Renal System II
Which RI value would indicate a normal Doppler evaluation for transplant rejection?
0.5-0.7
A duplicated collecting system shows:
2 hyperechoic renal sinus areas separated by a cleft
What is the normal thickness of the distended bladder wall?
3 mm
Descibe Von-Hippel-Lindau renal involvement?
3rd-5th decade, seen as bilateral cysts on ultrasound, RCC is most frequenct cause of death
You are performing a follow-up ultrasound study on a patient with a large left renal cyst. Which of the following most accurately describes the prevalence of renal cysts?
50% of people over age 50
Which age group is most affected by Transitional Cell Carcinoma?
50+ years old
What medical disease, to some extent, occurs with every renal transplant and is treated with diuretics and hydration?
ATN
What is related to hypernephroma?
Association with smoking, calcifications w/in mass
Which form of polycystic disease has a loss of reniform shape?
Autosomal Dominant
Which form of polycystic disease has bilateral enlarged kidneys?
Autosomal Dominant
Which form of polycystic disease has cysts found in liver, spleen and pancreas?
Autosomal Dominant
Which form of polycystic disease has 4 subcategories?
Autosomal Recessive
Which form of polycystic disease has bilateral enlarged echogenic kidneys?
Autosomal Recessive
Which form of polycystic disease has microscopic cysts?
Autosomal Recessive
You have been asked to identify the ureteral jets. Where are the ureteral orifices in the urinary bladder?
Base of the trigone along the posterior aspect
What is true about RCC?
Can occur is cyst wall of chronic dialysis patients, more common in older men, unilateral and well encapsulated
You are performing a Doppler study of a renal transplant to rule out stenosis of the renal artery. The renal artery is usually anastomosed to which vessel?
Common Iliac Artery
Metastases to the kidney are most commonly from a:
Contralateral kidney tumor
Which of the following 2 items are the major causes of renal artery stenosis?
Fibromuscular dysplasia, atherosclerosis
What are hormones produced by the pancreas?
Glucagon, insulin, somatostatin
The sonographic appearance of infantile polycystic kidneys includes:
Hyperechoic kidneys with micro cysts
ATN is associated with which of the following 4 things?
Increased renal size, ARF, Prominent medullary pyramids and anechoic, most common cause of failure in post-transplant patients
Which Doppler method evaluates the segmental and intralobar arteries?
Indirect
Bladder duplication:
Is a rare anomaly
The renal arteries are ____ branches off the Aorta?
Lateral
A neurogenic bladder is:
Loss of voluntary control of voiding
Which of the following describes the normal waveform of the main renal artery?
Low Resistance
Describe medullary cystic disease.
Marked by normal renal function, a variable number of renal cysts, often associated w/ polyuria and progressive azotemia
What is true about mesoblastic nephroma?
More common in males, most common solid benign mass in neonates, it is a fetal renal hamartoma, benign couterpart of Wilm's tumor
Describe nephrolithiasis.
More common w/ urinary stasis, tends to be small in size, CT is a good modality to evaluate, mainly in males
What is the most common renal tumor found in children?
Nephroblastoma
Angiomyolipomas are more commonly encountered in:
Patients with tuberous sclerosis
Which of the following conditions affect male children, is characterized by bilateral hydronephrosis, overly distended bladder, and dilated ureters?
Posterior urethral valves
You are scanning the urinary bladder and notice multiple artifactual bands in the near field at the anterior bladder wall. What is the source of these echoes?
Reverberation artifact
A patient has been referred to your ultrasound lab for an evaluation of a new renal transplant. Where should you look?
Right Lower Quadrant
The common hepatic duct is formed by the:
Right and left hepatic ducts
You are having difficulty identifying the renal arteries in a patient referred for questionable renal artery stenosis. Which vessel is most helpful as a landmark for the location of the renal arteries?
Superior Mesenteric Artery
What malignant tumor is most common in children aged 2-5?
Wilm's tumor
A ureterovesical junction is:
junction between the distal ureter and base of the bladder
During color Doppler evaluation of the kidney, inadequate fill is seen in the intrarenal vasculature. Which Doppler parameter will you adjust to improve sensitivity to flow?
Decrease filter to a lower setting
What Doppler parameter should you measure to look for rejection in a renal transplant?
Resistive Index
Which of the following is an aggressive malignant bladder tumor?
SCC
Which of the following 2 organs are common primaries that metastasize to the kidneys?
Breast, liver
Which of the following is a differential diagnosis for a WIlm's tumor?
Neuroblastoma
If a patient is suspected of having RCC, what other 3 areas should be evaluated for tumor extension?
Renal vein, IVC, right atrium
You are performing a Doppler evaluation to rule out renal artery stenosis. You will compute a ratio comparing the velocity in the renal artery to what vessel?
Abdominal aorta above the level of the renal arteries
You are performing a renal sonogram and identify hydronephrosis in the right kidney. Which of the following is NOT a potential cause of hydronephrosis?
Acute pyelonephritis
A hypernephroma is a solid renal mass. It is known as:
Adenocarcinoma of the kidney, renal cell carcinoma, Grawitz's tumor
A renal mass that is highly echogenic due to its high fat content is:
Angiomyolipoma
During an abdominal ultrasound on a 52 year old female, a hyperechoic mass is noted on the left kidney. Her renal lab values are normal. What is the most likely diagnosis for this pathology?
Angiomyolipoma
Which form of polycystic disease has no renal parenchyma is identified at later stages?
Autosomal Dominant
Which form of polycystic disease has randomly placed cortical cysts?
Autosomal Dominant
Which form of polycystic disease maybe seen in utero?
Autosomal Recessive
Inflammation of the bladder is termed:
Cystitis
In infantile polycystic disease:
Cysts cannot be seen sonographically
You are scanning a patient with autosomal dominant polycystic kidney disease. What statements are true?
Cysts may be complicated by bleeding or infection, high blood pressure is common, liver cysts maybe present in up to 30% of patients, progressive renal failure is common
Which Doppler method can be hindered by the presence of multiple renal arteries?
Direct
Which of the following is an extrinsic cause of hydronephrosis?
Endometriosis
What is the sonographic appearance of renal vein thrombosis?
Enlarged kidneys with acute renal vein thrombosis
You have detected a solid mass in the right kidney of a 47 year old male. You should tailor your exam to evaluate which of the following three areas?
Evaluate for renal vein thrombus, retroperitoneal adenopathy, extension of tumor into the renal vein, liver mets
You are scanning a patient post renal biopsy and discover a cystic mass in the kidney. What should you do?
Evaluate the cyst with color Doppler
The term exstrophy is best defined as:
Failure of the mesoderm to form over the lower portion of the abdomen
The sonographic appearance of a porcelain GB:
Hyperechoic structure with a posterior shadow
What is a common songraphic appearance of mets to the liver?
Hyperechoic, hypoechoic, heterogenous
Which stage of RCC has spread to perinephric fat w/in Gerota's fascia?
II
Which stage of RCC has spread to renal vein, IVC, and/or regional lymph nodes?
III
Transplanted kidneys are usually placed:
In the pelvis along the ilopsoas muscle
Which is true of the sonographic appearance of chronic pancreatitis?
Increased echogenicity
Which renal artery courses between the pyramids?
Interlobar
You have been asked to evaluate an atypical renal cyst that was seen on CT. Which of the following 3 features are indicative of an atypical cyst?
Irregular walls, internal septations, wall calcifications
Adult polycystic disease may be characterized by:
Latent disease until the 3th-4th decade, HTN and impaired renal function, autosomal dominant disease, may have associated cysts in the liver, panc, spleen
The ligamentum venosum separates the:
Left lobe from the caudate lobe
You are scanning a patient with right flank pain and known polycystic kidney disease. You suspect the presence of hemorrhage within one of the renal cysts. What is the sonographic appearance of this finding?
Low-level echoes w/in the cyst
What is usually diagnosed in early childhood or in utero?
Multicystic dysplastic kidney
What cystic disease is non-hereditary and can be unilateral or bilateral?
Multicystic dysplastic kidney disease
A 1-week-old male infant presents with left flank mass. An IVP demonstrates a normal right kidney but fails to demonstrate the left kidney. The ultrasound examination demonstrates many noncommunicating spherical cystic structures in the left renal fossa, the largest of which is located laterally. No true renal parenchyma is identified. The right kidney is normal sonographically. This most probably represents:
Multicystic kidney
The sonographic appearance of Caroli's disease is:
Multiple cystic structures in the liver, cystic structures communicate with the biliary tree, stones maybe identified in the ducts
You have been asked to perform an ultrasound evaluation of a child with multicystic dysplastic kidney (MCDK). What are signs of this condition?
Multiple variable sized cysts, males are at greater risk, reniform shape, no identifiable renal sinus
A renal ultrasound was performed on an infant male. The right kidney had multiple anechoic areas noted. The left kidney was slightly enlarged, but otherwise normal. What is the most likely diagnosis?
Mutlticystic dysplastic kidney disease
You're completing a renal ultrasound on a 4 year old female. A large renal mass with areas of necrosis is found. What is the most likely diagnosis?
Nephroblastoma (Wilm's tumor)
A patient has been referred to your lab with a history of acute pyelonephritis. What is the most common ultrasound appearance of this condition?
Normal appearance
During routine surveillance of the urinary bladder, you detect the presence of periodic ureteral jets. This is a sign of:
Normality
Ultrasound findings in a patient with hypertension include a left kidney measuring 6.8 cm and a right kidney measuring 11.7 cm. Which of the following is consistent with these findings?
Occlusion of the left main renal artery
Describe medullary sponge kidney.
Occurs in adults, complications include stone formation and infection, normal renal function, multiple cystic dilatations of collecting ducts in medulla
What type of cyst can give the false appearance of hydronephrosis?
Parapelvic cyst
Which cause of acute renal failure does ultrasound play a key part in diagnosing?
Postrenal
Which of the following structures lies anterior to the bladder?
Pubic symphysis, abdominal wall, Space of Retzuis
Which of the following results from an ascending UTI?
Pyelonephritis
A patient is referred for ultrasound evaluation to rule out the presence of renal malignancy. What is the most common (malignant) solid renal mass in the adult?
RCC
A renal mass was noted during the abdominal scan on a 50 year old male. Doppler examination showed pulsatile flow within the mass. The mass shown is suspicious for what finding?
RCC
A malignant solid renal tumor mass can be all of the following:
RCC, TCC, SCC
Doppler analysis of intrarenal waveforms performed during renal sonography reveal a resistive index of 1.0. This finding is consistent with what three findings?
Renal obstruction, renal vein thrombosis, chronic medical disease
You are scanning a patient with suspected lymphoma of the kidney. Which ultrasound appearance is associated with renal lymphoma?
Solitary or multiple bilateral hypoechoic masses in enlarged kidneys
You are scanning a 69 year-old male with hematuria. Your ultrasound findings include right-sided hydronephrosis and a mass within the urinary bladder. Which of the following tumors most commonly occurs within the urinary bladder?
TCC
You detect irregular thickening of the bladder wall in a 53 year-old male with hydronephrosis and a dilated ureter. Which of the following would you suspect?
TCC
The functional unit of the kidneys is:
The nephron
You are scanning a 69 year old male with hematuria. Your ultrasound findings include right-sided hydronephrosis and a mass with urinary bladder. Which of the following tumors most commonly occurs within the urinary bladder?
Transitional cell carcinoma
If renal artery stenosis is suspected with a stenosis greater than 60%, which 3 Doppler findings would be visualized with spectral or color Doppler?
Turbulent flow, tardus parvus waveform, RAR greater than 3.5
What is the indication for a Doppler renal study to rule out renal artery stenosis?
Uncontrolled HTN
During a routine abdomen and pelvic ultrasound study, you detect a small, round cystic structure projecting into the urinary bladder. This most likely represents:
Ureterocele
Which of the following fluid collections will develop first following a renal transplant?
Urinoma
A 3 year old boy presents with hematuria and a palpable left flank mass. Sonographically depicts a solid renal mass. This finding would most likely represent:
Wilm's tumor