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SON-225 Case Studies > Henningsen Ch 5 - Hematuria > Flashcards

Henningsen Ch 5 - Hematuria Flashcards

1
Q

What are two synonyms for Renal Cell Carcinoma?

A

Hypernephroma

Adenocarcinoma

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2
Q

Which gender is more likely to have RCC, and at what age range is peak incidence?

A

Men, 60-70

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3
Q

What are the major risk factors for RCC?

A

Smoking

Obesity and Hypertension (roles not clarified)

Chemical exposure

Long-term dialysis

von Hippel-Lindau disease

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4
Q

What are the clinical signs of RCC?

A

Palpable mass

Flank pain

Weight loss

Fever

Hypertension

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5
Q

What percentage of RCCs are found incidentally?

A

>50%

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6
Q

Where can an RCC tumor spread?

A

Throughout kidney and perinephric fat

Renal vein

IVC

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7
Q

Where do RCC metastasis occur?

A

Adrenals

Bone

Brain

Kidney

Liver

Lungs

Lymph nodes

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8
Q

Define the 4 stages of RCC.

A

Stage 1 – 7 cm or smaller and only in the kidney

Stage 2 – larger than 7 cm but still only in kidney

Stage 3 – Renal vein, IVC or adrenal involvement

Stage 4 – Beyond Gerota’s fascia to more than one local node

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9
Q

What lab values are typically elevated with RCC?

A

BUN

Creatinine

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10
Q

What are the sonographic characteristics of RCC?

A
  • Isoechoic to hypoechoic, sometimes hyperechoic if small
  • Blend in with renal echotexture or complex with hemorrhage or necrosis
  • Calcifications
  • Unilateral typically
  • Vascular involvement
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11
Q

What are the 3 sections of the kidney parenchyma?

A

Cortex

Pyramids

Sinus

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12
Q

What are the 3 protective layers of the kidney?

A

Inner fibrous layer - connected to the outer layer of the ureters

Middle adipose layer - for protection of the perinephric capsule

Gerota’s fascia - outer layer surrounds the adrenal also, helps to protect and anchor the kidney

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13
Q

What 3 things do you look for when performing a sonogram due to hematuria?

A

Mass

Stone

Severe Infection

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14
Q

What are the most common causes of hematuria for someone under 40?

A

GU infection

Stones / Calcifications

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15
Q

What are the most common causes of hematuria for someone over 40?

A

Urinary tract cancer

Prostatic disease

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16
Q

What pathologies can cause hematuria with pain?

A

Stones

Renal vein thrombosis

Renal artery occlusion

Renal cancer

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17
Q

What are the risk factors for nephrolithiasis?

A

Male

Idiopathic

Familial

High concentrations of uric acids, calcium salts or calcium oxalate and calcium phosphate

Hot dry climate

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18
Q

What are the clinical symptoms of nephrolithiasis?

A

N/V

Fever

Chills

Painful urination

Dull flank pain or no pain if in UUT

Severe lower back pain if in LUT

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19
Q

What are the 2 most common sites for a stone to cause an obstruction?

A

UPJ

UVJ

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20
Q

What are two methods used to detect shadowing from a stone?

A

Harmonics

Twinkle sign artifact w/ color Doppler

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21
Q

What is the sonographic appearance of a kidney stone?

A

crescent shaped, echogenic focus

Shadowing depends on size and composition

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22
Q

What is the most common cause of pediatric hydronephrosis?

A

UPJ obstruction

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23
Q

Which kidney is most often affected by a UPJ obstruction?

A

Left

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24
Q

What are the possible causes of a UPJ obstruction?

A

Fibrous tissue bands compressing ureter

Structural abnormalities - kinking of ureter, abnormally located artery or vein

Stones

Tumors

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25
What are the sonographic characteristics of a UPJ obstruction?
Pelviectasis is present to the level of the UPJ Ballooning of the renal pelvis Atrophied parenchyma if long-standing
26
What are the clinical symptoms of a bladder mass?
Gross hematuria Leg swelling Lower back and suprapubic pain Dysuria Urinary frequency increase
27
What is the most common form of bladder cancer in the US?
Transitional Cell Carcinoma
28
What is the most common form of bladder cancer world-wide?
Squamous Cell Carcinoma
29
What are the clinical signs of TCC?
Painless hematuria Pain w/ hydro if collecting system involved Hematuria w/ clots
30
What group is most at risk for TCC?
Elderly males
31
If TCC travels to kidney, where will the tumor form and what may result?
Renal pelvis Separation and dilation of collecting system Renal contour preserved, but internal architecture distorted
32
What are the possible causes of Squamous Cell Carcinoma?
Indwelling catheters Bladder stones Infections
33
What are the sonographic characteristics of SCC?
Large mass in renal pelvis Hydronephrosis
34
What is the typical sonographic appearance of a malignant bladder mass?
Hypervascular bladder wall thickness Irregular Projecting into lumen Echogenic
35
What are the typical sources of metastasis to the urinary system?
Melanoma Lymphoma Breast CA Lung CA Pancreatic CA Stomach/colon CA Cervical CA
36
What are angiomyolipomas made up of?
Fat Muscle Arterial vessels
37
What are the clinical symptoms of AML?
Asymptomatic Palpable abdominal mass Hematuria Flank pain
38
What are the 2 types of AML?
Isolated Tuberous sclerosis associated
39
What demographic is most at risk for isolated AML and in which kidney?
Women 40-60 Right
40
When compared to Isolated AMLs, tuberous sclerosis associated AMLs are what?
Larger Bilateral Multiple
41
What are the sonographic characteristics of AML?
Intensely echogenic May have shadow Located in renal cortex
42
Are AMLs in young females typically multiple or solitary?
Solitary
43
What are the major risks with AMLs?
Rupture and/or hemorrhage Recurrence
44
What are the potential causes of a hematoma?
Trauma Post biopsy Masses (RCC and AML) Abscesses AV malformation Cysts
45
What are the clinical symptoms of a hematoma?
Mild to severe flank and abdominal pain Hematocrit may drop
46
What are the sonographic characteristics of a hematoma?
Depends on the age of bleed Anechoic - \< 24 hours Echogenic - in acute stage Complex - as it ages, clots, and degenerates May liquefy over time and return to anechoic features May displace normal structure Chronic may have areas of calcification w/ shadow
47
What demographic is most at risk for lipoma?
Middle-age women
48
What demographic is most at risk for hemangioma?
Young adults
49
What are the clinical symptoms of hemangioma?
Asymptomatic Recurrent hematuria Renal colic
50
What are the sonographic characteristics of a hemangioma and where are they typically located?
Variable echogenicity Located at PCJ or inner medulla
51
What are the clinical symptoms of lipoma?
Asymptomatic when small Abdominal and/or flank pain Occasionally hematuria
52
What are the sonographic characteristics of a lipoma?
Well defined Echogenic (fat)
53
What demographic is most at risk for oncocytoma?
Older men
54
What are the clinical symptoms of oncocytoma?
Asymptomatic when small HTN Abdominal and/or flank mass Hematuria Pain
55
What are the sonographic characteristics of a oncocytoma?
Similar to RCC Homogeneous Well defined Hypoechoic to isoechoic Radiating vessels may show on color Doppler Central scar on CT/MRI, echogenic on US if seen
56
What pathology is most likely represented in this image?
RCC
57
What pathology is most likely represented in this image?
Bladder stone
58
What pathology is most likely represented in this image?
AML
59
What pathology is most likely represented in this image?
TCC
60
What pathology is most likely represented in this image?
UPJ
61
What pathology is most likely represented in this image?
UVJ
62
60 y/o male. Microscopic hematuria. Mild HTN. Smoker. Well defined slightly hypoechoic mass in lateral mid-pole. 1.0x0.7x0.5 cm What is the most likely diagnosis and how does the patient history contribute to the diagnosis?
RCC Risk factors of Male, 60-70, smoking, HTN
63
Middle-age female. Flank pain, N/V, low-grade fever, microscopic hematuria. Mild hydro. Dilated ureter. Echogenic focus w/shadow near bladder seen post-void. What is the most likely diagnosis and what scanning techniques should be used to confirm?
Hydronephrosis and hydroureter secondary to UVJ obstruction. Use tissue harmonics to increase chance of seeing shadowing. Use color doppler to see twinkle artifact w/ comet tail
64
Male, 40 y/o w/ HX of gross hematuria No priors Very large hypoechoic mass in RT renal sinus, extending into RRV and IVC. What is the most likely diagnosis and prognosis?
TCC. Very poor due to infiltration of RRV and IVC.
65
Female, 45 y/o, mildly obese. RUQ pain, N/V after eating, elevated cholesterol, microscopic hematuria. Gallstones. Solid, well-defined iso-to-hyperechoic mass in medial mid-pole of RT kidney. What is the likely diagnosis, and what can be done to confirm?
Oncocytoma or RCC CT or MRI to see if there is a central scar, making this lesion an oncocytoma. Oncocytoma is usually asymptomatic. Symptoms here are from gallstones.
66
Male. 65 y/o. HX of painless hematuria Solid mass in RT renal cortex w/ displacement of parenchyma. Mass extends to IVC where echogenic area is present. What are the differentials and most likely diagnosis? Stage as appropriate.
RCC, TCC, Oncocytoma RCC most likely to invade renal vein and IVC. TCC in kidney originates in sinus, not cortex Oncocytoma usually more well-defined and unlikely to invade vessels Diagnosis: RCC stage 3 due to invasion of IVC

SON-225 Case Studies (2 decks)

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