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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
Q

What are the sonographic characteristics of a UPJ obstruction?

A

Pelviectasis is present to the level of the UPJ

Ballooning of the renal pelvis

Atrophied parenchyma if long-standing

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26
Q

What are the clinical symptoms of a bladder mass?

A

Gross hematuria

Leg swelling

Lower back and suprapubic pain

Dysuria

Urinary frequency increase

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27
Q

What is the most common form of bladder cancer in the US?

A

Transitional Cell Carcinoma

28
Q

What is the most common form of bladder cancer world-wide?

A

Squamous Cell Carcinoma

29
Q

What are the clinical signs of TCC?

A

Painless hematuria

Pain w/ hydro if collecting system involved

Hematuria w/ clots

30
Q

What group is most at risk for TCC?

A

Elderly males

31
Q

If TCC travels to kidney, where will the tumor form and what may result?

A

Renal pelvis

Separation and dilation of collecting system

Renal contour preserved, but internal architecture distorted

32
Q

What are the possible causes of Squamous Cell Carcinoma?

A

Indwelling catheters

Bladder stones

Infections

33
Q

What are the sonographic characteristics of SCC?

A

Large mass in renal pelvis

Hydronephrosis

34
Q

What is the typical sonographic appearance of a malignant bladder mass?

A

Hypervascular bladder wall thickness

Irregular

Projecting into lumen

Echogenic

35
Q

What are the typical sources of metastasis to the urinary system?

A

Melanoma

Lymphoma

Breast CA

Lung CA

Pancreatic CA

Stomach/colon CA

Cervical CA

36
Q

What are angiomyolipomas made up of?

A

Fat

Muscle

Arterial vessels

37
Q

What are the clinical symptoms of AML?

A

Asymptomatic

Palpable abdominal mass

Hematuria

Flank pain

38
Q

What are the 2 types of AML?

A

Isolated

Tuberous sclerosis associated

39
Q

What demographic is most at risk for isolated AML and in which kidney?

A

Women 40-60

Right

40
Q

When compared to Isolated AMLs, tuberous sclerosis associated AMLs are what?

A

Larger

Bilateral

Multiple

41
Q

What are the sonographic characteristics of AML?

A

Intensely echogenic

May have shadow

Located in renal cortex

42
Q

Are AMLs in young females typically multiple or solitary?

A

Solitary

43
Q

What are the major risks with AMLs?

A

Rupture and/or hemorrhage

Recurrence

44
Q

What are the potential causes of a hematoma?

A

Trauma

Post biopsy

Masses (RCC and AML)

Abscesses

AV malformation

Cysts

45
Q

What are the clinical symptoms of a hematoma?

A

Mild to severe flank and abdominal pain

Hematocrit may drop

46
Q

What are the sonographic characteristics of a hematoma?

A

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
Q

What demographic is most at risk for lipoma?

A

Middle-age women

48
Q

What demographic is most at risk for hemangioma?

A

Young adults

49
Q

What are the clinical symptoms of hemangioma?

A

Asymptomatic

Recurrent hematuria

Renal colic

50
Q

What are the sonographic characteristics of a hemangioma and where are they typically located?

A

Variable echogenicity

Located at PCJ or inner medulla

51
Q

What are the clinical symptoms of lipoma?

A

Asymptomatic when small

Abdominal and/or flank pain

Occasionally hematuria

52
Q

What are the sonographic characteristics of a lipoma?

A

Well defined

Echogenic (fat)

53
Q

What demographic is most at risk for oncocytoma?

A

Older men

54
Q

What are the clinical symptoms of oncocytoma?

A

Asymptomatic when small

HTN

Abdominal and/or flank mass

Hematuria

Pain

55
Q

What are the sonographic characteristics of a oncocytoma?

A

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
Q

What pathology is most likely represented in this image?

A

RCC

57
Q

What pathology is most likely represented in this image?

A

Bladder stone

58
Q

What pathology is most likely represented in this image?

A

AML

59
Q

What pathology is most likely represented in this image?

A

TCC

60
Q

What pathology is most likely represented in this image?

A

UPJ

61
Q

What pathology is most likely represented in this image?

A

UVJ

62
Q

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?

A

RCC

Risk factors of Male, 60-70, smoking, HTN

63
Q

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?

A

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
Q

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?

A

TCC. Very poor due to infiltration of RRV and IVC.

65
Q

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?

A

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
Q

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.

A

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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