Kidneys Pt 2 PDF

SON 2112 Abdominal Sonography II Chapter 10 by Kawamura Carrie Hall Cystic Renal Masses A. Polycystic Renal Disease 1. Autosomal Dominant Polycystic Kidney Disease (ADPKD) 2. Autosomal Recessive Polycystic Kidney Disease (ARPKD) (Pediatric chapter 20) 3. M...

SON 2112 Abdominal Sonography II Chapter 10 by Kawamura Carrie Hall Cystic Renal Masses A. Polycystic Renal Disease 1. Autosomal Dominant Polycystic Kidney Disease (ADPKD) 2. Autosomal Recessive Polycystic Kidney Disease (ARPKD) (Pediatric chapter 20) 3. Multicystic Dysplastic Kidney (Pediatric chapter 20) B. Medullary Cystic Disease 1. Medullary Sponge Kidney 1. Hereditary in differentiation 2. Nephronophthisis (Uremic Medullary Cystic Disease) 2. Non-Hereditary but C. Cortical Cysts developmental 1. Simple Cysts 3. Acquired disorders 2. Complex Cysts OR Atypical Renal Cysts a. Hemorrhagic Cysts b. Infected Cysts c. Septated or Multilocular Cysts 3. Calcification(s) in Cysts Sonography excellent modality for a. Calcified Wall examining type of cystic disease: b. Milk of Calcium (MOC) Its an anatomic examination D. Parapelvic and Peripelvic Cysts Can distinguish cystic from solid E. Acquired Cystic Disease Good for imaging kidneys F. Cysts Associated with Systemic Disease Portable 1. Tuberous Sclerosis 2. von Hippel-Lindau  Complications Include: Infection, renal calculi, cyst rupture, Inherited (*10% found in spontaneous mutation) hemorrhage, and uretic obstruction Usually later in life around 4th * Associated with arterial aneurysms decade especially cerebral arterial Berry Bilateral renal enlargement due to aneurysms of the circle of Willis. development of numerous cysts of varying sizes Associated with cysts in Liver (50%), Pancreas(10%), and Spleen Destruction of the residual renal tissue in advanced stages can lead to renal failure and hypertension Longitudinal and (B) transverse sections of the right kidney reveal relatively small, multiple cysts seen throughout the kidney. Ascites is also seen (arrows). On a 70-year-old man, longitudinal views of the right kidney (C) and left kidney (D) demonstrate multiple cysts of various sizes, which replace the normal renal parenchyma.  Associated with: 1. Pulmonary hypoplasia (due to oligohydramnios) Previously known as infantile polycystic 2. Hepatic fibrosis kidney disease. This term no longer used… 3. Portal hypertension Usually present at birth Multiple small cysts throughout kidney from cystic dilation of the collecting tubules Sonographic Findings: secondary to hyperplasia of the interstitial Enlarged Kidneys bilaterally portions of the ducts Hyperechoic parenchyma Loss of cortico-medullary distinction  *Most Common cause of an Abdominal mass in NEWBORNS MCDK is a form of renal dysplasia Multiple non-communicating cysts with absence of renal parenchyma Resulting in renal atresia of ureteropelvic junction during development. Typically unilateral but can be bilateral (20%) Contralateral kidney demonstrates compensatory hypertrophy and in 10% of patients they have ureteropelvic junction obstruction May persist without any change, may increase in size, or may undergo spontaneous involvement. Kidney progressively involutes and eventually is no longer visible with sonograpahy Associated with: many syndromes, urinary malformations, and non-renal malformations  Sonographic Findings: Congenital dysplastic cystic dilatation of the medullary Bilateral hyperechoic pyramids due to tubular ectasia or dysplasia medullary pyramids with or Ectatic collecting tubules may be seen on excretory with/out shadowing urography Due to urinary stasis, calcium deposits form in these dilated tubules On this 27-year-old woman, longitudinal and transverse sections of both the (A) right and (B) left kidneys reveal hyperechoic renal pyramids. This was an incidental finding, as the patient had no history of renal disease. Based on this, the diagnosis of medullary sponge kidney is favored, although renal sinus lipomatosis could be considered as a differential  Simple or Complex (atypical) Simple renal cysts occur in 50% of people over age 50 Most are simple serous fluid originating from the renal cortex Have epithelial lining range from 1mm – 10cm Sonography cannot determine if benign(most cysts) or malignant Simple Cyst Criteria: A. Illustration shows common locations of simple and atypical renal cysts. No internal echoes Acoustic enhancement B. Longitudinal and transverse image of simple renal cyst in Sharply defines thin walls inferior pole of right kidney. Note well-defined posterior wall. Round or oval shape C. Longitudinal and transverse image displays a simple cyst in medullary region of left kidney. D.Longitudinal image demonstrates a renal cyst (C) arising from the inferior pole. E. This image demonstrates a large simple cyst located on the superior pole (C). F. Longitudinal image demonstrates a simple cyst in the midpole of the kidney (arrows). All of these cysts meet the criteria for simple cysts.  Sonographically- different types of renal cysts can not be distinguished. Sonography can determine the location. Cortical or parenchymal cysts- cysts located in the periphery of kidney Peripelvic cysts- cysts located in the Complex Cysts—Septated or Multilocular Cysts Longitudinal (F) and transverse (G) images of a renal cyst containing multiple echogenic center (renal sinus) of the kidney. septations (arrows) and debris along the posterior wall (small arrows). Cystic lesions not meeting criteria for simple cyst can be followed with sonography or CT or undergo aspiration for definitive diagnosis. A cyst that does not meet simple cyst criteria is a complex or Atypical cyst. Types include: Hemorrhagic cysts *Characteristics that may Infected or Inflammatory cysts suggest malignancy and Septate or multilocular cysts require histologic /FNA: Multiple or thick septations Thick calcifications Mural nodule/or solid Sonographic Findings Complex Renal Cysts: component Thin septations, minimal wall calcifications, internal echoes or lobulated shapes Developmental and Atypical Renal Cystic Masses Laboratory Entity Cause Clinical Features Sonographic Features Values Parapelvic Unknown Asymptomatic; Hematuria, Anechoic; parapelvic cysts and may be associated leukocytosi are solitary, larger, with well- peripelvic with hypertension s defined, sharp borders with cysts or hydronephrosis through transmission; peripelvic are smaller, multiple, or interconnecting network of cysts Parapelvic cyst. A longitudinal section of the right kidney reveals a parapelvic cyst near the inferior pole. Parapelvic cysts should not be confused with dilatation of the renal pelvis.  Development of multiple cysts in chronically failed kidneys during long-term dialysis Hemorrhage often occurs into these acquired renal cysts, resulting in pain and hematuria Patients undergoing long-term renal dialysis are at an increased risk for acquired renal cystic disease, which predisposes patients to renal cell carcinoma  Inherited disease which usually presents in 2nd – 3rd decade of life with serious visual impairment Although Von Hippel Lindau syndrome is characterized by retinal and central nervous system hemangioblastomas, sonographers need to be aware of their related tumors that can be found when performing a complete abdomen exam such as: Renal Cell Carcinoma, Pheochromocytomas, Islet cell tumors, Renal and Pancreatic cysts Imaging should be focused on evaluating the kidneys, adrenals glands and pancreas  A multi-system genetic disease. Classic presentation include: Seizures, mental retardation, and facial angiofibromas The kidneys are the main focus of an abdominal sonographic evaluation in A. In this 15-year-old male with tuberous sclerosis, multiple hyperechoic a patient with tuberous sclerosis. angiomyolipomas (arrows) were Patients with tuberous sclerosis have identified in the right kidney. an increased incidence of renal cysts and angiomyolipomas. Angiomyolipomas are typically bilateral in patients with tuberous sclerosis. A. Benign Neoplasms 1. Adenoma 2. Oncocytomas Sonographers Role 3. Angiomyolipoma (AML) 1.Location of Mass B. Malignant Neoplasms 2.Distinguish composition 1. Renal Cell Carcinoma (RCC) of mass 2. Wilms Tumor (Nephroblastoma)(Pedi) 3.Optimize machine 3. Mesoblastic Nephroma (Pediatric) 4. Urothelial Carcinoma settings a. Transitional Cell Carcinoma (TCC) 4.Document # of masses b. Squamous Cell Carcinoma (SCC) 5.Measurements C. Metastatic Renal Tumors 6.Follow-ups/ document 1. Lymphoma growth 7.Assess Vascularity Renal Oncocytomas ( oxyphilic adenomas) are a type of relatively benign renal tumors. Imaging characteristics of oncocytomas and RCCs overlap, and differentiating an oncocytoma from an RCC and other solid renal neoplasms is not always possible with sonography, CT or MRI. A central scar on CT or MRIs and a spoke wheel pattern of vessels on angiograms are often suggestive of oncocytoma but are not entirely specific.  Longitudinal (B) and Also known as Hamartoma- Mesenchymal transverse (C) images reveal a hyperechoic mixed tumors composed of fat cells mass within the midpole intermixed with smooth muscle cells and of the right kidney. The diagnosis of aggregates of thick-blood vessels in varying angiomyolipoma (AML) proportions. was made. Hyperechoic benign renal tumor. Its echogenicity is greater than or equal to that of the renal sinus A propagation speed artifact may result in the posterior displacement of structures due to the slower acoustic velocity in the fatty mass. A small hyperechoic lesion within the renal parenchyma CT confirmation of fat in an echogenic renal demonstrates the classic mass is considered diagnostic sonographic appearance of an angiomyolipoma. The mass is angiomyolipoma. very echogenic, 80% involve the right kidney. homogeneous, and well circumscribed.  Lipoma Leiomyoma Juxtaglomerular tumor (reninoma) Hemangioma Fibroma Multilocular cystic nephroma Benign Renal Tumors Tumor Characteristics/ Treatment Sonographic Features Adenomas Distinguished histologically; Echogenic cortical mass treated as malignant usually