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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…