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Examination technique
Good equipment control - differentiation renal parenchyma - liver - spleen, differentiation renal parenchyma- sinus Technical facilities sectorial transducers, Doppler technique, ultrasound histograms Differentiated longitudinal sections: - Right - paramediosagittal slices/sections - Left frontal slices/sections- left colic angle Equatorial" sections- the largest sizes Lateral approaches - lumbar approach Multiple sections, plans, approaches, acoustic windows
NORMAL KIDNEY US
Sections: longitudinal, transversal Sonic windows/ LK > intercostal, RK > subcostal mclav, intercostal Urinary bladdes full Capsula Parenchyma Cortex Medulla Pyramids of Malpighi visibile only in children In adults the difference cortex/medulla appears only in glomerulary edema from AGN Kidney pelvis the most echogenic structure in the
Well delimited contour, regular, or with incisions (rare) = ECHOGENIC capsule Parenchyma the most hypoechogenic thickness (IP): 1,5-2 cm Size: longitudinal 10 - 13 cm transversal 3,5 - 5 cm
PYELIC/KIDNEY ABNORMALITIES
Diagnosis problems complicated abnormalities Differential diagnosis pyelocalyceal cysts/dilatations (UIV) Pseudotumoral irregular aspect, intracystic vegetations Precalyceal canalicular ectasia Cacchi-Ricci disease sponge kidneys hyperechogenic pyramids, tiger aspect
PARENCHYMA CYSTS in all large renal mass Large renal volume> 15 cm Different sizes clear, non-comunicating, own walls IP disapeared family aggregation
HYDRONEPHROSIS US
Confirmation, severity,
causes, complications Comunicating cavities US Type of obstruction clot, pus, lithiasis, stenosis Complications hydropyonephrosis, urinoma (posttraumatic) Limitations - false +, false -, discordant UIV) Pyelocalyceal dilations are reversible, can be remited after mobilisation of the calcul
LIMITATIONS of KIDNEY US
The technique is operator/patient dependent Difficult view of the entire pyelic tree in the absence of dilation (lumbar, iliac, pelvic) Lack of functional information - partly substituted by some contrast agents (vesicoureteral reflux) Absence of specific contrast agents with urinary elimination Tumoral pathology, lithiasis of the urinary tract - apparently non-obstructive UIV