L11 - Kidneys & Urinary Tract Imaging - (Part 1).pdf

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 10 Kidneys & Urinary Tract Imaging (Part 1) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Readings • Moore, KL & Dalley, AF 2006, Clinically Oriented...

FRD40721 - Radiography & Medical Imaging Science ( Ultrasound Imaging ) Lecture 10 Kidneys & Urinary Tract Imaging (Part 1) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Readings • Moore, KL & Dalley, AF 2006, Clinically Oriented Anatomy, 5th Ed. Lippincott, Williams & Wilkins Company, Canada. • Rumack, CM Wilson, SR & Charboneau, JW 2011, Diagnostic Ultrasound Vol.1, 4th Ed. Mosby, St. Louis • Bates, JA 2011, Abdominal Ultrasound: How, Why and When, 3rd Ed. Churchill Livingstone, Edinburgh • Moore, KL & Persaud, TVN 2003, The Developing Human: Clinically Oriented Embryology, 7th Ed. Saunders, USA. • An optional reading for this topic is: Strauss, S et al 2000, “Sonographic Features of Horseshoe Kidney: Review of 34 Patients”, Journal of Ultrasound in Medicine, Vol. 19, pp.27-31. Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy  Kidneys: – Retroperitoneal organs • Between peritoneum and back muscles – Lateral to spine bilaterally – Level of T12-L4 – Lateral convex border, medial concave border – Superior, middle and inferior poles – Liver displaces right kidney inferiorly – Morrison’s pouch – peritoneal space between right kidney and liver Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy  Ureter: Begin at the renal pelvis at the hilum of the kidney Extend inferiorly along psoas muscle Empty into bladder obliquely Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy  Bladder: - Located within pelvis - Anterior to peritoneal cavity - Smooth muscular wall - Wall thickness variable with level of bladder distension Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy-Kidneys and Adrenals Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy-IVC Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy-Aorta, Celiac and SMA Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy - Kidney • 4 outer layers: – – – – Fibrous capsule Perirenal adipose Gerota’s fascia Pararenal adipose • Multiple layers of cushioning and protection Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy • Parenchyma – Outer layer : cortex – Inner layer: medullary pyramid – Columns of Bertin • Sinus – Fatty fibrous tissue – Collecting system – Blood vessels and lymphatics • Hilum – Artery enters kidney – Vein and ureter exit kidney Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Physiology Primary excretory organs - urine production and homeostasis Excrete metabolic waste products, maintain blood volume Filter 1200ml blood/min Function independently Urine: 95% water, 5% nitrogenous waste blood urea nitrogen (BUN) and creatinine Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Physiology 2 -3 major calyces which receive urine from minor calyces Conveyed to renal pelvis then through hilum into ureter Ureters: inner mucosal layer, middle smooth muscle, outer fibrous layer Urine transported to bladder via peristalsis, frequency dependant on hydration Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomy – Kidney Size • Depends on: – Height, weight, age, sex • Adult average 9-12cm length – <2cm difference – 2.5-4cm AP – 4-6cm wide • Left Kidney slightly larger than right • Ureter 28-34cm long, 2-8mm diameter Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Kidney Renal Capsule • - Thin, continuous, smooth, line along periphery • - Hyperechoic compared to adjacent cortex Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Kidney Renal Parenchyma - Cortex • Homogenous, echotexture • Right kidney – hypoechoic or isoechoic compared to liver • Left kidney – hypoechoic compared to spleen • Uniform thickness Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Kidney Renal Parenchyma - Medulla • - Medullary pyramids triangular shaped • - Hypoechoic compared to adjacent cortex Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Kidney Renal Sinus • - Centrally located in kidney • - Hyperechoic due to fat and fibrous tissue • - Irregular margins Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Kidney Renal Pelvis • - May or may not be visible • - May contain some urine without dilatation of collecting system Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Ureter • - Not normally visible on ultrasound unless dilated with fluid • - VUJ (ureterovesical junction)– two bumps along posterior wall of bladder Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Ureteral jets • Ureteric jets may be assessed in real time at VUJ in the bladder Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance - Bladder • When distended with urine, appears as anechoic fluid-filled structure • Bladder wall should have uniform thickness when adequately distended • Post-void bladder, collapsed wall with little or no urine Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance – Bladder (full) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Sonographic Appearance – Bladder ( Post-Void) Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Normal Variants • HYPERTROPHIED COLUMN OF BERTIN – Unresorbed cortex from one or both lobes of kidneys that fuse during fetal development – Thickened region of cortex between adjacent medullary pyramids – Upper and middle thirds of kidney – Differentiate from mass Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Normal Variants HYPERTROPHIED COLUMN OF BERTIN Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Normal Variants • DROMEDARY HUMP – Prominent lateral bulge in the cortex of the mid pole – More common in left kidney – Differentiate from mass Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Normal Variants DROMEDARY HUMP Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomical Variants Extra-renal Pelvis • Renal pelvis located outside kidney • Usually contains anechoic urine • No associated dilatation of collecting system Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae Anatomical Variants Extrarenal Pelvis Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae To be continued … Questions???? Course: FRD3061 Medical Imaging Science and Methods 2Ultrasound 1 Lecture 4: Kidneys Normal Anatomy fchs.ac.ae