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Diagnostic ultrasound ( PDFDrive )

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CHAPTER

9

The Kidney and Urinary Tract

Mitchell Tublin, Deborah Levine, Wendy Thurston, and Stephanie R. Wilson

SUMMARY OF KEY POINTS

• Renal ultrasound is the screening modality of choice for

the initial evaluation of renal insuficiency. Relevant

imaging markers include parenchymal echogenicity, renal

length, and collecting system dilatation.

• The primary role for ultrasound in the evaluation of renal

masses is to differentiate between cystic and solid lesions,

although an appropriate differential diagnosis may be given

based on clinical history and cyst complexity.

• Echogenic renal masses are problematic, and although

several discriminatory features have been proposed,

renal computed tomography or magnetic resonance

imaging is typically employed for larger lesions to

differentiate between renal cell carcinoma and

angiomyolipoma.

• The role of ultrasound in the evaluation of hematuria

continues to evolve. Ultrasound is an effective screening

modality for typical “urologic” causes of hematuria

(namely, renal calculi) in younger patients.

• Focal and diffuse bladder wall thickening at ultrasound is

nonspeciic and may be caused by a variety of infectious,

inlammatory reactions or neoplastic processes. Urine

analysis, clinical history, and potentially cystoscopy are

typically performed after thickening is identiied at

sonography.

CHAPTER OUTLINE

EMBRYOLOGY

Development of the Kidneys and Ureter

Development of the Bladder

Development of the Urethra

ANATOMY

Kidney

Ureter

Bladder

SONOGRAPHIC TECHNIQUE

Kidney

Ureter

Bladder and Urethra

HYDRONEPHROSIS

PITFALLS IN ASSESSMENT OF

OBSTRUCTION

CONGENITAL ANOMALIES

Anomalies Related to Renal Growth

Hypoplasia

Fetal Lobation

Compensatory Hypertrophy

Anomalies Related to Ascent of Kidney

Ectopia

Crossed Renal Ectopia

Horseshoe Kidney

Anomalies Related to Ureteral Bud

Renal Agenesis

Supernumerary Kidney

Duplex Collecting System and

Ureterocele

Ureteropelvic Junction Obstruction

Congenital Megacalices

Congenital Megaureter

Anomalies Related to Vascular

Development

Aberrant Vessels

Retrocaval Ureter

Anomalies Related to Bladder

Development

Bladder Agenesis

Bladder Duplication

Bladder Exstrophy

Urachal Anomalies

Anomalies Related to Urethral

Development: Diverticula

GENITOURINARY INFECTIONS

Pyelonephritis

Acute Pyelonephritis

Renal and Perinephric Abscess

Pyonephrosis

Emphysematous Pyelonephritis

Emphysematous Pyelitis

Chronic Pyelonephritis

Xanthogranulomatous Pyelonephritis

Papillary Necrosis

Tuberculosis

Fungal Infections

Candida Albicans

Parasitic Infections

Schistosomiasis

Echinococcal (Hydatid) Disease

Acquired Immunodeiciency Syndrome

Cystitis

Infectious Cystitis

Malacoplakia

Emphysematous Cystitis

Chronic Cystitis

FISTULAS, STONES (CALCULI), AND

CALCIFICATION

Bladder Fistulas

Renal Calculi

Ureteral Calculi

Bladder Calculi

Nephrocalcinosis

GENITOURINARY TUMORS

Renal Cell Carcinoma

Imaging and Treatment Approaches

Sonographic Appearance

Biopsy and Prognosis

Pitfalls in Interpretation

Transitional Cell Carcinoma

Renal Tumors

Ureteral Tumors

Bladder Tumors

Squamous Cell Carcinoma

Adenocarcinoma

Oncocytoma

Angiomyolipoma

Lymphoma

Kidney

Ureter

310

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