Midterm #2 Flashcards
1
Q
are kidneys retroperitoneal or intraperitoneal?
A
retroperitoneal
2
Q
where are the kidneys located?
A
RUQ and Right Hyperchondrium
3
Q
which kidney sits more superior in the body?
A
left kidney because the right is pushed down by the liver
4
Q
which muscle is considered the “kidney bed”
A
Quadratus Lumborum
5
Q
what muscles lie posterior medial and posterior to the kidneys?
A
- Psoas
- QL
6
Q
what are the external layers of the kidneys?
A
1 Renal Capsule (Tough fiberous capsule) 2 Perirenal Fat (Surrounds capsule) 3 Gerota’s Fascia (Anchor’s the kidney) 4 Pararenal Fat
7
Q
what are alternate names of the renal capsule?
A
true capsule/fibrous capsule
8
Q
what is an alternate word for perineohric fat?
A
adipose capsule/packing fat of Zukerkandl
9
Q
what is another name for Fascia of Gerota?
A
perirenal fascia/perinephric fascia
10
Q
what is another name for pararenal fat?
A
pararenal body
11
Q
what are the 4 retroperitoneal spaces pertaining to the kidney?
A
- anterior pararenal space
- perirenal space
- retrorenal space
- Posterior pararenal space
12
Q
Anterior Pararenal Space
A
Fat area between the posterior peritoneum and Gerota’s fascia
13
Q
what other organs does the Anterior Pararenal Space contain?
A
- pancreas
- descending portion of the duodenum
- ascending and descending colon
- superior mesenteric vessels
- inferior portion of the common bile duct
14
Q
Posterior Pararenal Space
A
Space between Gerota’s fascia and the posterior abdominal wall muscles
15
Q
what does the Posterior Pararenal Space contain?
A
- iliopsoas and quadratus lumborum muscles
- the posterior abdominal wall
- contains fat and nerves.
16
Q
Perirenal Space
A
Space separated from the pararenal space by Gerota’s fascia
17
Q
what does the Perirenal Space contain?
A
kidneys and adrenal glands perinephric fat ureters renal vessels aorta and inferior vena cava lymph nodes
18
Q
What is the purpose of these External layers specifically for Kidney’s?
A
Perirenal fat and Pararenal fat (layers 2 and 4) accommodate movement during respiration
19
Q
what are the 2 areas the kidneys are divided into?
A
- Renal parenchyma
- central sinus
20
Q
Renal Parenchyma
A
- cortex
- medulla
21
Q
Central Sinus
A
- renal sinus
- renal hilum
22
Q
Renal Cortex
A
Outer portion more superficial layer
23
Q
Medulla
A
- Deeper layer of the Parenchyma
- folds into projections called renal pyramids
- Within medulla 8 to 18 cone shaped sections called renal pyramids
- Areas between the pyramids called the renal columns
24
Q
Renal pyramids
A
- triangular structures composed of medullary substance
- Base of pyramid is toward the outer circumference of the kidney
- The apices (narrow tip) converge toward the renal sinus
- Renal Papilla at the apices
25
what is the Central Sinus occupied by?
Blood vessels
Renal pelvis
Nerves
Fat
26
Renal Hilum
Area where the ureter, renal artery and renal vein enters or leaves the Kidneys
27
what is the renal sinus continuous with?
hilum
28
Renal Arteries and Renal Veins Lie more _________ to the Renal Pelvis
anterior
29
are kidneys highly ________
vascular
30
Renal artery
large branch of the abdominal aorta; brings blood into each kidney
31
Renal vein
large branch that brings deoxygenated blood to IVC
32
order of arteries and veins as they leave the kidney
- renal artery
- renal vein
- Segmental (arteries and veins)
- Lobar (artery and veins)
- Interlobar (a and v)
- Arcuate (a and v)
- Interlobular (a and v)
33
Collecting system
Where urine flows out and makes its way to the bladder then out of body
34
what are parts of the collecting system within the kidney?
Minor calyces
Major Calyces
Renal Pelvis
Ureter
35
what is the contour of the kidney?
smooth borders
36
what is the shape of the kidney?
- bean
| - convex and concave medially
37
what is the size of kidneys?
- 11 cm length
- varies with size of person and age
- Cortex outer layer decreases with age
- Known as “parenchymal reduction” measure of AP thickness
38
what is the echogenicity of the kidneys?
- Normal Rt renal cortex is slightly hypoechoic or isoechoic to the liver
- Normal Lt renal cortex is hypoechoic to the spleen
39
urine formation
#1 function excrete metabolic waste products in the form of urine (waste taken from blood)
40
Homeostasis
Regulates water-salt and acid-base balance
41
what kind of gland does the kidneys act like?
Acts as an endocrine gland therefore secretes hormones
42
what are the two types of nephrons?
- cortical nephron
| - juxtamedullary nephron
43
describe cortical nephron
Located mostly in Cortex
| Shorter loop of Henle
44
describe juxtamedullary nephron
Adjoining Medulla
| Longer loops of Henle
45
renal corpuscle=
Glomerulus & Bowman’s Capsule
46
Tubules=
proximal, Loop of Henle, distal convoluted tubules
47
where is the loop of henle located?
in the medulla
48
what is filtration?
filters the blood and to produce urine
49
Tubular Reabsorption
substances needed by the body are reabsorbed into the blood
50
Tubular Secretion
Waste products and excess water pass into collecting ducts as urine
51
describe serum creatinine
Formed in muscle in small amounts, passed into blood and excreted in urine
Increase creatinine = disturbance in function
52
Blood Urea Nitrogen
Urea = end product of protein metabolism normally low
BUN level increases = function or perfusion impaired
53
what is caused by BUN?
- ???dehydration
- urinary tract obstructions
- Can lead to mental confusion, disorientation and coma
54
is transient pyelectasis normal?
yes
55
when can Transient Pyelectasis occur?
patient drinks lots of water (hydrated)
56
what can Transient Pyelectasis look like on an ultrasound?
- Calyces and pyramids more anechoic more prominent
| - Resolves after patient empty’s bladder
57
if the whole collecting system is anechoic is this normal?
no
58
name the 3 sets of kidneys in the embryo
- Pronephros
- Mesonephros
- Metanephros
59
Pronephroi
- Early in 4th week gestation
| - Rudimentary and nonfunctioning
60
Mesonephroi
- Late in 4th week
| - Function as interim kidneys
61
Metanephroi
permanent kidneys
62
what are the 2 sources developed from metanephroi?
- uretic bud
| - metanephrogenic blastema
63
what is contained in the ureteric bud?
- ureter
- renal pelvis
- calices
- collecting ducts
64
Ureteric bud interacts with and penetrates the ________
metanephrogenic blastema
65
where are the kidneys in the abdomen?
travel from pelvis to RUQ
66
normal varients in notes
write these down (lesson 12)
67
what does HCB stand for?
Hypertrophied Column of Bertin
68
where is the HCB usually located?
upper and middle thirds of the kidney
69
is the HCB a concern or a normal variant?
normal varient
70
what plane is the HCB best seen in?
saggital
71
is the junctional cortical (parenchymal) defect a concern or a normal variant?
normal varient
72
what is the junctional cortical (parenchymal)?
site of failed fusion located anteriorly and superiorly and traced medially to inferiorly into renal sinus
73
what plane is the junctional cortical (parenchymal) best seen in?
Saggital
74
what kidney is the Junctional Cortical (Parenchymal) Defect usually seen on?
right kidney
75
is the Extrarenal Pelvis a concern or a normal variant?
normal variant
76
what is the Extrarenal Pelvis?
mildly dilated UPJ (ureteropelvic junction) medial to hilum
77
what plane is the Extrarenal Pelvis best seen in?
Transverse (this is where we measure Ant. to Post.)
78
is the Dromedary Hump a concern or a normal variant?
normal variant
79
what is the Dromedary Hump?
bulge on the lateral aspect of the anterior kidney (not clinically significant)
80
Ureters functions as a ________
conduit
81
Bladder acts as a ________
reservoir for urine
82
Urethra functions as a _______
conduit
83
how long are the ureters?
25-30cm in length
84
where do the ureters course?
- inferiorly behind the parietal peritoneum anterior to the Psoas muscle
- crosses iliac vessels anterior to the sacroiliac joint
- Enters inferior bladder
85
what are the 3 layers of ureters?
- inner mucosal layer
- Medial layer of longitudinal and circular smooth muscle
- Outer fibrous layer
86
what terms describes how ureters transfer urine to bladder
urethral peristalsis
87
what term describes the proximal ureter as it leaves the kidney?
ureteropelvic junction (UPJ)
88
what is the term to describe the ureter as it enters the bladder?
ureter vesicle junction (UVJ)
89
is the bladder intra or retro?
retro
90
what muscle is the bladder wall mostly made of?
smooth muscle
91
inner layer of bladder forms folds called_______
rugae
92
where do the urethral opening lie on the bladder?
anterior, lower corner
93
how many planes and positions do you scan the kidneys?
2 planes and 2 positions
94
how many planes and positions do you scan the bladder?
2 planes and 1 position (supine)
95
what is the echogenicity of the bladder?
Anechoic fluid filled structure with echogenic walls (acts as specular reflector)
96
what is the contour of the bladder?
smooth when full
97
what is the shape of the bladder in TRV?
square with curved edges
98
what is the shape of the bladder in SAG?
appears triangular
99
how do you measure bladder volume?
(Lx W x AP {H}) x 0.523=cc
100
what do you measure in the bladder in SAG?
length
101
What do you measure on the bladder in TRV?
AP (height) and right to left (width)
102
what 2 volumes must you measure with the patient?
prevoid and postvoid (full bladder and emptying bladder)
103
is the bladder wall normally measured?
no
104
what may you see with colour doppler in the bladder?
jets at the UVJ
105
where can the reverberation artifact appear in the bladder?
mostly in the near field (anterior portion of the bladder) adjust gains to fix this
106
what are 3 pitfalls when scanning the bladder?
- obese patients
- surgical scars can produce artifacts (go around the scar)
- abdominal dressings
107
what fused with the cloacal membrane on the 7th week in the bladder?
urorectal septum
108
what divides the urogenital sinus and dorsal rectum in the bladder?
urorectal septum fused with the cloacal membrane
109
urogenital sinus
bladder
110
bladder is continuous with ________
allantois
111
what does the allantois become?
urachus (fibrous cord aka median umbilical ligament )
112
what 2 things occur when the bladder grows?
- Distal mesonephric ducts becomes part of the connective tissue into the bladder trigone
- Ureters open into bladder
113
what are 3 anomalies (abnormalities) related to growth of the kidneys?
Hypoplasia
Fetal Lobulation
Compensatory Hypertrophy
114
what is hypoplasia?
underdevelopment/incomplete
small kidneys occur which causes reduced nephrons
115
what is persistent fetal lobulation?
seen in ultrasound as smooth indentations
116
where is persistent fetal lobulation normally present?
in children until 4-5 years of age
117
what is Compensatory Hypertrophy
ONE KIDNEY GETS BIGGER AND MAKES UP FOR THE SMALLER ONE
| diffuse (nephrectomy, renal egenesis, e.t.c) or focal (area of normal tissue enlarged)
118
what are 3 anomalies (abnormalities) related to ascent of the kidney?
Ectopia
Crossed Renal Ectopia
Horseshoe Kidney
119
what is ectopia?
kidney is not located in the normal position usually in the pelvis or thorax
120
do people with ectopia show symptoms?
no
121
what are some possible complications of ectopia?
infection, stones, blunt, trauma
122
what is crossed renal ectopia?
displacement of one kidney to the opposite side
123
what are the 2 forms of crossed renal ectopia?
- fused (85-90%)
| - lying on one side without fusion
124
what kidney is more common for crossed renal ectopia?
left kidney going to right is more common
125
what is the horseshoe kidney?
lower pole fuse at midline
126
what are some symptoms of the horseshoe kidney?
abdominal pain, nausea, stones, urinary tract infections
127
where do you see the horseshoe kidney on ultrasound?
: located at lower level than normal, bridge of renal tissue (isthmus) connecting 2 kidneys
128
what are the anomalies related to the ureteral bud of the kidney?
-agenisis
-Ureteropelvic junction obstruction
-supernumerary kidney
-Duplex Colllecting system and uterocele?
MORE ON MOODLE
129
what is renal agenesis?
failure of formation unilateral or bilateral
| No kidney
130
what are the causes of renal agenesis?
- absence of metanephrogenic blastema
- absence of ureteral bud development
- absence of interaction and penetration of the uretral buds with metanephrogenic blastema
131
what is supernumerary kidney?
extra small kidney above, below, in front, or behind normal kidney
132
is supernumerary kidney common or rare?
rare
133
what are the symptoms of supernumerary kidney?
Pain
Fever
Hypertension
Palpable abdominal mass
134
what is Duplex Ureter System and Ureterocele?
an extra ureter
135
what are the types of Duplex Ureter System and Ureterocele?
- complete
- incomplete
- unilateral
- bilateral
136
what is urecterocele?
- a congenital abnormality found in the distal ureter
- Distal ureter balloons at UVJ forming a sac-like pouch
- associated with a duplicated collection system
- incidental and clinically insignificant
137
what are complications with Duplex Ureter System and Ureterocele?
- ureteral obstruction
| - recurrent or persist urinary tract infection
138
what is the treatment for Duplex Ureter System and Ureterocele?
surgery
139
what gender is congenital megaureter most common?
males
140
which ureter is congenital megaureter most common?
left ureter
141
what are the Anamolies Related to Vascular Development?
- Retrocaval Ureter (ureter passes behind IVC)
| - Aberrant Vessels (vessels enter at a place other than the hilum)
142
what are the Anomalies Related to Bladder Development?
- Bladder Agenesis
- Bladder Duplication
- Bladder Exstrophy
- Urachal Anomalies
143
what are the Anomalies Related to Urethral Development?
-diverticula
144
what is the retrocaval ureter?
Abnormal embryogenesis of IVC, ureter passes behind the IVC before entering the pelvis
145
does the retrocaval ureter most commonly happen in males or females?
males (3:1)
146
which ureter does the retrocaval ureter most commonly occur?
right ureter
147
what are the symptoms of retrocaval ureter?
- right flank pain
| - UTI
148
what does ureterocele mean?
little pouch that collapses when patient empties bladder
149
what is bladder agenesis?
bladder is absent in US
- still born
- very rare
150
what are the 3 types of bladder duplication?
- peritoneal (looks like 2 bladders) complete or incomplete
- internal septum (like gallbladder) complete or incomplete
- transverse band-band of muscle that divides the bladder into 2 unequal cavities
151
what is bladder exstrophy?
part of the urinary bladder is present outside the body and often inside out
-failure of the abdominal wall to close during fetal development
152
where is bladder exstrophy mostly found?
males (2:1)
| seen in babies
153
Urachus
remnant of the channel between the bladder and the umbilicus 4 types
154
what are the 4 types of urachus?
- patent urachus
- urachal cyst
- urachal sinus
- diverticulum
155
Urethral Diverticulum
“pocket” or outpouching forms next to Urethra and connects with Urethra
156
Which of the following are considered an anomaly related to Growth?
A. Renal Agenesis
B. Ureterocele
C. Persistent Fetal Lobulation
C. Persistent Fetal Lobulation
157
Which of the following anomalies is easier to diagnosis using ultrasound only?
A. Hypoplasia
B. Cross Renal Ectopia
C. Horseshoe Kidney
C. Horseshoe Kidney
158
Which bladder anomaly is the most likely to be seen with pelvic ultrasound on an adult?
A. Bladder Duplication
B. Bladder agenesis
C. Bladder Exstropy
A. Bladder Duplication
159
MATCH
Renal ectopia growth
Supernummary ascent
Hypoplasia ureteral bud
Renal ectopia=ascent
supernummary=uteral bud
hypoplasia=growth
160
A person has unilateral right renal agenesis. The left kidney is enlarged what is this called?
A. Compensatory hypertrophy
B. Duplex Collecting system
C. Diverticulum
What type of anomaly is this?
A. Compensatory hypertrophy
growth
161
If you are scanning the LUQ and there is no kidney found????
-Patient has not had surgery
List the possible Anomalies and the category they fall within
- agenesis (ureteral bud)
- ectopia (ascent)
- Hypoplasia (growth)
162
Very hydrated patient and collecting system
May be anechoic areas due to collecting system being dilated
What is this known as and how is it resolved?
known as transient pyelectasis
| resolved by voiding (emptying bladder) and if it persists (stays there) it is not normal
163
why does renal duplication artifact occur?
result of sound beam refraction between lower portion of spleen or liver and adjacent fat
164
which kidney is renal duplication artifact more common in?
left kidney and also in obese patients
165
what can renal duplication artifact mimike?
duplex collecting system
Suprarenal masses
Upper pole renal cortical thickening
166
how to resolve renal duplication artifact?
change transducer position
| use deep inspiration
167
Intravenous Urography
radiographic examination
168
Nuclear Medicine
IV radionuclide filtered through kidneys at a specific rate and concentration
169
what makes US different from other modalities such as CT
- we can scan live
- pre and postvoid
- see jets of urine going into bladder
170
what is US good at seeing when looking at the urinary system?
jets
171
what are the limitations of US and the urinary system?
- don't see kidney function
- cant differenciate different masses
- quality of scan (body habitus)
172
```
Pick the lab test which may indicate an Adrenal Gland problem
A. LFT’s
B. Amalyse
C. WBC
D. Aldosterone
```
D. Aldosterone
173
Pick the best answer: Where should you look to locate a Right Adrenal gland when scanning?
A. Transverse Liver Right between Upper pole of Kidney and IVC
B. Transverse Liver at the level of the hepatic veins look posterior to IVC
C. Transverse Liver Right between lower pole of Kidney and IVC
A. Transverse Liver Right between Upper pole of Kidney and IVC
174
where is the spleen located?
- LUQ
- Left hypochondrium
- Intraperitoneal
175
is the spleen in contact with the diaphragm?
yes
176
what is inferiomedial to the spleen?
- stomach
- left kidney
- pancreas
- splenic flexure
177
what surrounds the spleen?
fibrous capsule
178
what is the shape of the spleen?
ovoid (oval)
- convex superolateral
- concave inferomedially
179
are the borders of the spleen smooth?
yes
superiorly
posteriorly
latterly
180
where are the gentle indentations of the spleen?
medial aspect
181
what is the hilum composed of?
- white pulp
| - red pulp
182
what enters and exits the hilum of the spleen?
-splenic artery and vein
| the spleen is highly vascular
183
what are the ligaments of the spleen?
Splenorenal ligament
Phrenicocolic ligament
Gastrosplenic ligament
184
are the ligaments of the spleen usually seen?
no
185
what are the spleens functions?
- immunity
- tissue repair
- hematopoiesis
- red blood cell and platelet destruction
- blood reservoir
186
do you need a spleen to survive?
no
187
why might we scan the spleen?
- LUQ pain
- Mono (enlarged spleen)
- suspected rupture (trauma)
188
what is the best way to measure the spleen?
eyeballing
| -compare with Lt kidney
189
how big is the spleen?
11-12 cm in length
| 5cm width
190
does the weight of the spleen increase or decrease with age?
decrease in size and weight
191
what is the shape of the spleen?
convex superolatterly
| concave inferomedially
192
what is the echogenicity of the spleen?
higher echogenicity than the liver and left kidney
193
what is the echotexture of the spleen?
parenchyma is homogenous
194
what are some difficulties when scanning the spleen?
- ribs
| - air from lungs
195
what are the 3 sagittal images of the spleen?
- hilum
- hilum with measurement
- left kidney interface
196
what does the spleen arise from?
mesenchymal cells
197
the cells of the spleen differentiate to form _________
- splenic pulp
| - splenic capsule
198
Base of the dorsal mesentery fuses with the ____________
posterior peritoneum
| -forms the splenorenal ligament
199
what are the normal varients of the spleen?
| number and location
```
number
-accessory
-asplenia
-polyspenia
location
-wandering
-ectopic
```
200
accessory spleen
Homogenous isoechoic mass similar to the spleen
Typically found
hilum or inferior border of spleen
201
what is the most common normal variant?
accessory spleen
202
Asplenia
complete absence
| rare
203
Polysplenia
multiple small accessory spleen
204
Wandering spleen
- migrated from its normal location in the left upper quadrant.
- dorsal mesentery fails to fuse properly with posterior peritoneum
- lack of support ligaments
205
Ectopic
The spleen is located in the abdominal cavity outside of where it should be
206
where are the 4 locations you may find lymph nodes?
- auxillary
- cervical (neck)
- inguinal
- abdomen
207
what are the functions of the lymph system?
- collect and transport excess fluids, lymph
- absorb fats from small intestine to the liver
- help to produce cells that fight infection
208
how big are lymph nodes?
smaller than tip of finger
209
what is the sonographic appearance of a lymph node?
ovoid in shape
fatty hilum
-superficial nodes=high f
deep nodes=low f
210
in lymph nodes is AP smaller or bigger in width than length?
AP is smaller than width or length
211
where is the right adrenal gland located?
between IVC and UP of Kid near Liver
212
where is the left adrenal gland located?
near Diaphram, Superior posterior border of Spleen
213
what are the 2 parts the adrenal glands are divided into?
- cortex
| - medulla
214
what tissue is the cortex made up of?
endocrine tissue-corticosteroids
215
what tissue is the medulla made up of?
-neurosecretory tissue-catecholamines
216
what is the inner layer of the renal cortex?
- Zona recticularis
| - gonadocorticoids
217
what is the middle layer of the renal cortex?
zona fasciculata
| -glucocorticoids
218
what is the outer layer of the renal cortex?
zona glomerulosa
| -mineralocorticoids
219
what are the functions of the adrenal glands?
Regulate homeostasis in the body
Sodium and water balance
Fight or Flight response
220
what are the hormones in adrenal glands that could indicate problems?
Aldosterone
| Cortisol
221
do we image the adrenal glands?
not in adults but there seen in children
222
what adrenal gland is harder to visualize?
left side is harder
223
if seen, what does the adrenal gland look like on ultrasound?
thin hyperechoic layers separated by hyperechoic layers
224
what transports semen outside?
```
Epididymis
Vas deferens
Join seminal vesicles
Ejaculatory ducts
Urethra
```
225
Seminal vesicles
2 hollow, sacculated structures
Base bladder
Superior to prostate gland
Inferior to vas deferens and ureters
226
Prostate
Small Chestnut sized/shaped organ
Base=Most superior part
Apex= Inferior part
227
Ejaculatory ducts
Join Urethra approx. mid way through prostate
228
Ducts
Transport the seminal fluid
229
Seminal Vesicles
Adds secretions to seminal fluid
230
Prostate
Adds secretions to seminal fluid
231
Urethra
conduit for semen and urine
232
Prostaticovesical arteries
from the Internal Iliac As
| prostatic and inferior vesical artery
233
Inferior vesical artery
Supplies the base of the bladder, seminal vesicles and ureter
234
Prostatic artery
Branches to capsular and urethral arteries
| Supply prostate
235
Venous
Form a network around the sides and base of the prostate- deep dorsal penile vein draining into the internal iliac veins
236
what are the 2 sections of the prostate?
Fibromuscular region/stroma
| glandular region
237
Fibromuscular region/stroma
Smaller section
Anterior to the prostatic urethra
*****Less clinical significance*****
238
Glandular region
posterior portion
239
what are the 4 zones of the prostate?
- Peripheral
- central
- transition zone
- periurethral glandular tissue/zone
240
Peripheral zone
- Largest ~ 70% of glandular tissue
- 70% of cancers found here
- posterior, lateral and apical regions of the prostate
- Resembles “eggcup” holding the egg of the central gland
241
central zone
- 25% of prostatic glandular tissue
- 5% of cancer located in Central Zone
- Vas deferens and seminal vesicles
242
Transitional zone
-lateral aspects of the proximal prostatic urethra
~ 5% of glandular tissue
-20 % of cancers
243
Periurethral glandular zone
Tissue that lines the proximal prostatic urethra
244
The prostatic urethra is divided by the _____________
verumontanum
245
verumontanum
- An area close to the centre of the prostate
- separates proximal and distal prostatic urethra
- Where ejaculatory ducts meet the urethra
246
clinical indications for scanning prostate?
- Prostate Problems suspected (lump on DRE)
- Lab Values increased (PSA)
- Urinary problems (weak stream)
247
Prostate-Specific Antigen (PSA)
Glycoprotein produced exclusively by the prostate
Increase possible prostate cancer exists
Higher the elevation= more likely a cancer exists
248
is PSA ideal?
no because it could be high and no cancer
249
what increases when prostate increases?
PSA
250
what is the borderline for prostate PSA level?
4-10 ng%
251
what percent of cancer can biopsys detect?
80%
252
What anatomy is assessed for Male Pelvis Ultrasound?
Prostate
Seminal vesicles
Bladder
253
where on the prostate is more cancers?
posterior
254
how many position and planes do we scan the prostate?
2 planes and in supine position
255
what must the patient do to prepare for the prostate exam?
fill bladder
256
what do we take images of with the prostate?
prostate and seminal vesicles
| also image the RLQ and LLQ in sag
257
what does the prostate look in an US?
heterogenous
| symmetrical in shape
258
TRUS stand for?
Trans Rectal Ultrasound
259
Major reasons presently for TRUS?
Prostate cancer evaluation
Biopsy
Guidance of therapeutic procedures
260
what is the patient positioning for TRUS?
Left lateral decubitus with legs together and bent up
| Digital rectal exam before probe insertion if performed by Radiologist
261
Transverse or Axial in TRUS?
Anterior abdominal wall is top of screen with right side of patient on left side of image
Seminal vesicles at the base to urethra at the apex
262
Sagittal in TRUS?
Anterior abdominal wall top of screen, head of patient on the left of image – foot at right of image
From right to midline to left lobe
263
what do we divide the prostate into on US?
- inner gland=transitional+ anterior fibromuscular stroma glandular tissue+ internal urethra sphincter
- outer gland=(peripheral zone + central zone)
264
Outer Gland (sometimes referred to as peripheral)
uniform, homogenous texture
| Slightly more echogenic than inner gland
265
Inner Gland (sometimes referred to as central)
More hypoechoic
| heterogeneous
266
“Surgical capsule” separates ________
Inner and outer gland
| Not always seen in young males
267
Traditionally when urologists resected the prostate they believed they dissected to this line therefore called surgical capsule is it a true capsule?
no
268
Outer Margin of the prostate ___________
prostate capsule
269
prostate capsule
Clear interface between prostate and periprostatic fat
270
Seminal vesicles appearance on US
relatively hypoechoic, multiseptated structures
271
Vas deferens appearance on US
Seen adjacent to Seminal vesicles
272
is Benign Ductal Ectasia a issue or normal variant?
normal variant
273
what is Benign Ductal Ectasia caused by?
atrophy and dilatation of prostatic ducts
| happens in older men
274
is Prostatic Calcifications and Corpora Amylacea normal variant or an issue?
normal varient
275
Prostatic Calcifications and Corpora Amylacea
More common with advancing age
| Bright echogenic foci or clumps in prostate
276
is Corpora Amylacea a normal variant or an issue
Proteinaceous debris
sound attenuation preventing TRUS examination
No clinical significance
usually not palpable
