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Chapter 7 153 The renal tract CHAPTER CONTENTS The normal renal tract 154 Ultrasound technique 154 Assessment of renal function 157 Normal variants 158 Renal cysts and cystic disease 160 Cysts 160 Autosomal dominant (adult) polycystic kidney disease 161 Autosomal recessive (infantile) disease 162 Acquired cystic disease 162 Multicystic dysplastic kidney (MCDK) 162 Benign focal renal tumours 162 Angiomyolipoma 162 Adenoma 162 Malignant renal tract masses 163 Renal cell carcinoma 163 Transitional cell carcinoma 164 Lymphoma 165 Metastases 165 Pelvicalyceal system dilatation and obstructive uropathy 166 Physiological dilatation 166 Obstructive uropathy 166 Vesicoureteric junction 170 Non-obstuctive hydronephrosis 170 Renal tract calcification 170 Renal tract stones 171 Nephrocalcinosis 173 Hyperparathyroidism 173 Renal tract inflammation and infection 174 Pyelonephritis 174 Focal pyelonephritis 175 Renal abscess 175 Tuberculosis (TB) 175 Xanthogranulomatous pyelonephritis (XGP) 177 Hydatid cysts 177 Diffuse renal disease and renal failure 177 Acute tubular necrosis 177 Glomerulonephritis 178 Medullary sponge kidney 179 Amyloid 179 The renal biopsy 179 Renal vascular pathology 179 Renal artery stenosis (RAS) 179 Renal vein thrombosis 180 Arteriovenous fistula 181 Ultrasound in dialysis 181 Renal trauma 182 Renal transplants 182 Normal anatomy 182 Normal ultrasound and appearances 182 Postoperative complications 185 Renal transplant dilatation 185 Rejection 185 Fluid collections associated with transplantation 186 Vascular complications 187 Infection 189 Acute tubular necrosis 189 Ciclosporin nephrotoxicity 191 Renal transplant dysfunction and Doppler correlation 191
154 ABDOMINAL ULTRASOUND THE NORMAL RENAL TRACT Ultrasound technique The right kidney is readily demonstrated through the right lobe of the liver. Generally a subcostal approach displays the (more anterior) lower pole to best effect, while an intercostal approach is best for demonstrating the upper pole (Fig. 7.1). The left kidney is not usually demonstrable sagittally because it lies posterior to the stomach and splenic flexure. The spleen can be used as an acoustic window to the upper pole by scanning coronally, from the patient’s left side, with the patient supine or decubitus (left side raised), but, unless the spleen is enlarged, the lower pole must usually be imaged from the left side posteriorly. Coronal sections of both kidneys are particularly useful as they display the renal pelvicalyceal system (PCS) and its relationship to the renal hilum (Fig. 7.2A). This section demonstrates the main blood vessels and ureter (if dilated). A B C D Figure 7.1 (A) Sagittal section through the normal right kidney (RK), using the liver as an acoustic window. The central echoes from the renal sinus are hyperechoic due to the fat content. The hypoechoic, triangular, medullary pyramids are demonstrated in a regular arrangement around the sinus. The cortex is of similar echogenicity to the liver. (B) TS through the hilum of the RK, demonstrating the renal vein (arrow) draining into the inferior vena cava (IVC) (arrowhead). (C) Left kidney (LK) in coronal section. The renal hilum is seen furthest from the transducer (s = spleen). (Compare this with the sagittal section of the RK in which cortex is seen all the way around the pelvicalyceal system.) (D) The renal cortex lies between the capsule and the lateral margin of the medullary pyramid (arrowheads).
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Abdominal Ultrasound
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Abdominal Ultrasound How, Why and W
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v Contents Contributors Preface ix
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vii Contributors Rosemary Arthur FR
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ix Preface Ultrasound continues to
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ABBREVIATIONS xi MHA MHV MI MPV MRA
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Chapter 1 1 Optimizing the diagnost
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OPTIMIZING THE DIAGNOSTIC INFORMATI
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Chapter 2 17 The normal hepatobilia
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THE NORMAL HEPATOBILIARY SYSTEM 19
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Chapter 3 41 Pathology of the gallb
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PATHOLOGY OF THE GALLBLADDER AND BI
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Chapter 4 79 Pathology of the liver
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PATHOLOGY OF THE LIVER AND PORTAL V
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Page 116 and 117: PATHOLOGY OF THE LIVER AND PORTAL V
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Page 136 and 137: THE PANCREAS 123 the patient’s le
Page 138 and 139: THE PANCREAS 125 Acute pancreatitis
Page 140 and 141: THE PANCREAS 127 E F G Figure 5.3 c
Page 142 and 143: A C DISTANCE = 3.43 CM 5%. 13 Over
Page 144 and 145: THE PANCREAS 131 G H I Figure 5.5 c
Page 146 and 147: THE PANCREAS 133 head of pancreas.
Page 148 and 149: THE PANCREAS 135 pancreatic juice i
Page 150 and 151: Chapter 6 137 The spleen and lympha
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Page 170 and 171: THE RENAL TRACT 157 A B q 0 LRA AO
Page 172 and 173: THE RENAL TRACT 159 junctions of or
Page 174 and 175: THE RENAL TRACT 161 A B Figure 7.5
Page 176 and 177: THE RENAL TRACT 163 carcinomas, the
Page 178 and 179: THE RENAL TRACT 165 the vesicourete
Page 180 and 181: THE RENAL TRACT 167 Table 7.1 Sourc
Page 182 and 183: THE RENAL TRACT 169 A B Figure 7.13
Page 184 and 185: THE RENAL TRACT 171 Table 7.2 Diffe
Page 186 and 187: THE RENAL TRACT 173 Ultrasound stil
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Page 192 and 193: THE RENAL TRACT 179 As with acute t
Page 194 and 195: THE RENAL TRACT 181 der with increa
Page 196 and 197: THE RENAL TRACT 183 ● ● Morphol
Page 198 and 199: THE RENAL TRACT 185 ● ● hydrone
Page 200 and 201: THE RENAL TRACT 187 A Figure 7.27 A
Page 202 and 203: THE RENAL TRACT 189 vascular reject
Page 204 and 205: THE RENAL TRACT 191 B A C Figure 7.
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Page 208 and 209: Chapter 8 195 The retroperitoneum a
Page 210 and 211: THE RETROPERITONEUM AND GASTROINTES
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THE RETROPERITONEUM AND GASTROINTES
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Chapter 9 215 The paediatric abdome
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THE PAEDIATRIC ABDOMEN 217 A B SPLE
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THE PAEDIATRIC ABDOMEN 219 B A B Fi
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THE PAEDIATRIC ABDOMEN 221 probe de
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THE PAEDIATRIC ABDOMEN 223 When the
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THE PAEDIATRIC ABDOMEN 225 + 78 A 2
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THE PAEDIATRIC ABDOMEN 227 A B C D
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THE PAEDIATRIC ABDOMEN 229 Table 9.
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THE PAEDIATRIC ABDOMEN 231 A LT B C
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THE PAEDIATRIC ABDOMEN 237 mesenter
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THE PAEDIATRIC ABDOMEN 239 E F G Fi
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THE PAEDIATRIC ABDOMEN 241 system i
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Chapter 10 The acute abdomen 243 CH
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THE ACUTE ABDOMEN 245 scan of the p
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THE ACUTE ABDOMEN 247 LIVER LS GB S
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THE ACUTE ABDOMEN 249 D A RT B C E
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THE ACUTE ABDOMEN 251 17. Patlas M,
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Chapter 11 253 Interventional and o
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INTERVENTIONAL AND OTHER TECHNIQUES
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275 Bibliography and further readin
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277 Index A Abdomen, acute gastroin
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INDEX 279 Continuous ambulatory per
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INDEX 281 Intravenous urography (IV
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INDEX 283 Phrygian cap, 29 Pneumobi
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