Urinary: Anatomy/Congenital Flashcards
Anterior pararenal space
Perirenal space
Posterior pararenal space
What does the posterior pararenal space contain?
Only fat pads
What does the perirenal space contain?
- Kidneys
- Proximal ureters
- Adrenals
What does the anterior pararenal space contain?
- Pancreas
- Duodenum
- Ascending and descending colon
Posterior parietal peritoneum
Note: This is the anterior border of the anterior pararenal space.
Leteroconal fascia
Anterior renal fascia (Gerota’s fascia)
Posterior renal fascia (Zuckerkandl’s fascia)
Transversalis fascia
What is the name of the potential space between the anterior pararenal space and the perirenal space?
The retromesenteric plane
What is the name of the potential space between the perirenal space and the posterior pararenal space?
The retrorenal plane
What is the normal length of the kidney?
9-15 cm
When should you call increased renal echogenicity?
If the kidney is hyperechoic relative to liver
Note: If the liver is very hyperechoic relative to the kidney, then it is a fatty liver.
Left kidney
Dromedary hump (due to mass effect from adjacent spleen)
Hypertrophied column of Bertin
Hypertrophied column of Bertin
Junctional parenchymal defect (echogenic line in the upper 1/3 of the kidney)
Note: This is basically only seen on longitudinal ultrasound.
Persistent fetal lobulation of the kidneys
Bilateral renal agenesis…
Think Potter sequence
Note: Pts will likely also have hypoplastic lungs.
Unilateral renal agenesis is associated with…
- Genital anomalies in women (70%), usually unicornuate uterus
- Genital anomalies in men (20%), usually ipsilateral absence of the epididymus and vas deferens
How can you differentiate between renal agenesis and a surgically absent kidney?
Look for a pancake adrenal (elongated, flattened adrenal suggests renal agenesis because it was not molded in utero by the ipsilateral kidney)
What are the major phases of renal contrast enhancement?
- Noncontrast
- Corticomedullary phase (25-40 seconds)
- Nephrographic phase (70-180 seconds)
- Excretory phase (180 seconds-8 minutes)
What renal contrast phase?
Corticomedullary (25-40 seconds)
What renal contrast phase?
Nephrographic (70-180 seconds)
What renal contrast phase?
Excretory/pyelographic (180 seconds-8 minutes)
What is the best contrast phase to evaluate for renal tumor invasion of the renal veins?
Corticomedullary (best for evaluating renal arteries and veins)
What is the best contrast phase to differentiate clear cell and papillary RCC?
Corticomedullary phase
Note: Clear cell should be similar to cortex on this phase while papillary should be less than cortex.
Where in the kidney is contrast in the corticomedullary phase?
In the vascular system and extracellular interstitial space (cortex is enhanced, but medulla is not)
Where in the kidney is contrast in the nephrographic phase?
Through the loops of Henle and collecting tubules (fairly uniform enhancement of renal cortex and medulla)
Where in the kidney is contrast in the excretory phase?
Urinary tract/collecting system (with progressive decrease in the nephrogram density)
What is the most sensitive phase to detect renal cell carcinoma?
Nephrographic (70-180 seconds)
Common causes of a delayed corticomedullary phase (e.g. corticomedullary appearance in portal venous images)
- Renal failure
- Renal artery stenosis
- Obstructive hydronephrosis
- Heart failure
What is the best phase to evaluate the renal papilla morphology?
Excretory phase (180 seconds-8 minutes)
Note: This is when you can look for papillary necrosis.
What is the best phase to look for a striated nephrogram (e.g. pyelonephritis)?
Excretory phase (180 seconds-8 minutes)
