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Diagnostic ultrasound ( PDFDrive )

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CHAPTER

52

The Pediatric Urinary Tract and

Adrenal Glands

Harriet J. Paltiel and Diane S. Babcock

SUMMARY OF KEY POINTS

• Ultrasound can reliably characterize renal duplication,

fusion, and rotational anomalies.

• Ultrasound is useful in evaluating renal, ureteral, and

bladder anatomy in patients with suspected

hydronephrosis.

• Contrast-enhanced voiding urosonography (CEVUS) is a

promising technique that may eventually replace

conventional voiding cystourethrography (VCUG) in

selected cases.

• Ultrasound is used to assess renal size and to exclude

anatomic abnormalities as the cause of acute kidney injury

(AKI).

• Ultrasound is the initial imaging study of choice in patients

with suspected urolithiasis, with noncontrast computed

tomography reserved for cases in which ultrasound is

nondiagnostic.

• Intravenous contrast-enhanced ultrasound may provide

valuable information regarding renal injury in patients with

blunt abdominal trauma.

• Ultrasound plays a key role in the evaluation of patients

with renal transplants, in both early and later postoperative

periods.

• Renal ultrasound is often helpful in distinguishing among

different types of renal cystic disease.

• Ultrasound is employed to distinguish cystic (usually

benign) from solid (often malignant) renal masses.

• Ultrasound is used to differentiate between neonatal

adrenal hemorrhage and neuroblastoma.

CHAPTER OUTLINE

PEDIATRIC URINARY TRACT

SONOGRAPHY

Technique

Normal Renal Anatomy

Normal Bladder Anatomy

CONGENITAL ANOMALIES OF THE

URINARY TRACT

Renal Duplication

Other Renal Anomalies

CAUSES OF HYDRONEPHROSIS

Ureteropelvic Junction Obstruction

Ureteral Obstruction

Bladder Outlet Obstruction

Vesicoureteral Relux

Prune-Belly Syndrome

Megacystis-Microcolon-Malrotation–

Intestinal Hypoperistalsis Syndrome

Bladder Exstrophy

Urachal Anomalies

URINARY TRACT INFECTION

Acute Pyelonephritis

Chronic Pyelonephritis

Neonatal Candidiasis

Cystitis

MEDICAL RENAL DISEASE

Acute Kidney Injury

Chronic Kidney Disease

URINARY TRACT CALCIFICATION

Renal Cortical Calciication

Medullary Nephrocalcinosis

Urinary Stasis

Renal Vein Thrombosis Calciications

Dystrophic Calciication

Urolithiasis

RENAL TRAUMA

RENAL VASCULAR DISEASE

Doppler Sonographic Examination

Technique

Normal Vascular Anatomy and Flow

Patterns

Causes of Increased Resistance to

Intrarenal Arterial Flow

Clinical Applications

Vessel Patency

Acute Renal Vein Thrombosis

Renal Artery Stenosis

Intrarenal Arterial Disease

RENAL TRANSPLANTATION

Vascular Complications

Perinephric Fluid Collections

Parenchymal Abnormalities

Urologic Complications

Tumors

RENAL CYSTIC DISEASE

Autosomal Recessive Polycystic Kidney

Disease

Autosomal Dominant Polycystic Kidney

Disease

Multicystic Renal Dysplasia

Nephronophthisis and Medullary Cystic

Disease

Congenital Renal Cysts

Tuberous Sclerosis and Von Hippel–

Lindau Disease

Acquired Cysts

RENAL TUMORS

Wilms Tumor

Mesoblastic Nephroma

Renal Cell Carcinoma

Angiomyolipoma

Multilocular Cystic Nephroma

Renal Lymphoma

Bladder Tumors

PEDIATRIC ADRENAL SONOGRAPHY

Normal Anatomy

Congenital Adrenal Hyperplasia

Neonatal Adrenal Hemorrhage

Neuroblastoma

Pheochromocytoma

Adrenocortical Neoplasm

1775

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