Urinary Tract ( IMAGES) Flashcards
Normal blood flow is seen through the right renal vein to the IVC
Longitudinal scan of the normal left kidney as imaged through the homogeneous spleen.
The psoas muscle is the posterior medial border of the kidney
Longitudinal image of a neonatal left kidney using a
18 MHz transducer with white arrow pointing to normal hypochoic renal pyramids.
The crura of the diaphragm lie posterior to the renal arteries and should be identified by their lack of pulsations and lack of Doppler flow (arrows).
Longitudinal scan of the kidney with prominent column of Bertin.
Coronal view of the left kidney.
The dromedary hump is a cortical bulge that occurs on the lateral border of the kidney, typically on the left more than on the right.
The junctional parenchymal defect (arrows) is a triangular area in the upper pole of the renal parenchyma.
TRV and SAG image of lobar dysmorphism
Remnant fetal renal lobulations (an irregularly shaped renal border).
Transverse and longitudinal scans of a patient with renal sinus lipomatosis.
Extrarenal pelvis.
A, Scan of the right kidney with an extrarenal pelvis appearing as a cystic area that extends beyond the confines of the renal borders.
B, Color Doppler confirming the extrarenal pelvis.
Enlarged solitary kidney with unilateral renal agenesIs.
Longitudinal view of a malrotated right kidney, with the renal pelvis facing anteriorly.
A, Longitudinal scan of a duplicated right collecting system with severe hydrone-phrosis of upper moiety.
B, Ectopic right distal ureter.
C, Longitudinal scan of a duplicated right collecting system with moderate hydronephrosis of the upper moiety.
D, Ureterocele of the distal right ureter (“rule of Weigert-Meyer”).
E & F, Longitudinal scan of a left collecting system with severe upper moiety, hydronephrosis, and ectopic ureter.
Ectopic kidney found in the pelvis, just posterior to the distended urinary bladder.
Crossed kidney on the right side of the body.
Sonogram (B) and IVP (C) of the left crossed fused kidney.
Transverse scan of the horseshoe kidney with isthmus connecting each pole.
A, Normal kidney
B, Large right ureterocele protruding into urinary bladder.
C, In gray scale the white arrow is pointing to the continuous ureteral jet known as the candle sign.
Upper pole renal cyst with no blood flow to the cyst.
Sagittal view of the left kidney with a cystic mass.
Transverse view of lower pole with a complex cyst.
single upper-pole cortical cyst with a thin septation.
B, Two small adjacent renal cysts (“kissing” cysts).
A, A small 15 mm mass within a cyst.
B, Color Doppler demonstrates intratumoral vascularity.
Transverse scan of a hemorrhagic cyst with no increase in blood flow.
Images of a young adult male with polycystic renal disease.
Longitudinal scans of both kidneys show enlarged kidneys (right kidney [RK] 15.2 cm and left kidney [LK] 17.4 cm) with a variety of cyst sizes.
C, Polycystic kidney with stone.
D, About one third of patients with polycystic renal disease also have cysts on the liver or other organs.
A 30-year-old male with a solitary left polycystic kidney and hematuria was sent to rule out obstruction. It is very difficult to rule out obstruction with so many small cysts.
Longitudinal scans of a young patient with medullary sponge kidney show neph-rocalcinosis and stone formation.
Longitudinal view of the right kidney with hyperechoic calyces and stones.
A, Longitudinal view of a small hyperechoic renal cell carcinoma.
B and C, Color Doppler demonstrates peripheral vascularity of the tumor (“basket sign”).
D, Contrast CT confirms a small enhancing renal tumor; pathology confirmed cell carcinoma.
Stage III renal cell carcinoma with invasion into the inferior vena cava.
A, Longitudinal scan shows lower pole mass with no normal renal parenchyma.
B, Measurement of the lower pole mass.
Longitudinal scan demonstrating the thrombus-filled inferior vena cava (IVC)
D, Longitudinal scan of IVC with color flow showing obstruction.
E, Transverse view of the dome of the liver with patent hepatic veins and nonvisualization of the IVC
Longitudinal scan of the right kidney showing a large (5.30 × 4.49 cm)
hypoechoic vascular mass with low resistive index (RI).
A transverse view of the right kidney demonstrating a cyst and a small hyperechoic mass, which is consistent with renal cell carcinoma.
Sixty-year-old patient with metastatic disease.
A, Sagittal image of right kidney shows irregularly shaped mass filling the renal sinus.
B, Transverse image of the squamous cell
carcinoma.
Sixty-year-old patient with bilateral renal lymphomas.
A, Sagittal image of right kidney with hypochoic upper pole mass.
B, Transverse image of upper pole of right kidney with hypochoic lymphoma.
Eight-year-old presents with hematuria and large palpable right renal mass disrupting the normal renal architecture (large heterogeneous mass invading collecting system and proximal ureter).
Color spectral Doppler shows increased vascularity of the mass.
One of the complications of a Wilms’ tumor (M) is spread beyond the renal capsule into the renal vein and inferior vena cava (IC).
B, This 18-month-old child had a large, complex tumor with extension into the inferior vena cava (IC, arrows). RK, Right kidney.
C and D, Longitudinal scan, showing the dilated inferior vena cava with tumor echoes along the posterior border. The tumor may extend into the right atrium of the heart. L, Liver; RK, right kidney.
A through D,
A 14-month-old child with a large Wilms’ tumor (M) extending from the right kidney (KID) into the inferior vena cava (IC). On coronal scan (D), the tumor mass is seen within the IVC.
The patient is rolled into a slight decubitus position for better imaging of the IVC and aorta (Ao). LIV, Liver.
Angiomyolipoma appears as an echogenic focal mass in the renal parenchma.
Left kidney mid-lower pole 3 cm hyperechoic vascular mass.
Longitudinal view of the left kidney shows large exophytic heterogeneous mass.
B, Hypervascular on power Doppler.
Mass proved to be oncocytoma.
Sagittal view of left kidney with lipoma.
Acute glomerulonephritis may be suspected when the echogenicity of the renal parenchyma exceeds that of the liver.
Patients with lupus nephritis demonstrate a highly echogenic renal parenchymal pattern compared with the liver.
Renal atrophy is usually present.
scans in a patient with acquired immunodeficiency syndrome (AIDS) show cortical echogenicity with normal to slightly increased renal size.
Transverse and longitudinal scans of a young male with acquired immunodeficiency syndrome (AIDS) show a mildly echogenic renal parenchyma.
A 73-year-old man with chronic renal disease.
Small echogenic kidney with inability to distinguish the medulla from the cortex region of the kidney.
B, Renal sinus lipomatosis appears as enlarged kidneys with an echogenic, enlarged renal sinus and a thin cortical rim. Renal sinus fat is easily seen on ultrasound as highly echogenic reflections.
Transverse (A) and longitudinal (B) scans of the pediatric patient with acute tubular necrosis and nephrocalcinosis.
The echogenic renal pyramids are well seen.
Hydronephrosis of the kidney.
The dilated pyelo-caliceal system appears as separation of the renal sinus echoes by fluid-filled areas that conform anatomically to the infundibula, calyces, and pelvis.
Slight dilatation of the collecting system is seen.
A longitudinal left kidney scan with dilatation of the proximal ureter caused by a stone (arrows).
A, Three small left uretral stones at the level of the crossing iliac vessels. Mild hydronephrosis is seen.
B, Small right distal UV stone causing obstruction of the ureter.
Severe left pelvocaliectasis. Note the absence of a dilated ureter after the ureteral pelvic junction (UPJ.
B, Severe left pelvocaliectasis without a dilated ureter after UPJ.
C, Color Doppler demonstrates the crossing vessel causing UPJ obstruction.
A, Grade 2 to grade 3 left uretero-hydronephrosis.
B, 1 cm obstructing stone in
the lower portion of the left ureter.
C, High resistive index (RI = 0.80) documenting an acute urinary
obstruction.
D, Absence of the left ureteral jet.
Normal right (A) and left (B) ureteral jets seen in the fluid-filled bladder.
A. Transverse scan of a fluid-filled bladder with a normal right ureteral jet. A partially obstructed left ureter with decreased flow.
B, Transverse scan of a partially obstructed distal left ureter. Arrows indicate the stone and shadowing posterior to the stone.
C, Transvaginal scan of the dilated distal ureter with a ureteral stone.
D, Normal resistive index (RI) of 0.59 for left kidney.
Patient with xan-thogranulomatous pyelonephritis shows a large, nonfunctioning right kidney secondary to a stone. Multiple areas of shadowing are seen within the renal parenchyma from the renal stones.
Longitudinal scans of the right kidney show hyperechoic pyramids, consistent with nephrocalcinosis.
Normal resistive index (RI) of 0.74 in a 4-year-old female. The arrow indicates an early systolic peak.
Longitudinal and Transverse color Doppler of normal intrarenal vessels with vascular flow throughout the renal cortex.
Normal renal spectral waveform taken at the interlobar arteries
Normal arcuate vessel Doppler spectral signal.
A rapid systolic rise with a resistive index (RI) of 0.56.
A gradual decrease into diastole.
Longitudinal scan of normal size of right kidney.
B, Longitudinal scan of small (shrunken) left kidney with cortical atrophy.
C, Normal spectral waveform right kidney.
D, Parvus-tardus (delayed ST) left kidney consistent with renal artery stenosis.
A, Color duplex Doppler with a pulsating vascular malformation in the right renal hilum.
B, Arterialization of renal venous flow.
A 69-year-old male presented with right flank pain.
A midpole echogenic structure with indicating posterior shadowing, representative of?
Renal Stone
A small (3.1 mm) right renal stone detected using tissue harmonics.
A, Small stone in the renal sinus
B, Color Doppler. A twinkle effect.
An 8 mm right midpole obstructing ureteral stone.
B, Color Doppler shows twinkle sign
Longitudinal scan of a 65-year-old man with a stone in the distal left ureter
B, Partial obstruction of left ureter with decreased ureteral jet.
C, Transverse scan of bladder with left ureteral stone measuring 8 mm and normal right ureteral jet.
D, Increased left intrarenal resistive index (RI) of 0.73.
Transverse scan of the bladder stone with shadowing measuring (1.21 cm )
Transverse scan of two bladder diverticula, one on either side.
Transverse scan of the urinary bladder with a stone in the diverticulum
Carcinoma of the urinary bladder with blood flow seen within the mass.
Junctional parenchymal defect or junctional line.
Chronic renal failure.
The kidney is significantly more echogenic than the adjacent liver parenchyma
The kidney is small, and there is also loss of the normal corticomedullary differentiation
Complex renal cyst.
This renal cyst has several septations
Autosomal dominant polycystic kidney disease.
Advanced renal cystic disease results in the parenchyma being replaced by numerous noncommunicating cysts of varying sizes.
Multicystic dysplastic kidney.
The parenchyma of this multicystic dysplastic kidney has been completely replaced by large cysts.
1. Unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossa
2. Compensatory hypertrophy of the contralateral kidney
Acute pyelonephritis.
Acute renal infection with interstitial hemorrhage produces hyperechoic focal swelling in the upper pole of this kidney
Pyonephrosis.
Pus (arrows) is noted within the dilated calices (c) and renal pelvis (P) in this kidney
Chronic pyelonephritis
Longitudinal image of a 10-year-old boy showing a small echogenic left kidney with a dilated calyx (C) and overlying parenchymal atrophy
Fungus ball.
Transverse image of the kidney in a 2-month-old infant with Candida albicans showing a dilated renal pelvis (p) and calices (c) that contain echogenic urine and a mobile fungal ball
Moderate hydronephrosis.
Urine-filled dilated renal pelvis and calices
Kidney stones.
Numerous renal stones are seen within the dilated calices as echogenic foci with posterior shadowing
Medullary nephrocalcinosis.
With nephrocalcinosis, the pyramids are filled with small stones that may or may not produce acoustic shadowing.
Renal cell carcinoma.
Longitudinal (left and transverse images (right) of the left kidney showing a heterogeneous solid lesion (arrows) in the superior pole.
Renal hematoma.
Longitudinal image of the left kidney demonstrating a hypochoic collection anterior to the kidney
The collection lies between the echogenic renal capsule and the renal cortex.
The hematoma follows the contour of the kidney.
Renal vein thrombosis.
A spectral Doppler waveform from a segmental renal artery in the renal sinus demonstrating reversed diastolic flow in a patient presented with abrupt anuria 3 hours postsurgery.
Thrombosis of the main renal vein was found at surgery.
STING procedure.
Transverse sonogram showing round echogenic foci protruding into the bladder lumen representing the bulking agents effect.
subureteral Teflon injection
Wilms tumor.
Longitudinal image of the kidney revealing an isoechoic mass
It was proven to be a nephroblastoma (Wilms tumor)
Ureterocele.
small, left-sided ureterocele is noted in the transverse image of the bladder
Bladder diverticuli.
Transverse image of the urinary bladder (B) revealing two-bladder diverticuli
Urinary bladder wall thickening.
Endovaginal image of the urinary bladder showing a thickened irregular bladder wall, consistent with chronic cystitis.
Transitional cell carcinoma.
Longitudinal image of the bladder revealing a broad-based mass originating from the bladder mucosa.
