Pathology Flashcards
(166 cards)
1
Q
cysts of the kidney can be
A
solitary or multiple
2
Q
complex cyst may contain
A
septations, thick walls, calcifications, internal echoes, and mural nodularity
3
Q
complex cyst are considered
A
malignant until proven benign
4
Q
with complex cysts internal echoes are often the result of
A
protein content, hemorrhage, and/or infection
5
Q
any irregularity at the base of the cyst should be considered
A
a malignant growth
6
Q
if septa is thicker than 1mm with vascularity on color or power Doppler, the lesion is
A
presumed malignant
7
Q
parapelvic cyst are
A
small cysts
8
Q
parapelvic cysts originate from
A
the renal sinus
9
Q
parapelvic cysts do not communicate with
A
the collecting systems
10
Q
what are the polycystic kidney disease
A
- autosomal-recessive polycystic disease (ARPKD)
- autosomal-dominant polycystic kidney disease (ADPKD)
11
Q
infantile polycystic disease
A
autosomal-recessive polycystic disease (ARPKD)
12
Q
rare polycystic kidney disease
A
autosomal-recessive polycystic disease (ARPKD)
13
Q
common polycystic kidney disease
A
autosomal-dominant polycystic kidney disease
14
Q
adult polycystic kidney disease
A
autosomal-dominant polycystic kidney disease
15
Q
four kinds of autosomal-recessive polycystic disease (ARPKD)
A
- perinatal
- neonatal
- infantile
- juvenile
16
Q
the type of diagnose of autosomal-recessive polycystic disease (ARPKD) depends on
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patients age at the onset of clinical signs
17
Q
perinatal form of autosomal-recessive polycystic disease (ARPKD) is found in
A
utero
18
Q
autosomal-recessive polycystic disease (ARPKD) usually progresses to
A
renal failure, causing pulmonary hypoplasia and intrauterine demise
19
Q
with autosomal-recessive polycystic disease (ARPKD) dilation of the renal collecting tubules causes
A
renal failure
20
Q
what is the most common form of polycystic kidney disease
A
autosomal-dominant polycystic kidney disease (ADPKD)
21
Q
when does autosomal-dominant polycystic kidney disease (ADPKD) usually clinically manifest
A
does not clinically manifest until the fourth or fifth decade when hypertension or hematuria develops
22
Q
by age 60 years, patient with autosomal-dominant polycystic kidney disease (ADPKD) approximately
A
50% of patients have end-stage renal disease
23
Q
sonographic findings of autosomal-dominant polycystic kidney disease (ADPKD)
A
- bilateral disease
- enlarged kidneys with multiple asymmetrical cyst vary in size and location in the renal cortex and medulla
24
Q
clinical symptoms of autosomal-dominant polycystic kidney disease (ADPKD)
A
- pain
- hypertension
- palpable mass
- hematuria
- headache
- UTI
- renal insufficiency
25
common non hereditary renal dysplasia (abnormal cells)
multicystic dysplasia kidney
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most common form of cystic disease in neonates
multicystic dysplastic kidney
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multicystic dysplastic kidney is thought to be caused by
early in-utero urinary tract obstruction
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multicystic dysplastic kidney usually occurs
unilaterally, with poor function
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when multicystic dysplastic kidney is bilateral involvement it is
incompatible with life
30
sonographic findings of multicystic dysplastic kidney disease in neonates and children
kidneys are multicystic, with the absence of the renal parenchyma and renal sinus
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sonographic findings of multicystic dysplastic kidney disease in adults
kidneys may be small (atrophic and calcified) and echogenic
32
medullary sponge kidney occurs in
the medullary pyramids
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medullary sponge kidney consists of
cystic or fusiform dilation of the distal collecting ducts (ducts of Bellini)
34
dilation from medullary sponge kidney causes
stasis of urine and stone formation
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medullary sponge kidney is a
developmental anomaly
36
sonographic findings medullary sponge kidney
- small echogenic kidneys
- loss of corticomedullary differentiation
- multiple medullary small cysts under 2 cm
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what occurs with nephrocalcinosis
parenchymal calcification occurs
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nephrocalcinosis affects
both kidneys
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nephrocalcinosis
diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex
40
hydronephrosis
is distention (dilation) of the kidney with urine caused by backward pressure on the kidney when the flow of urine is obstructed
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causes of hydronephrosis
- bladder tumors
- carcinoma of the cervix
- calculi
- neurogenic bladder
- pelvic mass
- prostatic enlargement
- retroperitoneal fibrosis
42
hydronephrosis grades
1-4
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hydronephrosis grade 1
small, fluid-filled separation of the renal pelvis
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hydronephrosis grade 2
dilation of some but not all calyces; renal sinus orientation still concave
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hydronephrosis grade 3
complete pelvocalictasis
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hydronephrosis grade 4
prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma
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hydronephrosis with a dilated ureter indicates obstruction of the UVJ junction is called
hydrouteronephrosis
48
when the renal collecting duct system is dilated what is scanned to located the obstruction
the ureters and bladder are scanned to locate the level of obstruction
49
a mildly distended collecting system can be caused by
overhydration, a normal variant of extrarenal pelvis, or by a previous urinary procedure
50
if hydronephrosis is suspected, the sonographer
should examine the bladder
51
what scanning technique is helpful in preventing the error of hydronephrosis
postvoid
52
at the level of obstruction from hydronephrosis, the sonographer
should sweep the transducer back and forth in two planes to see if the mass or stone can be distinguished
53
conditions that mimic hydronephrosis
- extrarenal pelvis
- parapelvic cysts
- reflux
- persistent diuresis (increased or excessive production of urine)
- congenital megacalyces
- papillary necrosis
- renal artery aneurysm
- arteriovenous malformation
54
arteriovenous malformation
an abnormal tangle of blood vessels where the arterial blood bypasses capillaries and reaches the veins
55
what is the most common kidney problem that occurs
kidney stones
56
kidney stones are more common in
men
57
where are majority of stones formed
in the kidney and course down the urinary tract
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large stones that fill the renal collecting system is called
staghorn calculi
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sonographic findings of urolithiasis
- very echogenic foci with posterior acoustic shadowing in the renal collecting system
- stones less than 3 mm may not shadow
60
clinical findings of urolithiasis
is extreme pain followed by cramping on one side. the pain may subside if the stone travels
61
treatment for urolithiasis
- lithotripsy
- nephrolithomy
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if the stone causes obstruction
hydronephrosis will be noted
63
depending on the location of the stone
the ureter may become dilated superior to the level of obstruction
64
if a renal mass is solid
it must be considered malignant unless fat is present
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calcifications in a renal mass are always
a sign of malignancy
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if a cystic renal mass does not meet the sonographic criteria for a simple renal cyst
it must be considered malignant
67
sonographic evaluation of a malignant mass
- wall thickness greater than 1mm
- irregularity at the base of the cyst
- septations evident
- calcifications evident
- vascularity present in the septa and/or cystic wall
68
what is another name for renal cell carcinoma
- hypernephroma
- Grawitz tumor
69
what is the most common of all malignant renal neoplasms
renal cell carcinoma
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renal cell carcinoma is twice as common
in men
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when does renal cell carcinoma develop
in the sixth or seventh decade of life
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clinical presentation of renal cell carcinoma is often
nonspecific
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patients with renal cell carcinoma may report
hematuria, flank pain, and palpable mass
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sonographic appearance of renal cell carcinoma
most RBCs are solid with no predilection for either right or left kidney or its location in the organ
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sonographic findings of renal cell carcinoma
- most RBCs are isoechoic; they may appear hyperechoic
- the larger the tumor, usually the more heterogenous its echotexture, which is caused by intertumoral hemorrhage and necrosis
- tumors less then 3cm are usually hyperechoic; distinguishing them from echogenic fat-containing tumors similar to angiomyolipoma is difficult
76
Transitional cell carcinoma accounts for
90% of malignancies that involve the renal pelvis, ureter, and bladder
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small transitional cell carcinomas ten to be
flat high-grade malignancy tumors
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transitional cell carcinoma spread
easily to the other tissues and organs
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patients with transitional cell carcinoma may have
gross or microscopic hematuria and flank pain
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sonographic findings of transitional cell carcinoma
hypoechoic mass in the collecting system, with low vascularity on color Doppler
81
what is the most malignant bladder tumor in adults
transitional cell carcinoma in the bladder
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bladder tumors are not detected sonographically until they
become advanced
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clinical findings of transitional cell carcinoma in the bladder
gross or microscopic hematuria
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sonography transitional cell carcinoma in the bladder can not distinguish between
benign and malignant tumors
85
what is recommended to detect small tumors in the bladder
cystoscopy and to obtain biopsy of the tissue
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tumors that are less than
3-4mm can not be seen sonographically
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sonographic findings of transitional cell carcinoma in the bladder
- echogenic irregular mass in the bladder
- may be along the bladder wall
- most commonly located in the posterior wall of the bladder
- may also be flat in appearance
- single or multiple
88
metastases of the kidneys is relatively
common
89
what are the most common primary malignancies that metastasize to the kidneys
- carcinoma of the lung
- breast
- renal cell carcinoma of the contralateral kidney
90
sonographic findings of metastases to the kidneys
- multiple
- poorly marginated
- hypoechoic masses are evident
91
what is the most common abdominal malignancy
nephroblastoma
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what is the most common solid renal tumor in pediatric patients
nephroblastoma
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what is also know as
nephroblastoma
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nephroblastoma peak incidence is
2.5 to 3 years of age
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nephroblastoma is
2 to 8 times more common in patients with horseshoe kidneys
96
clinical signs of nephroblastoma
- abdominal flank mass
- hematuria
- fever
- anorexia
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sonographic findings of nephroblastoma
- determine whether the mass is cystic or solid and confirm that it is renal in origin
- mass varies from hypoechoic to moderately echogenic
- increased vascularity
98
patients with benign renal tumors are usually
asymptomatic
99
patients with benign renal tumors have flank pain if the mass is
large or if hemorrhaging from the mass has occurred
100
types of benign renal tumors
- angiomyolipoma
- oncocytoma
- lipoma
101
what is the most common benign renal tumor
angiomyolipoma
102
angiomyolipoma are composed of
fat, muscle, and blood vessels
103
angiomyolipoma tumor size varies between
1 to 20cm
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sonographic findings of angiomyolipoma
hyperechoic lesion
105
angiomyolipoma complications
intramural hemorrhage
106
angiomyolipoma appears
as echogenic focal mass in the renal parenchyma
107
what is a uncommon benign renal tumor
oncocytoma
108
oncocytoma tumor size
varies but average size 6 cm
109
patients with oncocytoma typically
asymptomatic
110
oncocytoma may cause
pain and hematuria
111
sonographic findings of oncocytoma
- hypoechoic in more than 50% of cases
- may have increase vascularity
- "spoke-wheel" patterns of enhancement evident with a central scar
- extremely difficult to differentiate from RCC
112
oncocytoma has increased incidence in
middle-aged and older patients
113
lipoma tumors consists of
fat cells
114
lipoma are found more often
in women than in men
115
patients with lipoma are typically
asymptomatic
116
sonographic findings of lipoma is
well-defined echogenic mass within the kidney
117
what 3 things do sonographers evaluate when scanning the kidneys
- is the cortical thickness WNL?
- can you see a difference between the cortex and the central renal sinus?
- is the cortical echogenicity less echogenic (or more hypoechoic) than the liver
118
4 processes that happen to the kidney with medical renal disease
- increase in cortical echogenicity
- cortical thinning
- atrophy of the kidney
- increase in size
119
increase in cortical echogenicity
produces a generalized increase in cortical echoes, which are believed to be result of a deposition of collagen and fibrous tissue
120
cortical thinning
causes a loss of normal anatomic detail, resulting in the inability to distinguish the cortex and medullary regions
121
atrophy of the kidney
decrease in the size of the kidney
122
acute renal failure
is a common medical condition caused by a variety of diseases or pathophysiologic mechanisms
123
acute renal failure may occur
- prerenal
- renal
- postrenal
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prerenal stage of acute renal failure is
secondary to the hypoperfusion of the kidney
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renal stages of acute renal failure may be caused by
parenchymal disease
(acute glomerulonephritis, acute interstitial nephritis, or acute tubular necrosis
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acute renal failure may also be caused by
renal vein thrombosis or renal artery occlusion
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postrenal failure usually result of
outflow obstruction
128
postrenal failure usually
increased in patients with a malignancy of bladder, prostate, uterus, ovaries, or rectum
129
causes of acute renal failure
- prerenal
- renal
- postrenal
130
prerenal acute renal failure
- hypoperfusion
- hypotension
- congenital heart failure
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renal acute renal failure
- infection
- nephrotoxicity
- renal artery occlusion
- renal mass or cyst
132
postrenal acute renal failure
- lower urinary tract obstruction
- retroperitoneal fibrosis
133
sonographic findings of acute renal failure
- enlarged
- hypoechoic
134
loss of renal function as a result of chronic renal disease such as
- glomerulonephritis (infection of the kidneys)
- chronic pyelonephritis (infection of the kidneys)
- renal vascular disease
- diabetes
135
sonographic findings of chronic renal disease
- small and echogenic
- diffusely echogenic kidney with a loss of normal anatomy; is a nonspecific sonographic findings
- if chronic renal disease is bilateral, small kidneys are identified
- may be the result of hypertension, chronic inflammation (infection), or chronic ischemia
136
what is the most common renal disease to produce acute renal failure
acute tubular necrosis
137
acute tubular necrosis can be
reversible
138
sonographic findings of acute tubular necrosis
bilaterally enlarged kidneys evident with hyperechoic pyramids, can revert to a normal appearance
- if it reverses, it is probably acute tubular necrosis
139
renal atrophy
is when the kidney has shrunk to an abnormal size with abnormal function
140
renal atrophy is a result of
numerous disease processes
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renal sinus lipomatosis occurs
secondary to renal atrophy
142
pyonephrosis
occurs when pus is found within the collecting renal system
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sonographic findings of pyonephrosis include
the presence of low-level echoes with a fluid-debris level
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emphysematous pyelonephritis
occurs when air is in the parenchyma
145
emphysematous pyelonephritis may cause
for an emergency nephrectomy
146
xanthogranulomatous pyelonephritis
uncommon renal disease associated with chronic obstruction and infection
147
emphysematous pyelonephritis and xanthogranulomatous pyelonephritis sonographically show
enlarged and hypoechoic kidneys
148
renal artery stenosis results from
narrowing of the arteries that carry blood to the kidneys
149
renal artery stenosis causes
- high blood pressure
- elevated protein levels in urine
- decreased kidney function and swelling
150
what is the most common correctable of renal artery stenosis
hypertension
151
what are the most common caused of renal artery stenosis
- atherosclerosis
- fibromuscular dysplasia
152
sonographic characteristics of renal artery stenosis
- Absence of early
systolic peak (ESP)
- Systolic rise time: ΔT <
0.1 sec
- Peak systolic velocity
(PSV): >160/180 cm/sec
- Overall waveform
shape: “tardus” and
“parvus” waveform
- Resistive index: RI = (S-
D) ≥ 0.70 S
153
renal infaraction
occurs when part of the tissue undergoes necrosis after the cessation of blood supply (usually arterial occlusion)
154
sonographic findings of renal infarction
- infarctions within the renal parenchyma appear as irregular areas, somewhat triangular, and along the periphery of the renal border
- irregular area may be slightly more echogenic than renal parenchyma
- renal contour may be somewhat "lumpy-bumpy"
155
arteriovenous fistula
is the connection of a vein and an artery
156
arteriovenous fistula and pseudoaneurysms are most often
acquired
157
pseudoaneurysms may develop after
graft anastomosis, renal biopsy, or intratumoral hemorrhage
158
cystitis
inflammation of the bladder has several infectious and noninfectious causes
159
cystitis is usually
secondary to another condition that causes stasis of urine in the bladder
160
sonographic findings of cystitis
the bladder wall may appear normal in the early stages of inflammatory. as duration of inflammation increases, the smooth bladder wall will become diffuse or focal with hypoechoic thickening
161
as the inflammatory process progresses
the bladder will become fibrotic and scarred
162
what is the majority of bladder tumors in adults
TCCs
163
bladder tumors are usually not detected until
they have become advanced
164
patients with bladder tumors typically have
gross hematuria, dysuria, urinary frequency, or urinary urgency
165
sonographic findings of bladder tumors
- appearance of bladder masses vary
- usually an echogenic mass
166
all primary bladder tumors have the same sonographic appearance
irregular echogenic mass that projects into the lumen (wall) of the bladder
