pediatric kidneys
Terms
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- maintaining body ___ in the neonate is very important because small infants lose a potentially dangerous amount of body heat quickly whenever possible, scanning through the portholes of an isolette provides an optimal environment for the premature or oth
- temp
- when the exam is performed outside the isolette, body heat loss can be minimized by the use of heat lamps and by exposing only the area of the trunk being ____. imaging of the urinary bladder, which includes assessment for distal ureteral dilation, is co
- interrogated
- because of the infant's tendency to urinate spontaneously, scanning is gently initiated over the suprapubic region. if the urinary bladder is not distended at this time, or if __ occurs before adequate detail can be obtained, this area can be examined af
- voiding, rapidly
- long and short axis view of the kidneys and of the perirenal areas are initially obtained by scanning via the __ to obtain coronal and axial images via the anterior abdomen for long and trv images or both. renal scanning before and after the infant voids
- flank, hydronephrosis
- the normal kidney in the neonate is characterized by a distinct demarcation of the cortex and medullary pyramids. the medullary pyramids are large and __ not to be mistaken for dilated calyces or cyst.
- hypoechoic
- the surrounding cortex in a neonate kidney is quite ___ with echogenicity essentially similar to or slightly greater than that of normal liver parenchyma. because of a paucity of fat in the renal sinus of the neonate, this area is generally hypoechoic an
- thin, indistinct
- in a normal neonate kidney, the __ which lie at the bases of the medullary pyramids, appear as punctuate intensely echogenic structures. renal cortical echogenicity normally decreases to less than that of liver parenchyma usually by __ to __ months of ag
- arcuate arteries, 4-6 months
- the normal urinary bladder is thin walled in the distended state and should measure less than __ mm and when empty the wall thickness increases but should remain less than __ mm
- 3 mm, 5mm
- the normal adrenal glands are relatively larger and therefore more easily identified in the neonate than in the older infant or young child. each gland lies immediately superior to the upper pole of the kidney. the left adrenal gland extends slightly mo
- medial
- sonographically, the adrenal gland has an inverted __ or __ shape in the long plane. in the transverse, the portion of the gland delineated has a linear or ___outline. the normal adrenal __ in the neonate is relatively thin, appearing as a distinctly ec
- V or Y, curvilinear, medulla
- when the kidney is absent or ectopic, the ipsilateral adrenal gland remains in the renal fossa but as a result may have an altered ___. have patient take deep breath and mass separates from kidney if it's an __ mass
- configuration, adrenal
- means the dilation of the urinary collecting system; there are many causes of dilation of the collecting system; the most common is obstruction, reflux, or abnormal muscle development
- hydronephrosis
- sono appears as bear claw appearance; visible renal parenchyma surrounding a central cystic component, small peripheral cysts (dilate calyces) budding off a large central cyst (renal pelvis) and visualization of a dilated ureter. this must be distinguish
- hydronephrosis
- the most common type of obstruction of the upper urinary tract; most common reason for hydronephrosis; it most often results from intrinsic narrowing or extrinsic vascular compression; bilateral involvement may occur, must r/o contralateral multicystic dy
- ureteropelvic junction obstruction (UPJ obstruction )
- sono appears there is pelvocaliceal dilation without ureteral dilation
- UPJ obstruction
- frequently causes bilateral hydronephrosis; dilates everything proximal the bladder may be obstructed by a neurogenic bladder, pelvic mass, or congenital anomaly such as posterior urethral valves
- bladder outlet obstruction
- ___ are the most common cause of bladder outlet obstruction in the male neonate
- posterior urethral valve obstruction (PUV)
- sono appears the wall of the urinary bladder appears thickened and trabeculated; midline sag imaging with caudal angulation through the bladder may allow visualization of the distended posterior urethra; the resultant hydronephrosis and hydroureter is usu
- bladder outlet obstruction
- occurs more commonly in females and more often on the left side; it results from an ectopic insertion and cystic dilation of the distal ureter of the upper moiety of a completely duplicated renal collecting system
- ectopic ureterocele
- sono appears as a fluid mass within the urinary bladder, is located inferomedially to the ureteral insertion of the lower pole ureter; associated with duplicating collecting system; looks like foley catheter in bladder
- ectopic ureterocele
- associated with PUV; triad of hypoplasia or deficiency of the abdominal musculature, cryptorchidism, and urinary tract anomalies; this anomaly includes congenital absence or deficiency of the ab musculature, large hypotonic dilated tortuous ureters, a lar
- prune belly syndrome
- sono it varies depending on the severity of the syndrome; the most severely affected neonates show dysplastic echogenic kidneys. in the less severely affected, nonhydronephrotic kidneys with dilated ureters and a huge bladder is seen; this appearance may
- prune belly syndrome
- the most common cause of renal cystic diseas presenting in the neonate, and when hydronephrosis is excluded, it si teh most common cause of an ab mass in the newborn
- multicystic dysplastic kidney
- congenital, usually sporadic, non herediaty, renal dysplasia that is thought to be secondary to severe, generalized interference with ureteral bud function during the first trimester; bilateral occurence is fatal
- multicystic dysplastic kidney
- sono the classic appearance is of a unilateral mass resembling a bunch of grapes, which represents a cluster of discrete noncommunicating cysts, the largest of which are peripheral; there is no identifiable renal pelvis
- multicystic dysplastic kidney
- polycystic renal disease identified in the neonatal period the most; associated with bilary ectasia and hepatic fibrosis (the severity is proportional to the degree of renal involvement); the msot severe form is seen in teh neonatal stage, whereas the lea
- autosomal recessive polycystic kidney disease (infantile polycystic kidney disease)
- sono, the most striking feature is bilateral renal enlargement with diffuse increased echogenicity and loss of definition of the renal sinus, medulla and cortex; assoicated with mild hepatic fibrosis and uctal hyperplasia can produce a heterogeneous incre
- autosomal recessive polycystic kidney disease (infantile polycystic kidney disease)
- heriditary but usually presents in middle age; however, on rare occasions it has been reported in young infants; more typically the disease becomes manifested during the fourth decade of adulthood, with hypertension, hematuria, and enlarged kidneys; cysts
- autosomal dominant polycystic renal disease (adult polycystic kidney disease)
- sono teh well-defined cysts affect both kidneys; the cysts are of varying sizes and can be identified in the kidneys in the adult as the hyperplasia
- autosomal dominant polycystic renal disease (adult polycystic kidney disease)
- most likely to occur in the dehydrated or septic infant and is more prevalent in infants of diabetic mothers; one or both kidneys may be involved; there is renal enlargement, hematuria, proteinuria, and a low platelet count
- renal vein thrombosis
- occurs initially in teh small intrarenal venous branches, and at this stage the elarged kidney has a nonspecific disordered heterogeneous internal echogenicity corresponding tot he extent and severity of the process; if it reaches teh renal vein or ivc, i
- renal vein thrombosis
- there may be coexistent adrenal hemorrhage, particularly on the left side where the adrenal vein drains directly into the renal vein; calcification within the involved veins may eventually result; the use of color doppler helps the tech to identify if flo
- renal vein thrombosis
- the most common renal tumor of teh neonate and young infant; this tumor is benign but is indistinguishable from a wilms' tumor by any method of imaging; because the tumor may invade adjacent structures, nephrectomy is indicated; it is seen in children les
- congenital mesoblastic nephroma
- sono as with a wilms tumor, this lesion may be hyperechoic, hypoechoic, or of mixed echogenicity
- congenital mesoblastic nephroma
- precursor to wilms; an abnormal persistence of fetal renal blastoma that has the potential to develop into a wilms tumor; a rare cause of bilateral renal enlargement in the neonate and diffuse; it can occur in up to one third of kidneys with a wilms tumor
- nephroblastomatosis
- although this abnormality may be evident sonographically, CT or MRI has been shown to be more accurate; sono renal enlargement is seen; the involved areas may be hypoechoic, hyperechoic, or isoechoic compared with normal renal parenchyma
- nephroblastomatosis
- the most common intraabdominal malignant renal tumor in young children; the incidence of this tumor peaks between two and five years old; tumor is typically unilateral, but a small percentage can be bilateral
- nephroblastoma (wilm tumor)
- sonography is valuable in detecting extension into the renal vein, ivc, and right atrium for tumor invasion (thrombus)
- wilms tumor
- sono its appearance is variable, extending from homogeneous to complex texture; mass usually has areas of echogenicity and may have calcifications within; areas of necrosis and hemorrhage may be present; when teh tumor extends into the right atrium, cardi
- nephroblastoma (wilms tumor)
- a malignant tumor that arises in teh sympathetic chain ganglia and adrenal medulla, may be detected on antenatal sonography or at birth; can be seen between two months and two years with peak age of incidence at two years; second most common malignancy in
- neuroblastoma
- sono the neoplasm is usually highly echogenic; intrinsic calcification may be identified; sono eval of liver should be made for evidence of mets because it spread quickly; have patient take deep breath to show separation from kidney
- neuroblastoma
- commonly due to traumatic birth; large size, and neonatal hypoxia predispose; however the newborn with adrenal hemorrhage may have none of these associated factors but nonetheles present with an ab mass, jaundice, and anemia
- adrenal hemorrhage
- sono it shows ovoid enlargement of the gland or a portion of the gland; the appearance of the gland can range from anechoic to hyperechoic, or a mixture of echogenicities, depending on the extent, age, and severity of the process; will go from echogenic i
- adrenal hemorrhage
- resolves on its own; unlike a neoplasm the gland does not enlarge but rather decreases in size over time; generally within four to six weeks the lesion becomes appreciably smaller and subsequent calcification may be identified on the sonogram or radiograp
- adrenal hemorrhage