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Renal Stones

KEY FACTS Terminology Definition: Concretion in urinary system Imaging Most stones seen in kidneys & upper urinary tract Range in size from 1-2 mm to > 1 cm NECT most sensitive modality to detect stones Calcified density in urinary system Ultrasound shows hyperechoic urinary tract focus with posterior acoustic shadowing &/or twinkle artifact Signs of obstruction (US/CT/MR) Hydroureteronephrosis Nephromegaly Perinephric/periureteral edema Lack of ureteral jet in…

Pyelonephritis

KEY FACTS Terminology Acute infection of renal parenchyma; often difficult to clinically distinguish from lower UTI Imaging Imaging work-up of UTI controversial See professional society guidelines With pyelonephritis, marked inflammatory response to renal parenchymal infection causes swelling that alters normal tissue properties & effectively ↓ radiologic contrast agent delivery to site, which results in ↓ uptake on nuclear cortical scan ↓ perfusion on Doppler imaging with…

Wilms Tumor

KEY FACTS Imaging Ultrasound frequently 1st study performed; CECT & MR better characterize tumor & local extent Large, heterogeneous but predominantly solid hypoechoic (US)/hypoenhancing (CT/MR) renal mass Must carefully evaluate – Adjacent soft tissues for tumor rupture, adenopathy – Renal vein & inferior vena cava for tumor thrombus – Contralateral kidney for synchronous tumor or nephrogenic rests Chest radiograph or CT: Lung metastases in 10-20% Top…

Vesicoureteral Reflux

KEY FACTS Terminology Retrograde flow of urine from bladder toward 1 or both kidneys Imaging International Reflux Study Committee grading system of vesicoureteral reflux (VUR) I: Reflux into ureter but not reaching renal pelvis II: Reflux reaching pelvis without blunting of calyces III: Mild calyceal blunting IV: Progressive calyceal & ureteral dilation V: Very dilated & tortuous collecting system ± intrarenal reflux as modifier to grade…

Ureteropelvic Junction Obstruction

KEY FACTS Imaging Marked pelvocaliectasis that ends abruptly at ureteropelvic junction (UPJ) with normal caliber ureter downstream Dilated calyces relatively uniform in size & distribution; all connect centrally to disproportionately dilated pelvis Thinned but otherwise intact renal parenchyma Severity of delayed nephrogram, excretion, & collecting system drainage (on IVP, CECT, MRU, or nuclear renal scan) depends on degree of obstruction Contrast entering dilated collecting system (by…

Approach to Pediatric Genitourinary Tract

Genitourinary Tract Imaging Modalities Radiographs Plain radiographs are rarely utilized in the evaluation of the pediatric GU tract due to their low sensitivity for GU pathology. Associated pathologic calcifications may be incidentally detected, including urinary tract calculi, teratomas (which may resemble a tooth), & remote adrenal hemorrhages. Ultrasound is typically the next step in each of these scenarios. You’re Reading a Preview Become a Clinical Tree…