P. 1
Review Class

Review Class

|Views: 157|Likes:
Published by dr_shamimr

More info:

Published by: dr_shamimr on Dec 06, 2010
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

01/18/2015

pdf

text

original

DR.SHAMIM RIMA MBBS,FCGP,DMU M.

PHIL RADIOLOGY & IMAGING

THE KIDNEYS AND URETER

FETAL LOBULATION

FETAL LOBULATION FETAL LOBULATION

Ultrasound scan showing fetal lobulation.

NEONATAL KIDNEY

Term neonate: length 4.5cm. Lack typical increased central hilar echogenicity.
Medullary pyramid very prominent & lower echogenicity than overlying cortex.

ECTOPIC / PELVIC KIDNEY

These ultrasound images show the right kidney just to the right of the uterus in the true pelvis. There was no kidney visualized in the right renal fossa.

A crossed fused renal ectopia is an entity where one kidney crosses over to the other side and the parenchyma of the two kidneys fuse. In most cases it involves the left kidney. Renal function is usually normal. Other anomalies associated with this condition are the VACTER syndrome, hydronephrosis, annular pancreas, and multicystic dysplasia. Most cases are sporadic but dominant inheritance has been reported. Renal ultrasound showed a mass extending over the midline compatible with the diagnosis of a crossed fused ectopic left kidney.

ECTOPIC / PELVIC KIDNEY

An ectopic pelvic kidney indenting on the urinary bladder superiorly

HORSESHOE KIDNEY

a) kidneys located at a lower level than normal b) the lower poles of both kidneys pointing medially, c) a bridge of renal tissue or isthmus connecting the two kidneys. This isthmus is seen passing anterior to the abdominal aorta.

HORSESHOE KIDNEY
A curved configuration of the lower poles, elongation of the lower poles, and poorly defined lower poles, suggest the presence of horseshoe kidney. Other associated findings, such as stones, hydronephrosis, and cortical scarring, are reliably depicted on sonograms. Ultrasonography has also been useful in the diagnosis of horseshoe kidney in utero.
Transverse abdomen ultrasonogram showing a of the soft-tissue

hypoechoic mass (isthmus) that is anterior to the spine and aorta and that unites the lower renal poles.

HORSESHOE KIDNEY

Transverse slightly oblique ultrasonogram of the right kidney, showing the lower pole of the right kidney; the pole crosses over the spine, anterior to the aorta and inferior vena cava.

Transverse sonogram of the abdomen demonstrates a softtissue isthmus anterior to the spine.

CROSS FUSED RENAL ECTOPIA

Ultrasound showed two kidneys fused together with a septation in the middle.

CROSS FUSED RENAL ECTOPIA

Power doppler intervention, two pairs of vascular system was noted, fusing at the lateral right kidney. No normal left kidney seen.

CROSS FUSED RENAL ECTOPIA

DUPLICATION OF KIDNEYS

Incomplete duplication of both kidneys.

Complete duplication of the right kidney. 1 and 2 mark hilum of each renal segment.

CROSS FUSED ECTOPIC KIDNEY

well-defined indentation or niche (arrow) at the junction between the right kidney (RK) and the crossed-fused left kidney (LK). The right renal pelvis has a small amount of visible urine within it

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Sonography reveal bilateral grossly enlarged kidneys (14 to 16 cms. in length, 8 to 10 cms. width). The kidneys are replaced by multiple large cysts (more than 2 in each kidney) of sizes varying from 2 to 5 cms.

Criteria for diagnosis of ADPCK: a) more than 2 renal cysts in one/ both kidneys, if age less than 30 yrs. b) 2 or more cysts in each kidney, if aged from 30 to 59 yrs. c) 4 cysts in each kidney if aged more than 60 yrs.)

There is very little normal renal parenchyma seen in these images. Note that the cysts are non-communicating ruling out hydronephrosis. The right kidney shows an echogenic focus, in one cyst, which may be a calculus or calcification. A solitary cyst is seen in the right lobe of liver

MULTICYSTIC DYSPLASTIC KIDNEY
Ultrasound demonstrates

an abnormal right kidney which contains multiple

cysts of varying sizes that do not communicate. The small amount of renal visible cysts is

parenchyma between echogenic the

MEDULARY SPONG KIDNEY
Sagittal image of the left kidney. The left kidney is also normal in size and demonstrates extensive, curvilinear parenchymal calcification with posterior shadowing in the region of the medulla. Medullary sponge kidney is a developmental anomaly characterized by cystic dilatation of the collecting tubules in one or more renal medullary pyramids.

Sagittal scan of the right lumbar region The right kidney is normal in size but exhibits increased echogenicity of the medullary pyramids. No obvious acoustic shadowing is noted from the echogenic foci.

MEDULLARY NEPHROCALCINOSIS

HYDRONEPHROSIS

ACUTE RENAL FAILURE

CHRONIC RENAL FALURE

bilateral echogenic (hyperechoic renal cortex) kidneys 2) both kidneys appear small in size (atrophic) 3) reduced thickness (thinning) of renal cortex (10mm.) 4) reduction in cortico-medullary differentiation

RENAL STONE

ACUTE PYELONEPHRITIS

left kidney is significantly larger than the right kidney (10.3 versus 7.6 cm). The left kidney is diffusely enlarged, with loss of normal corticomedullary differentiation

CHRONIC PYELONEPHRITIS

PYONEPHROSIS

RENAL CYST

Parapelvic cysts: Peripelvic renal cysts with non communicating intrarenal cystic structures that could be mistaken for dilatated calices

RENAL ABSCESS

ACUTE RENAL ABSCESS

ANGIOMYOLIPOMA.

Ultrasound of the right kidney demonstrates a 1.5 cm round hyperechoic structure within the renal parenchyma

RENAL CELL CARCINOMA

hypoechoic, inhomogenous mass (10 x 8 cms.) at the upper pole of the left kidney. The central portion is markedly hypoechoic suggestive of necrosis.

WILM¶S TUMOR

Large homogeneous, echogenic mass right adrenal fossa, exerting mass effect on the right hepatic lobe, and right renal parenchyma which is not visualized.

HEPATO BILIARY SYSTEM

FATTY LIVER

AMOEBIC LIVER ABSCESS
Very early stage :
This may be termed as solid abscess. On ultrasound these lesions are usually small. The margins of the abscess may be ill defined, the abscess is hypoechoic as compared to the surrounding liver. However, there is no true liquefaction at this stage and therefore there is poor or no posterior acoustic enhancement. The demarcation between the abscess and the surrounding liver is also poor

Recently formed amoebic abscesses :
On ultrasound as a sonolucent or an hypoechoic area usually with fine internal echoes. Because of the liquefaction, there is associated posterior acoustic enhancement. The cavity may be round, oval or branching. The walls of the abscess at this stage are usually not very thick and sometimes the demarcation between the wall and the surrounding tissue can be poor. Sometimes the walls may be thicker and these may be seen as shaggy, ill-defined echogenic areas along the walls

Abscesses of some duration :

HEALING STAGE
The abscess heals, the liquid contents dry up, which has been described as putty appearance.On ultrasound it is seen again as a lesion with thick walls fairly echogenic as compared to surrounding organs. This shadow can be seen on ultrasound for a long time, even years. It is usually at this stage that the differential diagnosis of a neoplasm, haemangioma or granuloma inliver come into picture.

Pyogenic liver abscess: Sonographic features. Longitudinal sonogram of the liver shows bright reflectors within the abscess due to gas.

Liver abscess and pleural effusion

Pyogenic liver abscess: Sonographic features. Transverse sonogram of the liver shows a complex, predominately hypoechoic mass with posterior acoustic enhancement containing coarse, clumpy debris.

HEPATIC CYST

ELONGATED LEFT LOBE OF LIVER (THE BEAVER TAILED LIVER):

the left lobe of liver appears elongated (see ultrasound images above), and overlies the spleen. In the above pictures, the spleen is seen to be hyperechoic compared to the left lobe (the so called "beaver tailed liver").

LIVER FOR METASTATIC DISEASE 

By ultrasound metastases to the liver usually take on one of the following appearances: 

   

(1) hypoechoic mass, (2) mixed echogenicity mass, (3) mass with target appearance, (4) uniformly echogenic mass, (5) cystic mass, or (6) heterogeneous or "coarse" echo texture without focal mass 

LIVER METASTASES:

These ultrasound images of the liver reveal multiple, focal, echogenic mass lesions throughout the liver. The liver shows a nodular appearance.

associated pleural effusion and ascites.

Diffuse infiltration of the liver by metastatic renal cell carcinoma. Transverse image of the liver shows a heterogeneous echotexture with diffusely increased echogenicity. This patient proved to have diffuse metastatic renal cell carcinoma.

Ultrasound of the left lobe of the liver reveals a mass in the medial segment that has a hypoechoic "halo" (arrows). The presence of a halo generally indicates metastatic disease. The lesion proved to be a metastasis from colon cancer

Ultrasound of the liver reveals multiple echogenic masses due to metastatic breast cancer

Ultrasound of the liver shows a fluid-filled mass with a peripheral thin rim of viable tumor (arrows). This lesion was a necrotic metastasis from colon cancer. The irregular inner wall (open arrow) and internal echos (curved arrow) are clues that the lesion is not a simple benign cyst.

Transabdominal ultrasound shows a mass (arrows) in the right lobe. Note the echogenic central calcifications, which cast an aocustic shadow (open arrow). Note the lesion extends into the inferior vena cava (curved arrow).

Ultrasound-guided biopsy of necrotic metastasis from colon cancer. Gray-scale image of the liver shows a primarily fluidfilled metastasis from colon cancer.

Ultrasound of the right lobe of the liver reveals a uniformly hypoechoic mass (arrow) that proved to represent lymphoma

GB MASS

HEPATIC HEMANGIOMAS

RUPTURE OF THE UTERUS:

Ultrasound scan pictures show a rupture of the anterior wall of the lower uterine segment of the uterus. The ultrasound scan images also show a large hematoma of almost 5 cms. between the bladder and the uterus. This communicates freely with the uterine cavity which also seems to be filled with fluid.

ACUTE CHOLECYSTITIS

Chronic Cholecystitis with Gallbladder Polyps

moderately dilated common bile duct without evidence of choledocholithiasis.

CHOLEDOCHOLITHIASIS

URINARY BLADDER DIVERTICULA

Image through the long axis of the GB (GB) demonstrates the gallbladder neck (red arrow). GB wall thickness is measured between the gallbladder lumen and the hepatic parenchyma (red arrowheads) with normal thickness < 3mm.

LARGE NABOTHIAN CYSTS OF CERVIX

Transabdominal Ultrasound scan shows a clearly defined cystic lesions in the cervix of the uterus.

ACUTE PANCREATITIS:

The pancreas appears swollen, edematous and hypoechoic.

CHRONIC PANCREATITIS

FATTY CHANGE OF THE PANCREAS

CALCIFICATION/ CALCULI IN PANCREAS:

PANCREATIC PSEUDOCYST

BILE DUCT DILATATION

FIBROID UTERUS

OVARIAN CYST

HYDROSALPINX

OVARIAN CYST

Cyst containing homogeneous debris consistent with an endometrioma

Crescent sign. There is normal ovarian tissue adjacent to a benign cystic teratoma (between markers)

MULTILOCULATED CYST

POLY CYSTIC OVARY

Placenta Previa

placetal abruption

HYDATID CYST

HEMATOMETRA

A large amount of hypoechoic blood (clot) is seen within the uterus

UTERINE SYNECHIA

UTERINE SYNECHIA

HYDROCEPHALUS

INTRAUTERINE FETAL DEATH (IUFD):

ANENCEPHALY

Ultrasound findings of anencephaly. The cranial bones are absent. Amniotic fluid is seen above the orbits

Myelomeningocele

Sagittal ultrasound image demonstrates the break in the skin line (arrow).

Transaxial ultrasound image shows the myelomeningocele sac (short arrow) and divergent posterior ossification centers (long arrows).

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->