Chapter 9

Question 1

A newborn boy is seen for a renal sonogram as follow-up of an OB sonogram that showed markedly distended bladder, hydro, dilated tortuous ureters, and a keyhole appearance of the proximal urethra. These finds are consistent with which of the following congenital obstructive disorders?

Answer 1

Posterior Urethral Valve

Question 2

A 2-day old infant is referred for an abdominal ultrasound because of an echogenic liver nodule seen on the prenatal OB ultrasound. Additionally the infant has a strawberry colored mass on the right side of her neck. What is this liver mass?

Answer 2

Hemangioendothelioma

Question 3

A newborn baby born after prolonged labor and breech delivvery presents with a questionable RUQ mass. At the examination , a swollen and bluish discolored scrotum is noted. Lab showed anemia. A sonogram of the RUQ and scrotum revealed a crescent-shaped hyperechoic right suprarenal mass. What is this?

Answer 3

Unilateral adrenal hemorrhage

Question 4

A prenatal sonogram reveals the presence of bilateral enlarged kidney with a loss of corticomedullary differentiation. Hepatomegaly, mildly increased hepatic echogenicity, dilated intrahepatic biliary ducts, and poorly visualized peripheral portal veins are also noted . After dilvery, the infant is referred for renal sonography which displays the same characteristic large echogenic kidneys with poor corticomedullary differentiation; macrocyst are not present. The liver abnormalities noted on OB Ultrasound is not evident. What is the cause?

Answer 4

Autosomal Recessive Polycystic Kidney Disease

Question 5

A 3-year old boy w/ abdominal pain is seen with a large, firm, palpable mass in his LUQ. He is referred for an ultrasound. A large, spherical, heterogenous LUQ mass is identified. The sonographer is able to identify the pain in the left kidney. Evaluation of the IVC and left renal vein reveals the presence of tumor thrombus. Based on the clinical presentation and findings, what does this mass represent?

Answer 5

Wilms’ Tumor

Question 6

A 1-year old girl is referred for an abdominal ultrasound after a palpable mass is noted on the right side. The child has no significant clinical signs or symptoms of disease. The US reveals multiple, non communicating cyst in the right renal bed. What is most likely cause for this?

Answer 6

Multicystic dyplastic Kidney

Question 7

A 3-week old infant presents w/ persistent jaundice, dark urine, and enlarged girth. A fasting US is needed. An enlarged liver w/ echogenic area superior to the portal vein bifuracation is demonstrated in the RUQ. No GB indicated. What is this?

Answer 7

Biliary Atresia

Question 8

A 1-month old infant is referred for US of a palpable abdominal mass. No other clinical signs or symptoms have been noted. Labs indicate elevated catecholamine levels. The ultrasound showed a 5 cm homogenous left suprarenal mass with calcifications w/i mass. There is moderate blood flow w/i the mass. What is this?

Answer 8

Neuroblastoma

Question 9

A 1-year old boy is referred for an abdominal sonogram. The history revealed that he was a premie. He presented w/ hepatomegaly and elevated AFL. A 9 cm hepatic mass w/ calcifications is noted. It appears to have invaded the portal vein. What odes the history and features suggest?

Answer 9

Hepatoblastoma

Question 10

A 3- year old girl is referred for a renal US following a 6 month history of recurrent UTI’s. The US reveals a duplicated collecting system on right kidney. Mild-moderate hydro and dilated right ureter can be followed to the bladder where there is a uterocele seen. This describes??

Answer 10

UVJ obstruction

at the level of the bladder and ureter where the uterocele is.

Question 11

What is the “twinkle sign” associated with?`

Answer 11

the shadow from the stones

Question 12

A renal stone can cause hydro and dilated ureters

True or False

Answer 12

True

Question 13

What can be done to optimize the image to better show the shadowing?

Answer 13

Use a higher frequency and turn on the harmonics button!!

Question 14

Where else should you look if there is not a kidney in the usual place?

Answer 14

Ask the patient if they have ever had a nephrectomy (at the begin of exam) then look for pelvic kidney

Question 15

What pole of the kidney is conjoined and in which part of the abdomen??

Answer 15

the lower poles

conjunction shown in the midline of abdomen

Question 16

Renal cysts are more common with what age population?

Answer 16

the older population

Question 17

What 3 requirements are needed to diagnose a renal cyst?

Answer 17

anechoic, enhancement, and thin regular smooth borders.

Question 18

anomaly characterized by multiple cysts in a nonfunctioning kidney-occurs in 1 in 4300 live births. It may be the caused by an obstructive process in utero or a cessation of the embryologic development into the meanephros. Is usually unilateral but is commonly associated with contralateral renal anomaly ( UPJ obstructions). Drugs such as antiseizure medicines can cause kidney dysplasia. A mother’s use of illegal drugs, such as cocaine and genetic causes have also been implicated
Clinical Symptoms-palpable mass. Infants with bilateral MCDK or severe contralateral renal anomaly ay have respiratory distress from the lack of amniotic fluid in utero-poor prognosis.
Sonographically-multiple non-communicating cysts in renal bed and an empty bladder. Also include the contralateral kidney for associated anomalies such as UPJ obstruction.

Answer 18

Multicystic Dysplastic Kidney

Question 19

also called Nephroblastoma-MOST COMMON renal tumor in children-more than 80% of cases are diagnoses before 5 years of with a median age of 3.5 years old. Associated with Beckwith-Wiedmann syndrome and isolated hemitrophy, WAGR syndrome and Denys-Drash syndrome- usually UNILATERAL-90% survival rate
Clinically-palpable abdominal mass, hematuria, hypertension, malaise, bleeding may occur with rupture or bleeding.
Sonographic-homogenous or complex with calcification, with associated hydronephrosis.May have a mainly intrarenal location.

Answer 19

Wilms’ Tumor

Question 20

also known as infantile polycystic kidney disease; an inherited disorder involving cystic dilation of the renal collecting ducts and varying degrees of hepatic abnormalities such as cyst, fibrosis, and portal hypertension-1 in 20,000 live births. It can manifest in various forms depending on severity. Approx. 30% die in the neonatal period or in first year of life due to respiratory insufficiency.
Sonographically-presence of bilateral kidneys with a loss of cortimedullary differentiation, the bladder will appear empty and large echogenic kidneys. Macrocysts are seen with worsening disease..

Answer 20

Autosomal Recessive Polycystic Kidney Disease

Question 21

-most significant life-threatening hepatobiliary disorder in children and is the most common indication for liver transplantation in pediatric patients; is the serious progressive disease that is the result of narrowing or obliteration of the bile ducts. Commonly involves the extrahepatic portion of biliary tree including the bladder. Idiopathic-
Clinical Findings- persistent jaundice, acholic stools, dark urine, and enlarged girth from hepatomegaly; if untreated prognosis is poor with either liver transplant or death
Sonographic Findings-triangular cord sign and abnormal gallbladder-which appears as an echogenic area superior to the portal vein bifurcation which represents the bile duct.

Answer 21

Biliary Atresia

Question 22

cystic dilation of the biliary tree that affects the CBD- occurs in 1 in 5000 live births mostly in Asians- There are five types;
1. Fusiform dilation of CBD (most common) 2. Maniests as one of more diverticula of CBD 3. Choledochocele, is a dilation of intraduodenal portion of CBD 4. Dilation of intrahepatic and extrahepatic 5. Caroli’s disease and manifests dilation of intrahepatic ducts
Clinical findings-abominal pain, vomiting, jaundice for a long period of time, palpable mass
Sonographic Findings- fusiform dilation of CBD with associated intrahepatic ductal dilation or multiple cysts in the area of porta hepatis that are separate from the GB.

Answer 22

Choledochal Cyst

Question 23

When trying to figure out between hydro and multiple cysts, what should you do?

Answer 23

Try to elongate it. If it elongates it is possible hydro.

Question 24

What is important to do when imaging a complex renal cyst?

Answer 24

Put color to determine if there is blood flow

Question 25

What is a common finding when imaging ruptured renal cysts?

Answer 25

Pericystic fluid

Question 26

What decade of life is ADPKD common in?

Answer 26

4th and 5th decade

Question 27

What disease is ADPKD most common with?

Answer 27

End Stage Renal Disease.

Question 28

Is Multicystic Dysplastic Kidney Disease usually unilateral or bilateral?

Answer 28

unilateral

Question 29

A MCDK will become _________ due to non function

Answer 29

atrophic

Question 30

In stage one of Renal Cell Carcinoma, the mass must be under ______ cm

Answer 30

7

Question 31

_________ is a tumor that causes blood in the urine.

Answer 31

Transitional Cell Carcinoma

Question 32

Angiomyolipomas are common in the ________ of the kidney

Answer 32

cortex

Question 33

Angiomyolipomas are important to diagnose because they are at risk of ________________

Answer 33

Rupture or hemorrhage

Question 34

destruction of cells at the apex of the pyramids

Answer 34

papillary necrosis

Question 35

Papillary necrosis affects the ducts that ________ the kidney

Answer 35

empties