Neonatal/pediatric Adrenal & Urinary System Flashcards
Infant and young child renal views are obtained from a ____ position
Prone
Children and adolescents renal views are obtained in the __
Decubitus position
Dilation of renal pelvis
Pelvietasis
Medullary pyramids and large and ______
Hypoechoic
______ kidney is somewhat longer
Left
A kidney measurement of ____ should be monitored closely and may indicate infection, scarring, abnormalities
Greater than 1cm side-to-side
Normal neonatal adrenal glands are _______ than in the older infant/child
Larger
Left adrenal glad extends slightly more ____ that the right one
Medial
Adrenal gland sonographically
Inverted V or Y shape in the longitudinal plane
Central medulla in neonate is
Thin, echogenic stripe—-linear
Normal bladder should measure _____ in AP
<3mm
When bladder is empty, the bladder wall should measure ____
<5mm
Most common urinary tract anomaly in children
Congenital hydroneohrosis
Sonographic features of congenital hydronephrosis
Dilated calyces budding of large central cyst(renal pelvis)
Visualization of dilated ureter
Abnormal reflux infection of urine from the bladder and into the kidney
Vesicoureteral Reflux(VUR)
How many grades of VUR
5
1 being the least severe(ureters only)
5 being the worst(severe dilation of ureters and kidney w loss of papillary impressions)
Most common type of obstruction causing hydronephrosis of upper urinary tract in peds
Ureteralpelvic Junction obstruction (UPJ)
Most often results from intrinsic narrowing or extrinsic vascular compression at level of uteropelvic junction
UPJ
Ectopic ureterocele and duplex kidney more commonly occurs in ___
Female and left side
Seen as a fluid mass within the bladder
Ectopic ureterocele
Most common cause of bladder outlet obstruction in male neonate
Posterior urethral valves
Sonographic features of bladder outlet obstruction
Bladder wall is thickened
Prune-belly syndrome includes triad of :
Hypoplasia or deficiency of the abdominal musculature
Cryptorchidism
Urinary tract anomalies
Anomaly that includes Congenital absence or deficiency of the abdominal musculature, large hypotonic dilated tortuous ureters, large bladder, patent urachus, bilateral cryptorchidism, dilated prostatic urethra
Prune-belly syndrome
____% of prune-belly syndrome is associated with VUR
85%
Long tubular structure which connects the dome of the bladder to the umbilicus
Urachus
Urachus normally closes during the ___
4th and 5th month of gestation
Urachus sometimes remains patent——either at the ____ or the ____
Bladder or umbilical end
Most common cause of renal cystic disease in neonates
Multicystic Dysplastic Kidney Disease(MCDK)
Most common cause of abdominal mass in newborn/neonate
MCDK
Sonographic features MCDK
Cluster of grapes—largest cysts in the peripheral
No identifiable renal pelvis
If bilateral, usually fatal
Sonographic findings in ARPKD
Bilateral renal enlargement
diffuse increased echogenicity
Loss of definition of renal sinus, medulla, and cortex
Hypoechoic outer rim
Less severe cases of ARPKD sonographic findings
Hepatosplenomegaly
Portal hypertension
Renal parenchyma normal to echogenic
ADPKD have an increased incidence of
Renal cell carcinoma (RCC)
Sonographic findings of ADPKD
Bilateral, well defined cysts
Macroscopic cysts of varying size that can form in liver, spleen, pancreas
May be associated with tuberous sclerosis and Von Hippel-Lindau disease:
Renal cysts
Pts with tuberous sclerosis have a ___% incidence of having _____ which may resemble polycistic renal disease
40%
Renal cysts
Both tuberous sclerosis and von hippel lindau disease are associated with an increased incidence of
RCC
UTI— infection usually begins in ___
Bladder and ascends through ureter into the renal pelvis
Acute pylonepritis clinical symptoms
Sudden fever, flank pain, tenderness
Acute pylonephritis sonographic findings
Enlarged renal size
Altered echogenicity secondary to edema
Repeated episodes of acute pylonephritis causing kidney to become scarred and decrease in size
Chronic pylonephritis
Calcification of renal parenchyma, identified in the medulla and rarely in the cortex
Nephrocalcinosis
Most common neonatal adrenal mass
Adrenal hemorrhage
Predispose neonate to adrenal hemorrhage:
Difficult delivery, large size, diabetic mother, stress, hypoxia, septicemia, shock
Adrenal Hemorrhage is usually found secondary to other complications like:
Uncontrolled bleeding
Jaundice
Intestinal obstruction
Hypertension
Adrenal abscess
Impaired renal function
Most common intraadbominal malignant renal tumor in young children
Wilms tumor/ nephroblastoma
Wilms tumor/nephroblastoma incidence peaks between ____
2-5 years old
Nephroblastoma/Wilms tumor sonographic:
Unilateral
Adjacent renal tissue becomes compressed
Echogenic areas w calcification
Hydronephrosis may result
Well defined borders
Most common renal tumor of neonate
Congenital Mesoblastic Nephroma
Most common malignancy in children under 1
Neuroblastoma
Malignant tumor arises in the adrenal medulla
Neuroblastoma
Sonographic features of neuroblastoma
Highly echogenic
Increased vascularity
Adjacent kidney displaces inferiorily and sometimes laterally
