Chapter 27- Pediatric Adrenal Glands and Kidneys Flashcards
occurs when the fetus is stressed during a difficult delivery or a hypoxic insult (lack of oxygen)
adrenal hemorrhage
lie at the base of the medullary pyramids and appear as echogenic structures
arcuate arteries
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
autosomal dominant polycystic kidney disease (ADPKD)
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
autosomal recessive polycystic kidney disease (ARPKD)
most common benign renal tumor of the neonate and infant
congenital mesoblastic nephroma
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
cortex
dilatation of any tubular vessel
ectasia
occurs more commonly in females (on left side); ectopic insertion and cystic dilation of distal ureter of a duplicated renal collecting system
ectopic ureterocele
dilation of the renal collecting system
hydronephrosis
large and hypoechoic in the neonate
medullary pyramids
most common cause of renal cystic disease in the neonate; multiple cystic masses within the kidney; may have contralateral ureteral pelvic junction obstruction
multicystic dysplastic kidney (MCDK)
abnormal persistence of fetal renal blastema (potential to develop into Wilms’ tumor)
nephroblastomatosis
malignant adrenal mass seen in pediatric patients; hemorrhaging tumor principally consisting of cells resembling neuroblasts
neuroblastoma
poorly functioning enlarged kidneys
polycystic renal disease
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
posterior urethral valve
classification of cystic renal disease
Potter facies
dilation of the fetal abdomen secondary to severe bilateral hydronephrosis and fetal ascites; fetus also has oligohydramnios and pulmonary hypoplasia
prune belly syndrome
underdevelopment of the lung tissue that occurs in utero secondary to oligohydramnios
pulmonary hypoplasia
kidney becomes enlarged and edematous as a result of obstruction of the renal vein
renal vein thrombosis
most common neonatal obstruction of the urinary tract; results from intrinsic narrowing or extrinsic vascular compression
uteropelvic junction obstruction
most frequent malignant tumor in the neonate and infant
Wilm’s tumor ( nephroblastoma)
vertebral, anal, tracheoesophageal fistula, and renal anomalies
VATOR
adds cardiac and limb anomalies to the VATER syndrome
VAcTERL
What is the most common type of obstruction of upper urinary tract?
ureteropelvic junction obstruction
What is the sonographic appearance of the medullary pyramids?
hypoechoic and arranged around central sinus
The surrounding cortex is quite thin; the echogenicity is ______ or slightly _______ than normal liver parenchyma.
similar or slightly greater
Renal cortical echogenicity normally decreases less than liver by __ to ___ months of age.
4-6
The ______ _____ lie at the base of medullary pyramids and appear as intensely echogenic structures.
Arcuate arteries
Each adrenal gland lies immediately ______ to the upper pole of the kidney
Superior or Inferior?
Superior
The normal urinary bladder in thin-walled and should measure less than ____ mm
3 mm
When empty, the wall thickness increases but remains less than ___ mm
5 mm
If the child is well hydrated then the ____ ____ can be seen
distal ureters
What are the 3 most common causes of dilation of the collecting system (hydronephrosis)
1) Obstruction
2) Reflux
3) Abnormal muscle development
What is the most common cause of a bladder outlet obstruction in a male neonate?
Posterior Urethral Valves
What should we do to determine the severity of the hydronephrosis?
1) Determine where it is unilateral/bilateral
2) Determine if the ureters and bladder is dilated
3) Determine status of renal parenchyma
What are the sonographic findings of hydronephrosis?
Visible renal parenchyma w/ central cystic componenet, small peripheral cysts budding off central cysts and dilated ureter
Uteropelvic Junction Obstructions most often result from ??
Intrinsic narrowing or extrinsic vascular compression @ level of uteropelvic junction.
What are the sonograhpic findings of uteropelvic junction obstruction.
Pelvocalyceal dilation w/o ureteral dilation. When the obstruction is pronounced, the dilated renal pelvis extends inferiorly and medially
Malignant tumor that arises in sympathetic chain ganglia and adrenal medulla.
Neuroblastoma
Neuroblastoma occurs between the ages of ___ months to ____ years
2 months- 2years
What are the sonographic appearance of a neuroblastoma?
highly echogenic w/ intrinsic calcifications.
The smaller tumors are homogenous and hypoechoic whereas the larger ones are more complex.
What is a good way to differentiate between tumor and adrenal hemorrhage??
Put on color Doppler
Neoplastic growths will have increased vascularity.
What is the most common malignant renal tumor in young children and what is the typical age range?
Wilms’ Tumor
2-5 years of age
What is the 2nd most common abdominal tumor
Neuroblastoma
