Diagnostic Ultrasound - Abdomen and Pelvis
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Diagnostic Ultrasound - Abdomen and Pelvis

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09.07.2019 Views

Hydronephrosis (Left) Longitudinal transabdominal ultrasound of the kidney shows significant dilation of the renal collecting system ſt. The degree of marked parenchymal thinning indicates this is a longstanding process. (Right) Color Doppler ultrasound in the same patient shows that the RI = 0.7 is in the normal range, consistent with the chronic nature of this patient's significant hydronephrosis ſt. Diagnoses: Urinary Tract (Left) Transverse transabdominal color Doppler ultrasound of the urinary bladder shows an obstructing stone at right UVJ. Twinkling artifact is seen distal to the stone, which can be useful to identify stones in the urinary system. The ureter proximal to the obstructing stone is moderately dilated st. A normal left ureteral jet ſt is seen on the contralateral side. (Right) Coronal antenatal fetal US shows a bilateral dilated renal collecting system ſt (pelvis = 8 mm, normally measured in the AP dimension on a transverse image). (Left) Longitudinal ultrasound of a kidney with moderate hydronephrosis shows increased echogenicity of the medulla ſt, which is a finding consistent with medullary nephrocalcinosis, a condition that can predispose patients to development of renal calculi. (Right) Coronal reformat NECT of the abdomen in the same patient confirms nephrocalcinosis with bilateral multiple stones and right moderate hydronephrosis ſt, caused by an obstructing right ureteral stone . 461

Simple Renal Cyst Diagnoses: Urinary Tract TERMINOLOGY • Benign, fluid-filled, nonneoplastic renal lesion • Most common renal lesion, usually detected incidentally on imaging IMAGING • Unilocular, thin-walled, round/oval renal lesion • Anechoic: No internal echoes, septations, or solid components • Increased sound transmission gives rise to characteristic posterior acoustic enhancement (increased through transmission) • Ultrasound is ideal for characterizing simple or complex renal cysts in nonobese patients • Once diagnosis of simple renal cyst is established, no further imaging or monitoring of cyst is warranted TOP DIFFERENTIAL DIAGNOSES • Complex renal cyst KEY FACTS • Peripelvic cysts • Prominent pyramids • Cystic disease of dialysis • Perinephric collections • Pyelogenic cyst/pyelocalyceal diverticulum • Multilocular cystic nephroma CLINICAL ISSUES • Present in 20-30% of middle-aged adults • Present in 50% of patients > 50 years of age DIAGNOSTIC CHECKLIST • Well-defined round or ovoid renal lesion with posterior acoustic enhancement, distinct echogenic posterior wall, and complete lack of internal echoes (anechoic) • Important to distinguish simple renal cysts from complex cystic renal lesions (Left) Longitudinal ultrasound shows a typical simple cortical cyst, with complete lack of internal echoes ſt, imperceptible walls, and posterior acoustic enhancement . (Right) Longitudinal transabdominal ultrasound shows a large parapelvic renal cyst ſt in addition to multiple smaller cortical cysts . Large cysts may produce distension, pain, or spontaneous hemorrhage. (Left) Transverse color Doppler ultrasound shows a simple cortical renal cyst with complete lack of internal flow ſt. Posterior acoustic enhancement remains visible. (Right) Longitudinal US shows a small simple cyst in an echogenic kidney. Minimal echoes within the peripheral aspect of the cyst st are artifactual and confounding. Posterior acoustic enhancement remains evident . In the setting of underlying renal disease, the possibility of acquired cystic disease should be considered. 462

Hydronephrosis<br />

(Left) Longitudinal<br />

transabdominal ultrasound of<br />

the kidney shows significant<br />

dilation of the renal collecting<br />

system ſt. The degree of<br />

marked parenchymal thinning<br />

indicates this is a<br />

longst<strong>and</strong>ing process. (Right)<br />

Color Doppler ultrasound in<br />

the same patient shows that<br />

the RI = 0.7 is in the normal<br />

range, consistent with the<br />

chronic nature of this patient's<br />

significant hydronephrosis ſt.<br />

Diagnoses: Urinary Tract<br />

(Left) Transverse<br />

transabdominal color Doppler<br />

ultrasound of the urinary<br />

bladder shows an obstructing<br />

stone at right UVJ.<br />

Twinkling artifact is seen<br />

distal to the stone, which can<br />

be useful to identify stones in<br />

the urinary system. The ureter<br />

proximal to the obstructing<br />

stone is moderately dilated<br />

st. A normal left ureteral jet<br />

ſt is seen on the contralateral<br />

side. (Right) Coronal antenatal<br />

fetal US shows a bilateral<br />

dilated renal collecting system<br />

ſt (pelvis = 8 mm, normally<br />

measured in the AP dimension<br />

on a transverse image).<br />

(Left) Longitudinal ultrasound<br />

of a kidney with moderate<br />

hydronephrosis shows<br />

increased echogenicity of the<br />

medulla ſt, which is a finding<br />

consistent with medullary<br />

nephrocalcinosis, a condition<br />

that can predispose patients<br />

to development of renal<br />

calculi. (Right) Coronal<br />

reformat NECT of the<br />

abdomen in the same patient<br />

confirms nephrocalcinosis with<br />

bilateral multiple stones <br />

<strong>and</strong> right moderate<br />

hydronephrosis ſt, caused by<br />

an obstructing right ureteral<br />

stone .<br />

461

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