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THE RENAL TRACT 177 Xanthogranulomatous pyelonephritis (XGP) This condition (which gets its name from the yellow colour of the kidney) is the result of renal obstruction by calculi in the pelvicalyceal system. Frequently, a staghorn calculus is responsible. The kidney becomes chronically infected and the calyces enlarge and become filled with infected debris. The cortex may be eroded and thin (Fig. 7.20). On ultrasound, these appearances are similar to TB or to a pyonephrosis. The latter is usually accompanied by a more severe, acute pain and fever whereas XGP or TB has a lower-grade, chronic pain. CT may differentiate TB from XGP and is also more sensitive to extrarenal spread of disease. Hydatid cysts The Echinococcus parasite spends part of its life cycle in dogs. The larvae may be transmitted to humans through contact with dog faeces, finding their way to the lungs, liver and, less frequently, the kidneys. The parasite forms a cyst which has a thickened wall, often with smaller, peripheral daughter cysts. Frequently the main cyst contains echoes. Figure 7.20 Xanthogranulomatous pyelonephritis. Numerous stones have obstructed the PCS, which contains debris. The renal cortex is thin, and the architecture of the kidney is difficult to recognize. The condition is rare in the UK, but may be diagnosed when small, grape-like cysts are passed in the urine. DIFFUSE RENAL DISEASE AND RENAL FAILURE Most diffuse medical renal conditions have non-specific appearances on ultrasound, the kidneys often appearing normal in the early stages of disease. Renal failure may be acute or chronic and its causes are numerous. If acute, an increase in overall renal size may be observed and there may be a diffuse alteration in the renal echogenicity, however this can be either hypo-or hyperechoic compared with normal. Either increased or decreased corticomedullary differentiation may also be observed (Fig. 7.21). Although ultrasound is successful in detecting renal parenchymal disease, the acoustic changes are not specific and the cause must usually be diagnosed histologically, 19 ultrasound being invaluable in directing the biopsy procedure. In chronic renal failure the kidneys shrink and the cortex thins. The end-stage kidney can be quite tiny and hyperechoic and may be difficult to differentiate from the surrounding tissues (Fig. 7.21C). Depending on the cause, either one but generally both of the kidneys are affected. Acute tubular necrosis Acute tubular necrosis is the result of ischaemia, which destroys the tubules of the kidney, resulting in acute renal failure. It occurs when there is a sudden decrease in renal perfusion as a result of a severely hypotensive episode, for example, cardiac arrest, massive haemorrhage, drug toxicity or septicaemia. Patients are treated temporarily by dialysis. Tubular damage is capable of regeneration once the blood supply and perfusion pressure return to normal, reversing the renal failure. If suspected, it is useful to perform a biopsy to determine the cause of renal failure, in order to plan further management. On ultrasound the kidneys are normal in size or slightly enlarged. They may be completely normal in appearance, a not uncommon finding, although in some cases the echogenicity is altered,
178 ABDOMINAL ULTRASOUND A B C(i) C(ii) Figure 7.21 (A) Acute renal failure demonstrating an enlarged, diffusely hyperechoic kidney with loss of corticomedullary differentiation. (B) Acute renal failure in paracetamol overdose. The kidney is large (16 cm) and hyperechoic with increased corticomedullary differentiation. (C) Chronic renal failure. The kidney is shrunken with only a thin rim of cortical tissue remaining. The cortical rim may be of normal echogenicity (i) or hyperechoic (ii). The latter situation is more common. sometimes having a hyperechoic cortex with increased corticomedullary differentiation. Spectral Doppler can be normal or demonstrate increased arterial resistance with reduced or even reversed end diastolic flow. Glomerulonephritis Glomerulonephritis is an inflammatory condition which affects the glomeruli of the kidney. It may be either acute or chronic, and frequently follows prolonged infection. Patients may present in acute renal failure, with oliguria or anuria, or with features of nephrotic syndrome such as oedema, proteinuria and hypoalbuminaemia. Depending upon aetiology, acute renal failure may be reversible or may progress to chronic renal failure requiring dialysis. Glomerulonephritis can be caused by numerous mechanisms: ● ● ● Immunologic mechanisms, for example in systemic lupus erythematosus (SLE) or acquired immune deficiency syndrome (AIDS) Metabolic disorders, for example diabetes Circulatory disturbances, for example atherosclerosis or disseminated intravascular coagulation (DIC).
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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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Chapter 5 121 The pancreas CHAPTER
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THE PANCREAS 123 the patient’s le
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THE PANCREAS 125 Acute pancreatitis
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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 166 and 167: Chapter 7 153 The renal tract CHAPT
Page 168 and 169: THE RENAL TRACT 155 As with any oth
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.
Page 206 and 207: THE RENAL TRACT 193 computerised ul
Page 208 and 209: Chapter 8 195 The retroperitoneum a
Page 210 and 211: THE RETROPERITONEUM AND GASTROINTES
Page 228 and 229: Chapter 9 215 The paediatric abdome
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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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