Multimedia Lesson KIDNEY ULTRASOUND

Dr. Viorela Enchescu

E-EDUMED e-Learning Educational Center in Medicine Agreement N. LLP/LdV/TOI/RO/2010/006 This project has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Examination technique
Good equipment control - differentiation renal parenchyma - liver - spleen, differentiation renal parenchyma- sinus Technical facilities sectorial transducers, Doppler technique, ultrasound histograms Differentiated longitudinal sections: - Right - paramediosagittal slices/sections - Left frontal slices/sections- left colic angle Equatorial" sections- the largest sizes Lateral approaches - lumbar approach Multiple sections, plans, approaches, acoustic windows

NORMAL KIDNEY US
Sections: longitudinal, transversal Sonic windows/ LK > intercostal, RK > subcostal mclav, intercostal Urinary bladdes full Capsula Parenchyma Cortex Medulla Pyramids of Malpighi visibile only in children In adults the difference cortex/medulla appears only in glomerulary edema from AGN Kidney pelvis the most echogenic structure in the
Well delimited contour, regular, or with incisions (rare) = ECHOGENIC capsule Parenchyma the most hypoechogenic thickness (IP): 1,5-2 cm Size: longitudinal 10 - 13 cm transversal 3,5 - 5 cm

Kidney US examination technique

Kidney US examination technique

PYELIC/KIDNEY ABNORMALITIES
Diagnosis problems complicated abnormalities Differential diagnosis pyelocalyceal cysts/dilatations (UIV) Pseudotumoral irregular aspect, intracystic vegetations Precalyceal canalicular ectasia Cacchi-Ricci disease sponge kidneys hyperechogenic pyramids, tiger aspect

POLYCYSTIC BILATERAL KIDNEY

PARAPYELIC CYSTS
in renal sinus Normal kidney sizes Normal or slightly decreased IP Multiple formations in the sinus hypoechogenic/ transsonic NON-COMUNICATING Echogenic walls, equal Clear content, fluid Can fingerprint on the medulla without dissimulating the parenchyma size 1 - 3 cm Diff. Dg. with pyelocaliceal dilatations comunicating / form of "clubs"

PARENCHYMA CYSTS in all large renal mass Large renal volume> 15 cm Different sizes clear, non-comunicating, own walls IP disapeared family aggregation

HYDRONEPHROSIS US
Confirmation, severity,
causes, complications Comunicating cavities US Type of obstruction clot, pus, lithiasis, stenosis Complications hydropyonephrosis, urinoma (posttraumatic) Limitations - false +, false -, discordant UIV) Pyelocalyceal dilations are reversible, can be remited after mobilisation of the calcul

PATHOLOGY PARAPYELIC CYSTS

PATHOLOGY PARAPYELIC CYSTS

THE VALUE OF KIDNEY US

Noninvasive character, non-ionizing, low cost, addressability, repeatability Multiple indications of first intention- UIV alternative imaging (with CT) Direct view : R. kidney, perirenal sp., urinary bladder, pelvic structures Positive diagnosis, certainty, exclusion Examination in real time - physiological cycles, the effect of gravity, palpation with the transducer under direct visual control Exclusive direct morphological relations perirenal space anatomical and complementary relationshipsextension balance

LIMITATIONS of KIDNEY US
The technique is operator/patient dependent Difficult view of the entire pyelic tree in the absence of dilation (lumbar, iliac, pelvic) Lack of functional information - partly substituted by some contrast agents (vesicoureteral reflux) Absence of specific contrast agents with urinary elimination Tumoral pathology, lithiasis of the urinary tract - apparently non-obstructive UIV