docScenarios/indications Adult Kidneys Dromedary hump (RB dyer
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Scenarios/indications Adult Kidneys Dromedary hump (RB dyer
2009/7/23 Scenarios/indications Loin pain Renal cause? Other catastrophe? If renal in origin, is there any: Obstructive uropathy/hydronephrosis? Renal/ureteric stone Dr .TANG Ho Ming Hong Kong College of Emergency Medicine 09/2006 HKCEM 1 Adult Kidneys 09/2006 HKCEM Dromedary hump 2 (RB dyer 2004) 9 - 12 cm long Can vary in size up to 1.5 cm. Normal variant - dromedary hump on the lateral mid portion Hilum: renal vein, artery and ureter (anterior to posterior) 09/2006 HKCEM Adult Kidneys 3 09/2006 HKCEM 4 Anatomy (D Pancu 2003) Pyramids (8 - 18) contain the loops of Henle anechoic prominent in infant no distal enhancement Renal sinus: collecting system hyperechoic Note oblique lie of normal kidneys. 09/2006 HKCEM 5 09/2006 HKCEM 6 1 2009/7/23 Acoustic windows – probe positions Scanning Technique Supine (D Pancu 2003) Left decubitus and Right decubitus Prone Sitting / Standing Windows: liver for R kidney spleen for L kidney Scan in both longitudinal and transverse planes Compare both kidneys Scan the urinary bladder 09/2006 HKCEM 7 Normal Scan 09/2006 HKCEM 8 Normal Scan Liver RK Longitudinal Scan of Left Kidney Longitudinal Scan of Right Kidney 09/2006 HKCEM 9 Normal Scan 09/2006 HKCEM 10 Hydronephrosis Grade I - renal pelvis dilated Grade II - renal pelvis & major calyces dilated Grade III - renal pelvis, major & minor calyces dilated Transverse Scan of Right Kidney 09/2006 HKCEM 11 09/2006 HKCEM 12 2 2009/7/23 Grading of hydronephrosis (D Pancu 2003) Hydronephrosis Look for hydroureter Scan the bladder: false +ve when the bladder is full absent/abnormal ureteral jet UVJ for stones (consider TVS in female) 09/2006 HKCEM 13 Hydronephrosis 09/2006 HKCEM 14 Hydronephrosis Long Trans Hydronephrosis & Hydroureter Grade 1 hydronephrosis 09/2006 HKCEM 15 Hydronephrosis 09/2006 HKCEM 16 Hydronephrosis Acoustic Shadow Hydronephrosis & Stone at PUJ Grade 3 hydronephrosis 09/2006 HKCEM 17 09/2006 HKCEM 18 3 2009/7/23 Hydronephrosis Renal Stones Stones in renal sinus may not be visualized due to echogenicity Stones in ureter may not be visualized due to overlying bowel gas Acoustic shadow may not be present if stone is small Stones may be visualized at the UVJ with a full bladder Right Ureteral Jet, absent Left Ureteral Jet 09/2006 HKCEM 19 09/2006 HKCEM 20 Incidental findingsRenal Cysts Renal Stones Most common renal mass Frequency increases with age Stone Half of the population involved above age 50 K Discovery of several simple cysts in a child suggest: Acoustic Shadow polycystic disease von Hippel-Lindau disease Turner’s syndrome 09/2006 HKCEM 21 Renal Cysts 09/2006 HKCEM 22 Renal Cysts Simple cyst may have thin septations or a lobulated shape Criteria: Anechoic Calcifications not rare Strong back wall 20% cyst with Ca harbor malignancy Distal acoustic enhancement all calcified cysts should be CT No measurable wall thickness 09/2006 HKCEM 23 09/2006 HKCEM 24 4 2009/7/23 Renal Cysts Renal Cysts Renal Cyst Renal Cyst LK LK Distal Acoustic Enhancement Distal Acoustic Enhancement Transverse scan: Left Kidney 09/2006 HKCEM Longitudinal scan: Right Kidney 25 Renal Cysts 09/2006 HKCEM 26 Polycystic Kidneys Autosomal dominant polycystic disease Liver Pancreas Cerebral aneurysms 50% 5% 20% Simple cyst with septation 09/2006 HKCEM 27 Polycystic Kidneys Multiple, variably sized, irregular margins Bilateral in almost all cases Calcification in the walls Crystals in the cysts - comet tail Intracystic haemorrhage or infection may cause symptoms: 09/2006 HKCEM 28 Polycystic Kidneys complex cyst solid appearing fluid-debris level 09/2006 HKCEM Left Kidney 29 09/2006 HKCEM Right Kidney 30 5 2009/7/23 Chronic Parenchymal Disease Renal Cell Carcinoma Small kidneys (< 9 cm) Increase cortical echogenicity both acute and chronic renal parenchymal diseases can cause increase echogenicity Longitudinal scan: Right Kidney 09/2006 HKCEM 31 09/2006 Transverse scan: Right Kidney HKCEM 32 Basic Requirement Longitudinal scans of both kidneys Transverse scans of both kidneys Bladder scan showing UVJ Questions? 09/2006 HKCEM 33 09/2006 HKCEM 34 6
Gillian Lieberman, MD