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Pediatric Sonography > Pediatric Urinary System > Flashcards

Pediatric Urinary System Flashcards

1
Q

How does one determine if neonate kidneys are echogenic?

A

loss of corticomedullary distinction

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2
Q

How much should pediatric kidneys grow per year

A

approx 1 cm until maturation

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3
Q

What is the coarse of US plan for prenatal hydro after birth?

A

ultrasound on 1st DOL, repeat at 4 weeks

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4
Q

What is the most common form of urinary tract obstruction in pediatrics?

A

UPJ obstruction

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5
Q

What are the main causes of UPJ obstruction in peds?

A
  • *crossing vessel
  • abnormal smooth muscle
  • abnormal innervation of prox ureter
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6
Q

UPJ obstruction US findings: (2)

A
  • hydro ends at UPJ (pelvis disproportionately large compared to calyces)
  • distal ureter is normal/not seen
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7
Q

What is vesicoureteral reflux?

A

retrograde flow of urine from bladder to kidney

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8
Q

What often causes vesicoureteral reflux?

A

shortened abnormally angulated insertion of ureter into bladder

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9
Q

T/F: you always see hydro with reflux?

A

false

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10
Q

What is the most common cause of urethral obstruction in boys?

A

Posterior urethral valves

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11
Q

What are posterior urethral valves?

A

Chronic urethral obstruction due to fusion and thickening of normal folds in urethra, males only, associated with versicoureteral reflux

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12
Q

Posterior urethral valves symptoms in infant: (6)

A
  • uti
  • sepsis
  • urinary retention
  • large, palpable kidneys
  • poor urine stream
  • failure to thrive
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13
Q

Posterior urethral valves symptoms in child: (6)

A
  • abnormal voiding pattern
  • hesitancy
  • straining
  • poor stream
  • large post-void residual
  • renal insuficiency/failure
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14
Q

Posterior urethral valves US findings:

A
  • bilateral hydronephrosis and hydoureter
  • thick-walled bladder
  • renal parenchymal thickening
  • urinary ascites
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15
Q

What is ureteropelvic duplication? duplex kidney

A

two separate pelvicaliceal collecting systems in one kidney

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16
Q

Describe partial duplication in duplex kidney?

A

2 ureters join before insertion into bladder

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17
Q

Describe complete duplication in duplex kidney?

A

2 ureters insert separately

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18
Q

Describe Weigert-Meyer rule of complete duplication:

A

When the upper pole ureter inserts in bladder inferior and medial to lower pole ureter (ectopic insertion)

  • upper pole obstructs
  • lower pole refluxes
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19
Q

What is the likely diagnosis of right lower pole hydro only?

A

probable VUR

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20
Q

Symptoms of ureteropelvic duplication:(6)

A
  • uti
  • obstruction
  • hematuria
  • abdominal or flank pain
  • voiding dysfunction
  • urinary retention
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21
Q

Complete duplication of renal pelvis is more common in

A

females

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22
Q

What is a ureterocele?

A

congenital cystic dilatation of submucosal portion of distal ureter

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23
Q

Describe intravesical ureterocele?

A

when ureterocele is completely contained inside the bladder

24
Q

Describe extravesical ureterocele?

A

when part of the cyst extends to the urethra, bladder neck, or perineum

25
Q

What is an orthotopic (simple) ureterocele insertion?

A

normal orifice position anatomically

26
Q

Presenting symptoms of ureterocele: (4)

A
  • febrile UTI
  • hematuria
  • chronic enuresis
  • hydronephrosis
27
Q

Are ureteroceles more common on the right or left side?

A

left side

28
Q

Where can ectopic kidneys be located? (3)

A
  • pelvis
  • iliac
  • thoracic
29
Q

What is the most common renal anomaly? (1 in 400)

A

horseshoe kidney

30
Q

What are urachal abnormalities?

A

persistence of all or a portion of the connection between the bladder dome and the umbilicus (remnant of allantoic stalk)

31
Q

Is multicystic dysplastic kidney hereditary or non-hereditary?

A

non-hereditary

32
Q

Multicystic dysplastic kidney is commonly associated with what contralateral renal abnormalities? (2)

A
  • UPJ obstruction

- Vesicoureteral reflux

33
Q

Multicystic dysplastic kidney is likely due to what?

A

atresia of ureter or UPJ during development

34
Q

How do multicystic dysplastic kidneys appear sonographically? (5)

A
  • cysts of varying size with dysplastic echogenic parenchyma
  • cysts do not connect
  • largest cyst is not in center
  • minimal blood flow
  • entire kidney involved
35
Q

A junctional parenchymal defect is more often found on the _____ side

A

right

36
Q

With crossed kidney ectopia, which kidney is more often ectopic?

A

left

37
Q

Autosomal recessive polycystic kidney disease (ARPKD) is highly associated with what kind of abnormalities?

A

hepatic abnormalities like biliary duct ectasia and periportal fibrosis

38
Q

What renal disease results in the highest mortality rate after birth?

A

ARPKD

39
Q

Is ARPKD uni or bilateral?

A

bilateral

40
Q

Are ADPKD cysts more common in children or adults?

A

adults, excellent prognosis for children

41
Q

What can ADPKD result in?

A

abnormal development of renal tubules, like cystic dilation of loop of Henle, Bowman’s capsule, and prox convoluted tubule

42
Q

What are indications of ADPKD? (5)

A
  • asymptomatic in infants and children
  • flank pain
  • hematuria
  • hypertension
  • renal failure
43
Q

What is calyceal diverticulum?

A

urine-filled outpouching of a calyx into the renal parenchyma of variable size and location

44
Q

What might calyceal diverticulum result in?

A

stasis of urine can lead to infection, milk of calcium, or stone formation

45
Q

What organ does Wilm’s tumor arise from?

A

kidney, look for claw sign

46
Q

What is the most common renal malignancy in children but not neonates?

A

Wilm’s tumor, most cases present before age 5

47
Q

What size is a Wilm’s tumor typically?

A

large, averaging 12 cm

48
Q

___% of Wilm’s tumors have a favorable prognosis?

A

85%

49
Q

Clinical symptoms of Wilm’s Tumor: (5)

A
  • palpable abd mass
  • hypertension
  • hematuria
  • abd pain
  • fever
50
Q

Sonographic findings of Wilms Tumor:

A
  • large
  • heterogeneous (hemorrhage, necrosis, fat, calcification)
  • well-defined border
  • pseudocapsule (hypo/hyperechoic rim)
  • renal vein or IVC thrombosis
  • enlarged nodes
  • mets
51
Q

Clinical symptoms of angiomyolipoma

A
  • flank pain
  • abd pain
  • hematuria
52
Q

Angiomyolipoma is rare in children except those with

A

tuberous sclerosis

53
Q

How may focal pyelonephritis appear on ultrasound?

A

a solid mass with internal flow

54
Q

What is the most common renal tumor in infancy?

A

mesoblastic nephroma (first 6 months)

55
Q

What is mesoblastic nephroma?

A

benign hamartoma of mesenchymal connective tissue

56
Q

What is multilocular cystic nephroma?

A

nonheriditary, benign renal mass consisting of encapsulated mass with multiple non-communicating cysts separated by fibrous septa

Pediatric Sonography (7 decks)

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