Unit 9- Renal Anomalies (Elie)

What is agenesis?

Absence of a kidney, failure to form

What is Dysgenesis?

Defective embryonic development of kidney

What is Supernumerary?

Complete duplication of renal system

What is a Pseudotumor?

Overgrowth of cortical tissue mistaken for mass

What is this image showing?

Pseudotumor

Agenesis is considered______

Rare

Agenesis US appearance:

• Verify no small, nonfunctioning kidney present

• Enlargement of remaining kidney

What is renal hypoplasia?

• Incomplete development

• Normal, just smaller than normal

With renal hypoplasia, you want to differentiate from?

• Atrophy

  • Secondary to: pyelonephritis or renal artery stenosis

What is the variant Duplex Collecting System?

• Bifid Renal Pelvis

  • Duplication of renal pelvis with 1 ureter

A duplex collecting system can be ________ or ________

Complete or Incomplete

What is the appearance of a duplex collecting system?

• Complete confirmed with 2 ureteral jets on same side of bladder

• Enlarged kidney, smooth borders

• Central sinus separated by appearance of normal parenchymal tissue

What are these images showing?

• Duplex Collecting System/ Supernumerary

What is a Pelvic Kidney and what is it associated with?

• “Ectopic Kidney” - inferior

• Kidney not in renal fossa

  • Associated with: vesicoureteral reflux & abnormal extrarenal pelvis

What is this showing?

Pelvic Kidney

What is Crossed Renal Ectopia?

Both kidneys found on same side (Rt > Lt)

What percentage of a crossed renal ectopia are fused?

85-90%

What is the incidence of crossed renal ectopia?

1 in 1,000-1,500

In a Crossed renal ectopia the ureterovesical junctions are in what positions?

Normal positions

What are these images showing?

Crossed Renal Ectopia

What are these images demonstrating?

Crossed Renal Ectopia

What is a horseshoe kidney?

Fusion of lower polar regions

Where are horseshoe kidneys located?

• Located more inferiorly than normal

• Pelves located ventrally

• Closer to spine

• Isthmus of kidney is anterior to spine, Aorta & IVC

What other pathologic conditions are associated with a horseshoe kidney?

• Kidney malrotation

• Urolithiasis

• UPJ Obstruction

• Pyelocaliectasis

• Anomalous extrarenal pelvis

• Infection

What are these images showing?

Horseshoe Kidney

What is being shown in the image above?

• Transverse image of the right and left kidney showing the inferior poles connected and crossing anterior to the IVC and Aorta.

What is the responsibility of the sonographer before an exam?

Review a patient’s chart & previous exams (US, X-ray, CT, MRI, IVP, Lab work) & gather adequate patient history

What does the sonographer scan and evaluate?

• Size & shape of kidneys

• Location of mass lesion

• Look for distortion of renal or ureter structure

• Look for stones or gas within kidney

• Look at surrounding structures

US appearance of a Cystic Renal Mass?

• Smooth, thin well-defined border

• Round or oval

• Sharp interface between cyst & renal parenchyma

• Anechoic

• Increased Posterior enhancement

US appearance of a Solid Renal Mass?

• Irregular borders

• Low-level echoes

• Poor through transmission

• Increased Attenuation

US appearance of a Complex Renal Mass?

• Mixed echogenicity

  • Necrosis

  • Hemorrhage

  • Calcification

  • Abscess

• Characteristics of both cystic & solid

What are all the aspirations of renal masses?

• Simple Cyst (I)

• Mildly complex cyst (II)

• Mildly complex (IIF)

• Indeterminate lesion (III)

• Malignant lesion (IV)