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The Genitourinary Tract


THE KIDNEYS

FIGURE 13-1, Apparent absence of one psoas muscle. This finding is seen in many normal individuals and is not necessarily of significance.

FIGURE 13-2, Low-lying left kidney. The left kidney lies at a level lower than the right in 5% of normal individuals. Therefore this finding is not necessarily indicative of displacement.

FIGURE 13-3, Unusual configuration of the right kidney produced by rotation on its axis. This finding was proven by CT scan.

FIGURE 13-4, Costophrenic sulcus and the edge of the lung producing an unusual appearance in the nephrogram of the right kidney.

FIGURE 13-5, Splenic impression (←) on the left kidney that produces a “bump” in its midportion.

FIGURE 13-6, Hepatic impression (←) on the right kidney that produces a “bump” in its midportion ( ). A, Urogram. B, Angiogram.

FIGURE 13-7, Fetal lobulation of the kidneys.

FIGURE 13-8, Nonsignificant variation in the outline of the right kidney.

FIGURE 13-9, Two examples of the dromedary left kidney, an anatomic variation that simulates a mass lesion.

FIGURE 13-10, Gastric fundus simulating a suprarenal mass. A, Before ingestion of barium. B, After ingestion of barium.

FIGURE 13-11, Two examples of spurious suprarenal masses produced by the duodenal bulb. Left, Fluid- and air-filled. Right, fluid-filled.

FIGURE 13-12, Two examples of renal pseudotumors produced by the spleen.

FIGURE 13-13, Pelvic kidney.

FIGURE 13-14, Ptotic right kidney. Note the configuration of its collecting system and its position in the lateral projection.

FIGURE 13-15, Variations in renal outline of the right kidney with respiration. A, Expiration. B, Inspiration.

FIGURE 13-16, Anterior displacement and rotation of the kidneys by retroperitoneal fat. A, Year 1: Normal appearance of kidneys. B, Year 9: The contour of the right kidney has altered and appears shorter in its vertical dimensions. C, CT scan shows anterior displacement of the right kidney by fat.

FIGURE 13-17, Duplication variant producing a discrepancy in renal size. The left kidney is duplex and is distinctly larger than the right. A, Plain film. B, Urogram.

FIGURE 13-18, A, Costal cartilage calcification simulating renal calculi. B, Calcification is obscured by the contrast material on the urogram.

FIGURE 13-19, Multiplicity of calyces. This is an atavistic variant that may be mistaken for a disease state.

FIGURE 13-20, Unicalyx kidney. Another atavistic variant, it represents the normal arrangement in monkeys, dogs, and rabbits.

FIGURE 13-21, Megacalyces of the left kidney. This variant is often unilateral and represents a malformation of the renal papillae. The cortex is normal, but the medulla is hypoplastic. The dilated calyces and reduced parenchymal thickness resemble obstructive hydronephrosis or postobstructive atrophy.

FIGURE 13-22, A, Megacalyces of the right kidney. B, Detailed view of the right kidney.

FIGURE 13-23, Bilateral megacalyces. This condition may be genetically transmitted.

FIGURE 13-24, Two examples of extrarenal collecting systems. The clawlike configuration of the infundibula, best seen in the right kidney in A, is characteristic of this variation in development. Fifty percent of affected individuals have associated renal disease. B, Bilateral extrarenal collecting systems.

FIGURE 13-25, Miniature calyx. Tubular blush, produced by contrast material in the collecting tubules, is seen as a halo around this calyx.

FIGURE 13-26, Accessory calyx arising from the lower calyceal group.

FIGURE 13-27, Small calyceal diverticulum.

FIGURE 13-28, Calyceal diverticulum. Left, Early filling. Right, Late filling.

FIGURE 13-29, Calyx seen on end, simulating a filling defect.

FIGURE 13-30, Aberrant renal papilla entering the infundibulum of the lower pole.

FIGURE 13-31, Aberrant renal papilla entering the renal pelvis. This variant may be associated with hematuria.

FIGURE 13-32, Another example of an aberrant renal papilla entering the renal pelvis.

FIGURE 13-33, Flat upper pole calyceal groups that might be mistaken for distortion by an adjacent mass.

FIGURE 13-34, Composite upper pole calyces.

FIGURE 13-35, Large composite upper pole calyceal groups.

FIGURE 13-36, A, B, Mucosal folds seen within calyces and infundibula. C, Tomogram of left kidney shows the folds in the superior calyx. These folds do not indicate abnormality.

FIGURE 13-37, A, Incomplete filling of the calyces and infundibula may simulate a mass lesion. B, With adequate filling, the mass effect is no longer seen.

FIGURE 13-38, Bulge in the suprahilar region of the right kidney representing the hilar lip or renal uncus. A, Urogram. B, Nephrotomogram.

FIGURE 13-39, Deformity of the collecting system caused by excessive invagination of the cortical tissue in forming Bertin's columns. This entity is often found in cases with duplications of the collecting system and may simulate a neoplasm. A, Plain film. B, Arteriogram. C, Nephrogram.

FIGURE 13-40, A, Additional example of the deformity of the collecting system caused by Bertin's columns. B, Nephrogram.

FIGURE 13-41, Renal pelvic lipomatosis. The deposition of large amounts of normal fat in the renal pelvis produces radiolucency, stretching, and elongation of the infundibula, best seen in the right kidney (←). On occasion it may resemble the changes of polycystic disease as seen in the left kidney ( ).

FIGURE 13-42, Backflow. A, Pyelovenous. B, Pyelolymphatic. C, Pyelotubular. D, Tubular blush produced by contrast material in the collecting tubules of the renal papillae. This should not be mistaken for the tubular ectasia of the medullary sponge kidney.

FIGURE 13-43, Accessory renal hilus. Left, Nephrogram shows a defect in the superior pole of the kidney (←). Right, Renal angiogram shows a renal artery entering the kidney at the area of the defect. A separate renal artery supplies the remainder of the kidney.

FIGURE 13-44, Two examples of vascular impressions on the renal pelvis. Most such impressions are not clinically important.

FIGURE 13-45, Four additional examples of vascular impressions on the collecting systems.

FIGURE 13-46, Tortuous infundibulum.

FIGURE 13-47, Unusual bifid collecting system.

FIGURE 13-48, Abortive duplication of the renal pelvis.

FIGURE 13-49, Two examples of extrarenal pelves that simulate the changes of hydronephrosis. A, Bilateral extrarenal pelves. B, Duplicated extrarenal pelvis of the right kidney only.

FIGURE 13-50, Very large extrarenal pelves.

FIGURE 13-51, A, Simulated hydronephrosis produced by massive distention of the bladder (←). B, Appearance after bladder emptying.

FIGURE 13-52, “Yo-yo” effect (saddle reflux) of pelvic emptying in duplex kidneys. A, The upper segment of the right kidney is emptying, and the lower segment filling. B, The lower segment contracts, and the upper segment fills by reflux. These are normal dynamics in duplex kidneys. The transient distention of the upper segment could be misinterpreted as pathologic dilatation.

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