masses in the pediatric patient are renal in origin where?

A

Most common abdominal masses in the pediatric patient are renal in origin: hydronephrosis and multicystic renal dysplasia

44
Q

What is sonographers role for renal/ adrenal tumors

A

Determine the origin of the mass
Internal pattern (cystic, solid, or mixed)
Determine whether or not there is vascular flow

45
Q

The most common renal tumor of the neonate

A

Congenital Mesoblastic Nephroma

46
Q

Describe Congenital Mesoblastic Nephroma

A

Rare
Consist of connective tissue elements and can completely replace the renal tissue
Benign but indistinguishable from Wilms’ tumor
Because the tumor may invade adjacent structures, nephrectomy is indicated
Seen in children

47
Q

Us findings of Congenital Mesoblastic Nephroma

A

Ultrasound findings:
Solid
Hypoechoic, hyperechoic, or mixed echogenicity
Mass may extend through the renal capsule into the retroperitoneum
Indistinguishable from Wilms’ tumor

48
Q

Most common intraabdominal malignant renal tumor in young children

A

Wilms tumor

49
Q

describe wilms tumor

A

Incidence of tumor peaks between 2 and 5 years of age
Usually unilateral, but can be bilateral
Risk in developing Wilms’ tumor in patients with previous Wilms’ or with a family history of Wilms’ tumor
Can occur spontaneously
Ultrasound is used to monitor the tumor size in patients undergoing chemotherapy then the appropriate time of surgery is determined

50
Q

US findings of wilms tumor

A

Ultrasound findings
Variable- homogeneous to complex
May have calcifications within
Liquefaction may represent necrosis and hemorrhage
Sharply marginated and well defined, but bulky, with a hypoechoic to hyperechoic rim surrounding mass
Can invade the renal vein, IVC, right atrium, and contralateral kidney
Spreads through direct extension into renal sinus and peripelvic soft tissues, lymph nodes in the renal hilum, and paraaortic areas
Documentation of tumor extension can have a significant bearing on the surgical approach

51
Q

Malignant tumor arising in the sympathetic chain ganglia and the adrenal medulla
Second most common abdominal tumor of childhood

A

neuroblastoma

52
Q

describe neuroblastoma

A

Occurring between the ages of 2 months and 2 years of age
May be detected on antenatal sonography or at birth
About half of these tumors arise in the medulla of the adrenal gland, although tumors have been found in the neck, mediastinum, retroperitoneum, and pelvis
Tumors that arise within the adrenal gland show an abdominal mass, hypertension, diarrhea, and bone pain if metastasis is involved.

53
Q

US findings for neuroblastoma

A

Ultrasound findings
Highly echogenic and poorly defined
Intrinsic calcifications may be seen
Smaller tumors- homogeneous and hyperechoic
Larger tumors- more complex in appearance
Adjacent kidney is displaced inferiorly and at times laterally
Majority of patients present with mets because the disease spread early and wildly
Evaluate the liver, around the aorta, celiac, and SMA for mets
Intraspinal extension can occur (15% of patients)

54
Q

Some info on adrenal hemorrhage

A

Predisposing factors-difficult delivery, large size, infants of diabetic mothers, stress and hypoxia at delivery, septicemia, and shock
May have none of the above factors and still present with abdominal mass, jaundice and anemia
Usually hemorrhage is found secondary to other complications- uncontrolled bleeding, jaundice, intestinal obstruction, hypertension, adrenal abscess, or impaired renal function

55
Q

US findings for adrenal hemorrhage

A

Ovoid enlargement of the gland
Anechoic to hyperechoic or may be mixed echogenicity- depending on age, extent, and severity of the process
Can be mistaken for an adrenal neuroblastoma initially
F/U will show decreasing size and subsequent calcification may be identified

SON131-Abd 2 (4 decks)

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