DR.
SHAMIM RIMA
MBBS,FCGP,DMU
[Link]
RADIOLOGY & IMAGING
THE KIDNEYS AND URETER
FETAL LOBULATION
FETAL
FETAL LOBULATION
LOBULATION
Ultrasound scan showing fetal lobulation.
NEONATAL KIDNEY
Term neonate: length 4.5cm.
Lack typical increased central
hilar echogenicity.
Medullary pyramid very prominent
& lower echogenicity than overlying
cortex.
ECTOPIC / PELVIC KIDNEY
These ultrasound images show the right kidney just to the right of the uterus in
the true pelvis. There was no kidney visualized in the right renal fossa.
A crossed fused renal ectopia is
an entity where one
kidney crosses over to the other
side and the parenchyma of the
two kidneys fuse.
In most cases it involves the left
kidney. Renal function is usually
normal.
Other anomalies associated with
this condition are the VACTER
syndrome, hydronephrosis,
annular pancreas, and
multicystic dysplasia.
Most cases are sporadic but
dominant inheritance has been Renal ultrasound showed a mass extending over the
Renal ultrasound showed a mass extending over the
reported. midline compatible with the diagnosis of a crossed
midline compatible with the diagnosis of a crossed
fused ectopic left kidney.
fused ectopic left kidney.
ECTOPIC / PELVIC KIDNEY
An ectopic pelvic kidney indenting on the
urinary bladder superiorly
HORSESHOE KIDNEY
a) kidneys located at a lower level than normal
b) the lower poles of both kidneys pointing medially,
c) a bridge of renal tissue or isthmus connecting the two kidneys. This
isthmus is seen passing anterior to the abdominal aorta.
HORSESHOE KIDNEY
A curved configuration of the lower poles,
elongation of the lower poles, and poorly defined
lower poles, suggest the presence of horseshoe
kidney.
Other associated findings, such as stones,
hydronephrosis, and cortical scarring, are reliably
depicted on sonograms. Transverse ultrasonogram of the
abdomen showing a soft-tissue
Ultrasonography has also been useful in the hypoechoic mass (isthmus) that is
anterior to the spine and aorta and
diagnosis of horseshoe kidney in utero. that unites the lower renal poles.
HORSESHOE KIDNEY
Transverse slightly oblique
Transverse sonogram of the
ultrasonogram of the right kidney,
showing the lower pole of the right abdomen demonstrates a soft-
kidney; the pole crosses over the spine,
tissue isthmus anterior to the
anterior to the aorta and inferior vena
cava. spine.
CROSS FUSED RENAL ECTOPIA
Ultrasound
Ultrasoundshowed
showedtwo
twokidneys
kidneysfused
fused
together with a septation in the middle.
together with a septation in the middle.
CROSS FUSED RENAL ECTOPIA
Power doppler intervention, two pairs of vascular
system was noted, fusing at the lateral right kidney. No
normal left kidney seen.
CROSS FUSED RENAL ECTOPIA
DUPLICATION OF KIDNEYS
Complete duplication of the right
Incomplete duplication of both kidney.
kidneys. 1 and 2 mark hilum of each renal
segment.
CROSS FUSED ECTOPIC KIDNEY
well-defined indentation or niche (arrow) at the junction between the
right kidney (RK) and the crossed-fused left kidney (LK). The right renal
pelvis has a small amount of visible urine within it
AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Sonography reveal bilateral grossly enlarged kidneys (14 to 16 cms. in length, 8
to 10 cms. width). The kidneys are replaced by multiple large cysts (more than 2
in each kidney) of sizes varying from 2 to 5 cms.
Criteria
Criteriafor
fordiagnosis
diagnosisofofADPCK:
ADPCK:
a)a) more
morethan
than22renal
renalcysts
cystsininone/
one/both
bothkidneys,
kidneys,ififage
ageless
lessthan
than30
30yrs.
yrs.
b)b) 22or
ormore
morecysts
cystsinineach
eachkidney,
kidney,ififaged
agedfrom
from30
30toto59
59yrs.
yrs.
c)c)44cysts
cystsinineach
eachkidney
kidneyififaged
agedmore
morethanthan60
60yrs.)
yrs.)
There is very little normal renal parenchyma seen in these images. Note that
the cysts are non-communicating ruling out hydronephrosis. The right kidney
shows an echogenic focus, in one cyst, which may be a calculus or
calcification. A solitary cyst is seen in the right lobe of liver
MULTICYSTIC DYSPLASTIC KIDNEY
Ultrasound demonstrates
an abnormal right kidney
which contains multiple
cysts of varying sizes that
do not communicate. The
small amount of renal
parenchyma visible
between the cysts is
echogenic
MEDULARY SPONG KIDNEY
Sagittal image of the left
kidney. The left kidney is also
normal in size and
demonstrates extensive,
curvilinear parenchymal
calcification with posterior
shadowing in the region of
the medulla.
Medullary sponge kidney is a developmental anomaly characterized by
cystic dilatation of the collecting tubules in one or more renal medullary
pyramids.
Sagittal scan of the right lumbar region The right kidney is normal in size
but exhibits increased echogenicity of the medullary pyramids. No obvious
acoustic shadowing is noted from the echogenic foci.
MEDULLARY NEPHROCALCINOSIS
HYDRONEPHROSIS
ACUTE RENAL FAILURE
CHRONIC RENAL FALURE
bilateral echogenic (hyperechoic renal cortex) kidneys 2) both kidneys appear
small in size (atrophic) 3) reduced thickness (thinning) of renal cortex (10mm.) 4)
reduction in cortico-medullary differentiation
RENAL STONE
ACUTE PYELONEPHRITIS
left kidney is significantly larger
than the right kidney (10.3 versus 7.6
cm). The left kidney is diffusely
enlarged, with loss of normal
corticomedullary differentiation
CHRONIC PYELONEPHRITIS
PYONEPHROSIS
RENAL CYST
Parapelvic cysts:
Peripelvic renal cysts with non communicating
intrarenal cystic structures that could be mistaken for
dilatated calices
RENAL ABSCESS
ACUTE RENAL ABSCESS
ANGIOMYOLIPOMA.
Ultrasound of the right kidney demonstrates a 1.5 cm round hyperechoic
structure within the renal parenchyma
RENAL CELL CARCINOMA
hypoechoic, inhomogenous mass (10 x 8 cms.) at the upper pole
of the left kidney. The central portion is markedly hypoechoic
suggestive of necrosis.
WILM’S TUMOR
Large homogeneous, echogenic mass right adrenal fossa, exerting
mass effect on the right hepatic lobe, and right renal parenchyma
which is not visualized.
HEPATO BILIARY SYSTEM
FATTY LIVER
AMOEBIC LIVER ABSCESS
Very early stage :
This may be termed as solid
abscess.
On ultrasound these lesions
are usually small. The
margins of the abscess may
be ill defined, the abscess is
hypoechoic as compared to
the surrounding liver.
However, there is no true
liquefaction at this stage and
therefore there is poor or no
posterior acoustic
enhancement. The
demarcation between the
abscess and the surrounding
liver is also poor
Recently formed amoebic abscesses :
On ultrasound as a
sonolucent or an hypoechoic
area usually with fine internal
echoes. Because of the
liquefaction, there is
associated posterior acoustic
enhancement. The cavity may
be round, oval or branching.
The walls of the abscess at
this stage are usually not
very thick and sometimes the
demarcation between the wall
and the surrounding tissue
can be poor. Sometimes the
walls may be thicker and
these may be seen as
shaggy, ill-defined echogenic
areas along the walls
Abscesses of some duration :
On sonography an
abscess shows thick
walls which may vary
from a few mm to 1.5
cm in thickness. The
echogenicity of the
abscess also varies,
abscesses generally
become more
sonolucent at this
stage, some abscesses
become more
echogenic because of
organisation of fluid
HEALING STAGE
The abscess heals, the liquid contents dry up,
which has been described as putty [Link]
ultrasound it is seen again as a lesion with thick
walls fairly echogenic as compared to surrounding
organs. This shadow can be seen on ultrasound for
a long time, even years. It is usually at this stage
that the differential diagnosis of a neoplasm,
haemangioma or granuloma inliver come into
picture.
Pyogenic liver abscess: Sonographic features. Longitudinal sonogram of
the liver shows bright reflectors within the abscess due to gas.
Liver abscess and pleural effusion
Pyogenic liver abscess: Sonographic features. Transverse sonogram of
the liver shows a complex, predominately hypoechoic mass with
posterior acoustic enhancement containing coarse, clumpy debris.
HEPATIC CYST
ELONGATED LEFT LOBE OF LIVER (THE BEAVER TAILED LIVER):
the left lobe of
liver appears
elongated (see
ultrasound
images above),
and overlies the
spleen. In the
above pictures,
the spleen is
seen to be
hyperechoic
compared to the
left lobe (the so
called "beaver
tailed liver").
LIVER FOR METASTATIC DISEASE
By ultrasound metastases to the liver usually take on one of
the following appearances:
(1) hypoechoic mass,
(2) mixed echogenicity mass,
(3) mass with target appearance,
(4) uniformly echogenic mass,
(5) cystic mass, or
(6) heterogeneous or "coarse" echo texture without focal mass
LIVER METASTASES:
These ultrasound images of the liver reveal multiple, focal, echogenic
mass lesions throughout the liver. The liver shows a nodular appearance.
associated pleural effusion
and ascites.
Diffuse infiltration of the liver by metastatic renal cell carcinoma.
Transverse image of the liver shows a heterogeneous echotexture with
diffusely increased echogenicity. This patient proved to have diffuse
metastatic renal cell carcinoma.
Ultrasound of the left lobe of the liver reveals a mass in the medial segment
that has a hypoechoic "halo" (arrows). The presence of a halo generally
indicates metastatic disease. The lesion proved to be a metastasis from
colon cancer
Ultrasound of the liver reveals multiple echogenic masses due to
metastatic breast cancer
Ultrasound of the liver shows a fluid-filled mass with a peripheral thin rim of
viable tumor (arrows). This lesion was a necrotic metastasis from colon cancer.
The irregular inner wall (open arrow) and internal echos (curved arrow) are clues
that the lesion is not a simple benign cyst.
Transabdominal
ultrasound shows a
mass (arrows) in the
right lobe. Note the
echogenic central
calcifications, which
cast an aocustic
shadow (open
arrow). Note the
lesion extends into
the inferior vena
cava (curved arrow).
Ultrasound-guided biopsy of necrotic metastasis from colon
cancer. Gray-scale image of the liver shows a primarily fluid-
filled metastasis from colon cancer.
Ultrasound of the right lobe of the liver reveals a uniformly
hypoechoic mass (arrow) that proved to represent lymphoma
GB MASS
HEPATIC HEMANGIOMAS
Ultrasound scan
RUPTURE OF THE UTERUS: pictures show a
rupture of the
anterior wall of the
lower uterine
segment of the
uterus. The
ultrasound scan
images also show
a large hematoma
of almost 5 cms.
between the
bladder and the
uterus. This
communicates
freely with the
uterine cavity
which also seems
to be filled with
fluid.
ACUTE CHOLECYSTITIS
Chronic Cholecystitis with Gallbladder Polyps
moderately dilated common bile duct without evidence of
choledocholithiasis.
CHOLEDOCHOLITHIASIS
URINARY BLADDER DIVERTICULA
Image through the long axis of the GB (GB) demonstrates the
gallbladder neck (red arrow). GB wall thickness is measured between
the gallbladder lumen and the hepatic parenchyma (red arrowheads)
LARGE NABOTHIAN CYSTS OF CERVIX
Transabdominal Ultrasound scan shows a clearly defined cystic lesions
in the cervix of the uterus.
ACUTE PANCREATITIS:
The pancreas appears swollen, edematous and hypoechoic.
CHRONIC PANCREATITIS
FATTY CHANGE OF THE PANCREAS
CALCIFICATION/ CALCULI IN PANCREAS:
PANCREATIC PSEUDOCYST
BILE DUCT DILATATION
FIBROID UTERUS
OVARIAN CYST
HYDROSALPINX
OVARIAN CYST
Cyst containing homogeneous debris consistent with an endometrioma
Crescent sign. There is normal ovarian tissue adjacent to a
benign cystic teratoma (between markers)
MULTILOCULATED CYST
POLY CYSTIC OVARY
Placenta Previa
placetal abruption
HYDATID CYST
HEMATOMETRA
A large amount of hypoechoic blood (clot) is seen within the uterus
UTERINE SYNECHIA
UTERINE SYNECHIA
HYDROCEPHALUS
INTRAUTERINE FETAL DEATH (IUFD):
ANENCEPHALY
Ultrasound findings of anencephaly. The cranial bones are
absent. Amniotic fluid is seen above the orbits
Myelomeningocele
Sagittal ultrasound image demonstrates the break in the skin line (arrow).
Transaxial ultrasound image shows the myelomeningocele sac (short
arrow) and divergent posterior ossification centers (long arrows).