Urinary: Anatomy/Congenital

Question 1

Answer 1

Anterior pararenal space

Question 2

Answer 2

Perirenal space

Question 3

Answer 3

Posterior pararenal space

Question 4

What does the posterior pararenal space contain?

Answer 4

Only fat pads

Question 5

What does the perirenal space contain?

Answer 5

• Kidneys
• Proximal ureters
• Adrenals

Question 6

What does the anterior pararenal space contain?

Answer 6

• Pancreas
• Duodenum
• Ascending and descending colon

Question 7

Answer 7

Posterior parietal peritoneum

Note: This is the anterior border of the anterior pararenal space.

Question 8

Answer 8

Leteroconal fascia

Question 9

Answer 9

Anterior renal fascia (Gerota’s fascia)

Question 10

Answer 10

Posterior renal fascia (Zuckerkandl’s fascia)

Question 11

Answer 11

Transversalis fascia

Question 12

What is the name of the potential space between the anterior pararenal space and the perirenal space?

Answer 12

The retromesenteric plane

Question 13

What is the name of the potential space between the perirenal space and the posterior pararenal space?

Answer 13

The retrorenal plane

Question 14

What is the normal length of the kidney?

Answer 14

9-15 cm

Question 15

When should you call increased renal echogenicity?

Answer 15

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.

Question 16

Left kidney

Answer 16

Dromedary hump (due to mass effect from adjacent spleen)

Question 17

Answer 17

Hypertrophied column of Bertin

Question 18

Answer 18

Hypertrophied column of Bertin

Question 19

Answer 19

Junctional parenchymal defect (echogenic line in the upper 1/3 of the kidney)

Note: This is basically only seen on longitudinal ultrasound.

Question 20

Answer 20

Persistent fetal lobulation of the kidneys

Question 21

Bilateral renal agenesis…

Answer 21

Think Potter sequence

Note: Pts will likely also have hypoplastic lungs.

Question 22

Unilateral renal agenesis is associated with…

Answer 22

• Genital anomalies in women (70%), usually unicornuate uterus
• Genital anomalies in men (20%), usually ipsilateral absence of the epididymus and vas deferens

Question 23

How can you differentiate between renal agenesis and a surgically absent kidney?

Answer 23

Look for a pancake adrenal (elongated, flattened adrenal suggests renal agenesis because it was not molded in utero by the ipsilateral kidney)

Question 24

What are the major phases of renal contrast enhancement?

Answer 24

• Noncontrast
• Corticomedullary phase (25-40 seconds)
• Nephrographic phase (70-180 seconds)
• Excretory phase (180 seconds-8 minutes)

Question 25

What renal contrast phase?

Answer 25

Corticomedullary (25-40 seconds)

Question 26

What renal contrast phase?

Answer 26

Nephrographic (70-180 seconds)

Question 27

What renal contrast phase?

Answer 27

Excretory/pyelographic (180 seconds-8 minutes)

Question 28

What is the best contrast phase to evaluate for renal tumor invasion of the renal veins?

Answer 28

Corticomedullary (best for evaluating renal arteries and veins)

Question 29

What is the best contrast phase to differentiate clear cell and papillary RCC?

Answer 29

Corticomedullary phase Note: Clear cell should be similar to cortex on this phase while papillary should be less than cortex.

Question 30

Where in the kidney is contrast in the corticomedullary phase?

Answer 30

In the vascular system and extracellular interstitial space (cortex is enhanced, but medulla is not)

Question 31

Where in the kidney is contrast in the nephrographic phase?

Answer 31

Through the loops of Henle and collecting tubules (fairly uniform enhancement of renal cortex and medulla)

Question 32

Where in the kidney is contrast in the excretory phase?

Answer 32

Urinary tract/collecting system (with progressive decrease in the nephrogram density)

Question 33

What is the most sensitive phase to detect renal cell carcinoma?

Answer 33

Nephrographic (70-180 seconds)

Question 34

Common causes of a delayed corticomedullary phase (e.g. corticomedullary appearance in portal venous images)

Answer 34

- Renal failure - Renal artery stenosis - Obstructive hydronephrosis - Heart failure

Question 35

What is the best phase to evaluate the renal papilla morphology?

Answer 35

Excretory phase (180 seconds-8 minutes) Note: This is when you can look for papillary necrosis.

Question 36

What is the best phase to look for a striated nephrogram (e.g. pyelonephritis)?

Answer 36

Excretory phase (180 seconds-8 minutes)