Unit 9- Renal and Variants (Elie)

What are the four parts and branches of the Renal Artery?

- Main Renal Artery

-Segmental Arteries

-Interlobar Arteries

-Arcuate Arteries

Where does the RRA extend?

From lateral AO to hilum of kidney

1. -10:00 position

• -Posterior to IVC

On a longitudinal image, what does the RRA look like?

Seen as circular structure posterior to IVC

The RRA is _______ than the LRA

Longer

What are these images showing?

Right Renal Artery(RRA)

Where does the RRV extend?

From renal sinus to IVC

The RRV is ______ than the LRV

Shorter

What is this image showing?

Right Renal Vein (RRV)

Where does the LRA extend?

From posterolateral AO to hilum of kidney

• -4:00 position

What is this image showing?

Left Renal Artery (LRA)

Where does the LRV extend?

From renal sinus, anterior to AO, posterior to SMA to join IVC

The LRV is _______ than RRV

Longer

What is a variant of the Left Renal Vein?

Retroaortic LRV

What is this image showing?

Left Renal Vein (LRV)

Where does the Crura of Diaphragm run?

-Transversely in paraaortic region

Where is the crura of diaphragm located?

Posterior to renal arteries

How can the Crura of Diaphragm be identified?

-Lack of pulsations

-No doppler flow

What is the echogenicity of the Crura of diaphragm?

-Hypoehoic

What is this image showing?

Crura of Diaphragm

What is this image demonstrating?

Renal Angiogram

What is included in the Renal Medulla?

-Hypoechoic Pyramids

Where are the pyramids located in the renal medulla?

-At junction between renal cortex and central sinus

What do the renal pyramids look like sonographically?

-Uniform in size, shape & distribution

-Interlobar vessels run alongside the pyramids

-Arcuate vessels lie at base of pyramids

What is this image showing?

Renal Pyramids

What are normal variants?

Slight alterations in anatomy

What is the variant Column of Bertin?

- Cortex located at varying depths within medulla

-Contiguous with normal cortex tissue

-Same echogenicity as renal parenchyma

What is this image showing?

Column of Bertin

What is the Dromedary Hump variant?

-Cortical Bulge along lateral border

Where is a Dromedary Hump more common?

Left > Right

What is the echogenicity of a dromedary hump?

-Identical echogenicity to renal cortex

What can a dromedary hump resemble?

-Neoplasm = pseudotumor

What is this image showing?

Dromedary Hump

What is the variant Junctional Parenchymal Defect?

-Triangular, echogenic area

-Upper pole, anteriorly

What is this image showing?

  Junctional Parenchymal Defect

What is the renal variant Lobar Dysmorphism?

-Lobar fusion variant with malrotation of renal lobe

Where is the Lobar dysmorphism located?

-Middle & upper calyces may be splayed & displaced; lower calyx deviated posteriorly

What may lobar dysmorphism resemble?

-Mass or prominent Column of Bertin

What is the variant Fetal Lobulations?

-Fusion of two embryonic parenchymatous masses

-Indentation along border or surface giving kidney a lobulated appearance

What is this image showing?

Fetal Lobulations

What is the variant Sinus Lipomatosis?

-Abundant fibrofatty tissue in renal sinus

-Enlargement of sinus region

What is the echogenicity of Sinus Lipomatosis?

Increased echogenicity

What is this image showing?

Sinus Lipomatosis

What is the variant Extrarenal Pelvis?

-Larger Pelvis

-Transverse view shows continuity with renal sinus

Where does the Variant extrarenal pelvis extend?

-Extends medially from confines of renal tissue

Why should you use color on a Extrarenal Pelvis?

-To prove its not RA or RV

What is this image showing?

Extrarenal Pelvis