Chapter 27- Pediatric Adrenal Glands and Kidneys

Question 1

occurs when the fetus is stressed during a difficult delivery or a hypoxic insult (lack of oxygen)

Answer 1

adrenal hemorrhage

Question 2

lie at the base of the medullary pyramids and appear as echogenic structures

Answer 2

arcuate arteries

Question 3

congenital polycystic kidney disease that usually presents during middle age; sometimes asymptomatic, the severity of the disease varies widely; presents with hypertension, hematuria, and enlarged kidneys; cysts can also form in the liver, spleen, and pancreas

Answer 3

autosomal dominant polycystic kidney disease (ADPKD)

Question 4

rare, congenital polycystic renal disease also known as infantile polycystic disease; typically presents with diffuse enlargement, sacculations, and cystic diverticula of the medullary portions of the kidneys

Answer 4

autosomal recessive polycystic kidney disease (ARPKD)

Question 5

most common benign renal tumor of the neonate and infant

Answer 5

congenital mesoblastic nephroma

Question 6

the outer rim of the kidney; the cortex is thin in the neonate, with an echogenicity similar or slightly greater than that of the normal liver parenchyma

Answer 6

cortex

Question 7

dilatation of any tubular vessel

Answer 7

ectasia

Question 8

occurs more commonly in females (on left side); ectopic insertion and cystic dilation of distal ureter of a duplicated renal collecting system

Answer 8

ectopic ureterocele

Question 9

dilation of the renal collecting system

Answer 9

hydronephrosis

Question 10

large and hypoechoic in the neonate

Answer 10

medullary pyramids

Question 11

most common cause of renal cystic disease in the neonate; multiple cystic masses within the kidney; may have contralateral ureteral pelvic junction obstruction

Answer 11

multicystic dysplastic kidney (MCDK)

Question 12

abnormal persistence of fetal renal blastema (potential to develop into Wilms’ tumor)

Answer 12

nephroblastomatosis

Question 13

malignant adrenal mass seen in pediatric patients; hemorrhaging tumor principally consisting of cells resembling neuroblasts

Answer 13

neuroblastoma

Question 14

poorly functioning enlarged kidneys

Answer 14

polycystic renal disease

Question 15

the presence of a valve in the posterior urethra; occurs only in male fetuses; most common cause of bladder outlet obstruction in the male neonate

Answer 15

posterior urethral valve

Question 16

classification of cystic renal disease

Answer 16

Potter facies

Question 17

dilation of the fetal abdomen secondary to severe bilateral hydronephrosis and fetal ascites; fetus also has oligohydramnios and pulmonary hypoplasia

Answer 17

prune belly syndrome

Question 18

underdevelopment of the lung tissue that occurs in utero secondary to oligohydramnios

Answer 18

pulmonary hypoplasia

Question 19

kidney becomes enlarged and edematous as a result of obstruction of the renal vein

Answer 19

renal vein thrombosis

Question 20

most common neonatal obstruction of the urinary tract; results from intrinsic narrowing or extrinsic vascular compression

Answer 20

uteropelvic junction obstruction

Question 21

most frequent malignant tumor in the neonate and infant

Answer 21

Wilm’s tumor ( nephroblastoma)

Question 22

vertebral, anal, tracheoesophageal fistula, and renal anomalies

Answer 22

VATOR

Question 23

adds cardiac and limb anomalies to the VATER syndrome

Answer 23

VAcTERL

Question 24

What is the most common type of obstruction of upper urinary tract?

Answer 24

ureteropelvic junction obstruction

Question 25

What is the sonographic appearance of the medullary pyramids?

Answer 25

hypoechoic and arranged around central sinus

Question 26

The surrounding cortex is quite thin; the echogenicity is ______ or slightly _______ than normal liver parenchyma.

Answer 26

similar or slightly greater

Question 27

Renal cortical echogenicity normally decreases less than liver by __ to ___ months of age.

Answer 27

4-6

Question 28

The ______ _____ lie at the base of medullary pyramids and appear as intensely echogenic structures.

Answer 28

Arcuate arteries

Question 29

Each adrenal gland lies immediately ______ to the upper pole of the kidney

Superior or Inferior?

Answer 29

Superior

Question 30

The normal urinary bladder in thin-walled and should measure less than ____ mm

Answer 30

3 mm

Question 31

When empty, the wall thickness increases but remains less than ___ mm

Answer 31

5 mm

Question 32

If the child is well hydrated then the ____ ____ can be seen

Answer 32

distal ureters

Question 33

What are the 3 most common causes of dilation of the collecting system (hydronephrosis)

Answer 33

1) Obstruction
2) Reflux
3) Abnormal muscle development

Question 34

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

Answer 34

Posterior Urethral Valves

Question 35

What should we do to determine the severity of the hydronephrosis?

Answer 35

1) Determine where it is unilateral/bilateral
2) Determine if the ureters and bladder is dilated
3) Determine status of renal parenchyma

Question 36

What are the sonographic findings of hydronephrosis?

Answer 36

Visible renal parenchyma w/ central cystic componenet, small peripheral cysts budding off central cysts and dilated ureter

Question 37

Uteropelvic Junction Obstructions most often result from ??

Answer 37

Intrinsic narrowing or extrinsic vascular compression @ level of uteropelvic junction.

Question 38

What are the sonograhpic findings of uteropelvic junction obstruction.

Answer 38

Pelvocalyceal dilation w/o ureteral dilation. When the obstruction is pronounced, the dilated renal pelvis extends inferiorly and medially

Question 39

Malignant tumor that arises in sympathetic chain ganglia and adrenal medulla.

Answer 39

Neuroblastoma

Question 40

Neuroblastoma occurs between the ages of ___ months to ____ years

Answer 40

2 months- 2years

Question 41

What are the sonographic appearance of a neuroblastoma?

Answer 41

highly echogenic w/ intrinsic calcifications.

The smaller tumors are homogenous and hypoechoic whereas the larger ones are more complex.

Question 42

What is a good way to differentiate between tumor and adrenal hemorrhage??

Answer 42

Put on color Doppler

Neoplastic growths will have increased vascularity.

Question 43

What is the most common malignant renal tumor in young children and what is the typical age range?

Answer 43

Wilms’ Tumor

2-5 years of age

Question 44

What is the 2nd most common abdominal tumor

Answer 44

Neuroblastoma