RERENAL ULTRASOUND

RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 Basic PriRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 nciples Of Ultrasound Examination

High frequency ultrasonic sound waves arRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
e sent through a transducer to the organs from a site where the transducer is placed on skin. The sound
waves bounce off tissues like echoes and return to the transducer. The transducer coverts them into an
electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 NAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site
where the transducer is placed on skin. The sound waves bounce off tissues RENAL
ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
like echoes and return to the transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 RENAL ULTRASOUND

RERENAL ULTRASOUND

Basic Principles RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 Of Ultrasound Examination

High frequency ultrasonic sound waves are seRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
nt through a transducer to the organs from a site where the transducer is placed on skin. The sound
waves bounce off tissues like echoes and return to the transducer. The transducer coverts them into an
electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 NAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High freqRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 uency ultrasonic sounRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
d waves are sent through a transducer to the organs from a site where the transducer is placed on skin.
The sound waves bounce off tissues like echoes and return to the transducer. The transducer coverts
them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site
where the transducer is placed on skin. TRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
he sound waves bounce off tissues like echoes and return to the transducer. The transducer coverts them
into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasoRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
nic sound waves are sent through a transducer to the organs from a site where the transducer is placed
on skin. The sound waves bounce off tissues like echoes and return to the transducer. The transducer
coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.
 Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).

Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).
 Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.

Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.
 Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.

Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.
 RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site
where the transducer is placed on skin. The sound waves bounce off tissues like echoes and
return to the transducerRENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sRENAL ULTRASOUND

RENAL ULTRASOUND

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.
Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.

Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).
 Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).

Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.
 Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.

Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.
 Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.

Basic Principles Of Ultrasound Examination

High frequency ultrasonic sound waves are sent through a transducer to the organs from a site where the
transducer is placed on skin. The sound waves bounce off tissues like echoes and return to the
transducer. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

 Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.

Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).
 Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).

Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.
 Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.

Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.
 Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.

ound waves are sent through a transducer to the organs from a site where the transducer is placed on
skin. The sound waves bounce off tissues like echoes and return to the transducer. The transducer
coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.

Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).
 Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).

Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.
 Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.

Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.
 Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.

. The transducer coverts them into an electronic picture.

Different types of tissue affect the speed at which sound waves travel. Resistance to sound transmission
varies with the nature of tissue. Fluid transmits sound with no resistance. No echoes are returned. That is
why fluid is anechoic and appears dark. The sound is transmitted freely beyond fluid, posterior
enhancement.

Pus is complex fluid and will produce low level echoes due to high protein content and tissue debris.

Sound does not travel well through air and that is the reason US examination is not optimal in abdominal
examination. It is suitable for pelvic structure evaluation, where bowel can be displaced by filling bladder
with urine. This is achieved by asking the patient to drink a large amount of water before the procedure.
US is directed through fluid filled bladder to evaluate pelvic structures. Transvaginal US is also a method
that allows visualization of pelvic structures without bowel interference and no need for filling bladder.

Bone does not transmit sound waves. Thus, US it is not suitable for evaluation of adult head. It is useful in
children before the fontanelles are closed.

Calcified tissues do not transmit sound waves and are highly echogenic and appear white. Since they do
not transmit sound there will be shadows posterior to the lesion (acoustic shadows).

Fat and hair are echogenic and appear white but are not associated with acoustic shadows.

Value Of US In Renal Failure Cases

Image Atlas With Examples For Each Type Of Renal Failure

US is a non-invasive procedure useful in distinguishing the etiology for renal failure. It is critical for ruling
out obstruction. When procedures requiring contrast like IVP and CT cannot be done, US of kidneys is
very helpful.

Blood flow to kidneys can also be evaluated with doppler US. Flowing blood appears an echoic and dark.
Vessels can be recognized in that fashion. With doppler, sound waves become audible based on the
velocity of blood flow.

Right kidney can be evaluated through the liver. Left kidney is imaged in decubitus position. If
unsuccessful, it is examined from back. If the spleen is enlarged it can be used as a window. These
options avoid interference from bowel gas.

Normal Kidney

Normal kidney measures between 10.5

to 12.5 cms.
Cortex is about 2.5 cms and has the
same kind of echoes as liver.
Central echoes are from fat surrounding
renal pelvis and are white.
Medulla is hypoechoic and appears
dark. You can distinguish it from fluid
filled calyces, as there will be no
increased transmission of sound
beyond.
Renal pelvis is filled with urine and is
echo free with posterior enhancement
behind renal pelvis (next normal kidney).
 Normal Kidney

Kidneys appear normal in acute renal failure

(hypovolemia or acute tubular necrosis).

Chronic Renal Failure (Medical Kidney)

Kidneys are smaller than normal.

Surface may be irregular.
Cortex is thinned and is hyperechoic
than liver due to scar tissue.
Medulla is hypoechoic and appears
dark. You can distinguish them from fluid
filled calyces as there will be no
increased transmission of sound as in
fluid.
Renal pelvis is filled with urine and is
echo free. Note the posterior
enhancement behind renal pelvis.

Kidneys are small, irregular and hyperechoic

in chronic renal failure due to medical renal
disease.
 Hydronephrosis

Dilated anechoic calyces with increased

posterior transmission of sound.
Hyperechoic fat delineating dilated
calyces.
Cortex is normal with similar echo
pattern of liver.

Kidneys in obstructive renal disease show

hydronephrosis.

Simple Renal Cyst

Simple renal cysts are common. We call them

simple when they are in the cortex, thin walled,
the inner lining is smooth. The fluid is anechoic
with no internal echoes and has good sound
transmission with posterior enhancement. These
cysts do not require further work-up.
 Complex Renal Cyst

Cysts where the inner lining is irregular, with

septations and fluid has echoes are considered
complex cysts. Complex cysts require additional
further work-up to rule out cavitating cancer or
renal abscess.

Anechoic mass. Some irregularities are

seen along the inner lining (arrow
heads).
Posterior enhancement indicates that it
is clear fluid.