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Dr. Viorela Enchescu

Multimedia Lesson

KIDNEY ULTRASOUND

E-EDUMED e-Learning Educational Center in MedicineAgreement 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.

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NORMAL KIDNEY US

Sections: longitudinal,transversal

Sonic windows/ LK >intercostal, RK > subcostal m-clav, intercostal

Urinary bladdes full

Capsula Parenchyma

Cortex

Medulla

Pyramids of Malpighivisibile only in children

In adults the differencecortex/medulla appearsonly in glomerularyedema from AGN

Kidney pelvis the mostechogenic structure in the

Well delimited contour,regular, or with incisions(rare) = ECHOGENICcapsule

Parenchyma the most

hypoechogenic thickness (IP): 1,5-2

cm

Size:

longitudinal 10 - 13

cm transversal 3,5 - 5

cm

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Kidney US examination technique

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Kidney US examination technique

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PYELIC/KIDNEY ABNORMALITIES

Diagnosis problemscomplicatedabnormalities

Differential diagnosispyelocalyceal

cysts/dilatations(UIV)

Pseudotumoralirregular aspect,intracystic vegetations

Precalycealcanalicular ectasiaCacchi-Ricci diseasesponge kidneyshyperechogenic

pyramids, tiger aspect

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POLYCYSTIC BILATERAL KIDNEYPARAPYELIC CYSTS

in renal sinus Normal kidney sizes

Normal or slightly decreased IP

Multiple formations in the sinushypoechogenic/ transsonic

NON-COMUNICATING

Echogenic walls, equal

Clear content, fluid

Can fingerprint on the medullawithout

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

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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 arereversible, can be remitedafter mobilisation of the

calcul

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PATHOLOGY PARAPYELIC CYSTS

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PATHOLOGY PARAPYELIC CYSTS

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THE VALUE OF KIDNEY US

Noninvasive character, non-ionizing, low cost,addressability, repeatability

Multiple indications of first intention- UIV alternativeimaging (with CT)

Direct view : R. kidney, perirenal sp., urinary bladder,

pelvic structures Positive diagnosis, certainty, exclusion

Examination in real time - physiological cycles, the effectof gravity, palpation with the transducer under directvisual control

Exclusive direct morphological relations perirenal space anatomical and complementary relationships-extension balance

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LIMITATIONS of KIDNEY US The technique is operator/patientdependent

Difficult view of the entire pyelic tree inthe absence of dilation (lumbar, iliac,pelvic)

Lack of functional information - partlysubstituted by some contrast agents(vesicoureteral reflux)

Absence of specific contrast agents withurinary elimination

Tumoral pathology, lithiasis of theurinary tract - apparently non-obstructive UIV