Urinary 2 Flashcards
Accessory renal arteries occur in what % of individuals?
30%
Which renal artery is longer and where does it cross the IVC?
right renal artery, posterior to IVC
Segmental branches of the renal arteries become the _____ as they pass through the junction between the cortex and the medulla.
interlobar arteries
What do the interlobar arteries divide into?
arcuate arteries farther into the cortex
Small veins in the renal cortex combine and drain into
interlobar veins
The interlobar veins join to form the
main renal vein
Which renal vein is longer?
left, anterior to the aorta and posterior to the celiac
The angle of incidence should be adjusted to
30-600 degrees
Describe the PW doppler characteristics of main renal artery
quick upstroke with a sharp systolic waveform and low impedance flow pattern
Describe the PW waveform for the segmental, interlobar and arcuate arteries:
all exhibit quick upstrokes in systole and a continuous low impedance flow pattern
Describe the waveform for the renal vein
low velocity monophasic flow that responds to respiratory variations and flows away from the renal hilum
What is the major cause of renal artery stenosis?
arteriosclerosis
What two methods are used for evaluation of renal artery stenosis?
- direct: eval. main renal artery
- indirect: eval. the arcuate and interlobar arteries
The direct method for eval. renal artery stenosis results in what values?
greater than 150-190 cm/s
RAR (Renal Aorta Ratio) of direct method
compares the peak systolic velocity of the aorta to the PSV of the main renal artery
-if the renal artery PSV of the main renal artery is 3.5 X’s greater than that of the aorta, a diagnosis of a 60%or greater stenosis is made
RI equation
(Peak systole-end diastole)/peak systole
What RI is the upper limits of normal, except in pts. under the age of 6 and older pts.
.70
What does the indirect method of evaluating renal artery stenosis do
- eval. the intrarenal arteries
- look at the wave form and evaluate the acceleration time and acceleration index
Describe what the indirect method finds:
The ESP and prolonged systolic upstroke or acceleration time together with decreased peak systole and a dampening of the waveform are indicative of RAS
Tardus Parvus describes
the decreased acceleration time and the decreased peak
Renal variants:
- dromedary hump
- junctional parenchyma defect
- fetal lobulation
- duplex collecting system
- extrarenal pelvis
Renal agenesis:
failure of one or both kidneys to form , can be bi or unilateral
Renal dysgenesis:
defective embryonic formation
Renal pseudotumor
overgrowth of cortical tissue that indents the echogenic renal sinus…may be mistaken for renal tumor
Supernumerary kidney
complete duplication of the renal system
Most ectopic kidneys are located in the
pelvis
Characteristics of pelvic kidney
- may be malrotated
- may simulate adnexal mass
- associated with other abnormalities
Complications of pelvic kidney
- chronic pyelonephritis
- hydronephrosis
- stones
***Horseshoe kidney characteristics:
- fusion anomaly
- fusion of polar regionsof the kidneys during fetal dev.-almost always lower poles**
- assoc. with improper ascent and malrotation of the kidneys
- generally lie close to spine
***Crossed-fuse kidney characteristics
- fusion anomaly
- both kidneys located on the same side of the body-commonly the upper pole of the ectopic kidney is fused to the lower pole of the other kidney
Characteristics of duplicated ureters
- may be complete with separate ureters draining the upper and lower collecting systems of the kidneys
- enter the bladder separately
- unilateral or bilateral
- more common in females
- incomplete duplication occurs when the ureters join together and enter the bladder as one
Describe ureterocele
- cysts like enlargement of the lower end of the ureter
- caused by congenital or acquired stenosis of the distal end of the ureter
- may cause infection of the upper urinary system
- if large they may cause bladder outlet obstruction
- found more often in adults than children
Residual bladder volume
- evaluated in pts with outflow obstruction
- post-void bladder scanned in 2 planes
- (L x W x H) x .523
What residual volume is normal in an adult
<20 cc
***Normal bladder wall measurements
-nondistended: <3mm
How much fluid does a normal bladder hold?
600-800 ml of fluid
Parts of bladder:
- apex =top
- neck=bottom
- trigone= middle
Acute cystitis
inflammation of the urinary bladder
What can acute cystitis be caused by?
catheterization, obstruction, bladder calculi, pregnancy, getting pregnant, sexual intercourse, poor hygiene
What does acute cystitis look like sonographically?
thick urinary bladder mucosal wall, smooth, continuous redundant and polypoid looking
What is ureterocele?
obstructed ureter, wall of ureter will balloon into urinary bladder
-cyst-like enlargement lower end of ureter
What is a papiloma?
pre-malignant tumor to transitional cell carcinoma
- .5-2 cm in size
- same appearance as TCC
- lateral to bladder wall
What is the most common malignant bladder tumor?
transitional cell carcinoma (mass or focal thickening of wall)
ex. squamous cell
squamous cell
associated with infections, stones, strictures
What is patent urachus?
early in life continuous with allantois, allantois progresses into urachus if lumen persists while urachus forms and a fistula develops.
- causes urine to drain from bladder to umbilicus
- urachal cysts develop if lumen persists
What is posterior urethral valve syndrome?
presence of valve in posterior urethra, presenting with:
- thickened urinary bladder wall (keyhole sign)
- hydronephrosis
- hydroureter
T/F: posterior urethral valve syndrome is found in female fetuses only?
False, male fetuses only
What is prune belly syndrome?
- dilation of fetal abdomen
- secondary to severe bilateral hydronephrosis and fetal ascites, oligohydramnios
What is urinary bladder extrophy?
- fetal anomaly in utero
- defect in abdominal wall of urinary bladder
- everted bladder becomes exposed on abdominal wall
Where are adrenal glands situated?
superior anterior and medial to kidneys bilaterally
What shape is the right adrenal gland?
triangle
What shape is the left adrenal gland?
crescent
What pts can you see the adrenal glands easily?
infants and young children..abnormal if seen in adults
The cortex is what % of the adrenal gland?
90%
What does the cortex produce?
steriod hormones, regulated by the pituitary
What does the adrenal medulla produce?
Caticolmines-epinepherine and adrenaline (responsible for fight or flight)
What is the 4th most common site for metastasis?
adrenal glands, most commonly from lung and renal cell carcinoma
Son findings of metastatic disease in adrenal glands.
- usually bilateral
- hypoechoic
- 4cm
- round/oval
- large mass displaces kidney inferiorly
Characteristics of cysts in the adrenal glands
- uncommon
- no clinical symptoms
- females
- unilateral, found incidentally
- vary in size
- most are benign
- ring calcifications around cysts indicative for malignancy
Who is most likely to have adrenal gland hemorrhage?
neonates (large size of gland and trauma during birth)
Hemorrhage of adrenal glands in adults:
associated with anticoagulation therapy (liver transplant, surgery, trauma or tumor)
Chronic primary hypoadrenalism AKA
Addison’s disease
What is chronic primary hypoadrenalism/ Addison’s disease ?
atrophy of glands due to insufficient secretions of hormones
-uncommon, usually occurs from autoimmune disorder of TB
Symptoms of Addison’s disease:
fatigue, muscle weakness, hypotension, GI disease (managed by administering steroids)
Hyperadrenalism AKA
Cushing’s syndrome
What is hyperadrenalism AKA Cushings?
- excessive glucose production
- pancreas no longer able to produce insulin and diabetes will occur
- protein loss occurs (results in weakened muscle & elastic tissue)
- poor wound healing, susceptible to tearing and bruising
- red welts on thighs and abdomen
- hypertension in 99% of cases
What happens with congenital adrenal hyperplasia?
- deficiency of an enzyme
- overstimulates pathway of an enzyme
- results in virilazation (male characteristics in women)
- glands symmetrically enlarged
- hursitism, ambiguous genitalia, precocious puberty
Hursitism
excessive body hair
Adrenal adenoma
- hyperfunctioning or nonfunctioning tumor, mostly benign
- poorly encapsulated tumors ranging in size 1-5 cm in diameter
- difficult to detect with u/s
- may cause Cushings
What do adrenal adenomas consist of?
- lipid filled cells that do not secrete hormones
- single nodule larger than 1 cm
What are myelolipomas
- rare benign tumors of cortex
- found between 4th and 6th decades of life
- most found post mortem
- asymptomatic (fatty and bone marrow elements)
Son findings of myelolipomas
hyperechoic mass in adrenal bed
What do adenocarcinomas produce?
steroids
Adenocarcinomas that do not produce steroids are:
highly malignant
Son findings on adenocarcinomas:
small mass: homogenous
large mass: necrosis, hemorrhage or calcifications
Adenocarcinomas have what tendency?
to invade renal veins, IVC, HV’s, and Rt. atrium
What organs are most often primary for adrenal gland metastisis?
lung, breast, stomach, colon, kidney
What does metastisis of the adrenal gland cause?
adrenal insufficiency
Son findings of metastasis of the adrenal glands:
- glands will vary in size and echogenicity
- central necrosis causes sonolucent areas within the tumors
What % of pheochromocytoma originates on medulla?
90%
Incidence of malignancy in pheochromocytoma:
5-10%
What do pheochromocytoma excreet?
epi and norepi in excessive quantities
Symptoms of pheochromocytoma:
high blood pressure, headaches, tachycardia, excessive perspiration
Son findings of pheochromocytoma:
- large sharply marginated tumors
- significant solid components
- central hemorrhage and necrotic changes are common
- can produce cystic component focal echogenic abnormalities
What is a neuroblastoma?
highly malignant tumor of the medulla
What is the most common malignancy in the adrenal gland?
neuroblastoma
Neuroblastomas present as abdominal mass in what age group?
children, usually less than 4 years old, 50% less than 2 years
Neuroblastomas can metastasize to what?
- lymph nodes
- liver
- lung
- bone
Son findings of neurblastoma
- appears as inhomogenous echogenic solid mass
- occasional calcifications and cystic degeneration
- must be differentiated from Wilm’s tumor
