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Simple Cysts
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Simple cysts: Pathogenesis of a simple cyst is not known. Simple renal cysts are common and may be located anywhere in the kidney.
Sonographic Appearance: Smooth, round borders, well-defined walls, and anechoic.
Image provided by: Philips
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Parapelvic Cysts
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Parapelvic cysts: is found in the renal hilum but does not communicate with the renal collecting system. The cyst can cause pain, hypertension, or obstruction.
Sonographic Appearance: Well defined mass with no septations, may have irregular borders.
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Von Hippel-Lindau Disease
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Von Hippel-Lindau Disease: is an autosomal-dominant genetic disorder. Pathologies include retinal angiomas, cerebellar hemangioblastomas, and a variety of abdominal cysts and tumors.
Sonographic Appearance: Bilateral cysts and masses, masses may develop within the cysts, and hyperplastic linings of cysts.
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Tuberous Sclerosis
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Tuberous Sclerosis: an autosomal-dominant genetic disorder that may cause multiple renal cysts or angiomyolipomas or cutaneous, retinal, and cerebral hamartomas.
Sonographic Appearance: Multiple angiomyolipomas or cysts.
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Acquired Cystic Disease of Dialysis
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Acquired Cystic Disease of Dialysis: patients on renal dialysis have been shown to have an increased incidence of renal cysts, adenomas, and renal carcinoma.
Sonographic Appearance: Found in cortex, normal or small echogenic kidneys with decreased in corticomedullary distinction with simple or atypical cysts.
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Adult Polycystic Disease
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Adult Polycystic Disease: may present with hypertension, renal failure, abdominal or flank pain, fever, chills, and uremia.
Sonographic Appearance: Bilateral enlarged kidneys with multiple cysts, loss of renal parenchyma, cysts may be found in the liver, spleen, testes, or pancreas.
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Infantile Polycystic Kidney Disease
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Infantile Polycystic Kidney Disease: may be seen in utero and presents with renal insufficiency and lung hypoplasia.
Sonographic Appearance: Bilateral enlarged echogenic kidneys, cysts are too small to be seen, and there is no distinction between the corticomedullary region.
Image provided by: www.TheFetus.net
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Multicystic Dysplastic Kidney
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Multicystic Dysplastic Kidney: a nonhereditary renal dysplasia that usually occurs unilaterally. It is the most common palpable abdominal mass in neonates.
Sonographic Appearance: Multiple cyst of varying size with no renal parenchyma surrounding the cyst; enlarged kidneys in children, small kidneys in adults.
Image provided by: thefetus.net
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Medullary Sponge Kidney
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Medullary Sponge Kidney: a rare, nonhereditary, benign renal disease found in children.
Sonographic Appearance: Normal or small kidneys with echogenic parenchyma, or small cysts in medulla and corticomedullary region with increased echogenicity.
Image provided by: GE
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Medullary Cystic Disease
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Medullary Cystic Disease (nephronopthisis): an autosomal-recessive disease characterized by salt-wasting nephropathy, presenting in young children.
Sonographic Appearance: Small echo-dense kidneys, tubular atrophy, and glomerular sclerosis; multiple small cysts under 2 cm.
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Renal Cell Carcinoma
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Renal Cell Carcinoma: the most common of all renal tumors which is twice as common in males as in females. The tumors tend to be multiple and bilateral. The incidence is increased with Von Hippel-Lindau and patients on long-term dialysis.
Sonographic Appearance: Hyperechoic, irregular margins, cystic or complex mass that may have areas of calcifications; may displace renal pyramids; renal vein or IVC thrombosis.
Image provided by: GE
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Transitional Cell Carcinoma
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Transitional Cell Carcinoma: is the most common tumor of the renal collecting system. The incidence is three to four times higher in males and increases with age.
Sonographic Appearance: May be multiple; not well-defined within the renal sinus; solid, hypoechoic mass.
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Renal Lymphoma
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Renal Lymphoma: a secondary process via either heamtogenous spread or contiguous spread from the retroperitoneum.
Sonographic Appearance: Enlarged kidney; hypoechoic mass, may be bilateral.
Image provided by: www.diagnostico.com.ar
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Wilm’s Tumor
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Wilm’s Tumor: the most common solid renal tumor of childhood. Wilm’s tumor is associated with Beckwith-Widemann syndrome, sporatic aniridia (no color in the eye), omphacele, and hemihypertrophy . Most patients present with a palpable abdominal mass.
Sonographic Appearance: A well defined, fairly homogenous, large mass with the pattern ranging from hypoechoic to moderately hyperechoic. These tumors can undergo necrosis, displaying central anechoic to cystic areas. The sonographer should scan the contralateral kidney and the liver for signs of metastasis.
Image provided by: GE
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Benign Renal Tumors
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Benign Renal Tumors: Adenomas and oncocytomas are two common benign renal tumors.
Sonographic Appearance: Adenoma can have calcifications, the oncocyomas resemble spoke whell patterns of
enhancement with a central star.
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Angiolipoma
Angiolipoma: an uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex. There may be hemorrhage in the tumor itself of in the subscapular or pernephric space.
Sonographic Appearance: A focal, solid hyperechoic mass.
Image provided by: GE
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Acute Glomerulonephritis
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Acute Glomerulonephritis: necrosis or proliferation of cellular elements (or both) occurs in the glomeruli. The vascular elements, tubules, and interstitium become secondarily affected; the end result is enlarged, poorly functioning kidneys.
Sonographic Appearance: Increased cortical echoes.
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Acute Interstitial Nephritis
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Acute Interstitial Nephritis: has been associated with infectious processes-scarlet fever and diphtheria. It may be a manifestation of an allergic reaction to certain drugs. Patient signs and symptoms include uremia, proteinuria, hematuria, rash, fever, and eosinophilia.
Sonographic Appearance: Enlarged and mottled kidneys with increased cortical echoes.
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Lupus Nephritis
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Lupus Nephritis: a connective tissue disorder believed to result from an abnormal immune system. The renal manifestations are hematuria, proteinuria, hypertension, renal vein thrombosis, and renal insufficiency.
Sonographic Appearance: Increased cortical echoes and renal atrophy.
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Acquired Immunodeficiency Syndrome
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Acquired Immunodeficiency Syndrome (AIDS): a highly contagious disease, mainly spread by sexual activity or sharing infected needles. Unexplained uremia or azotemia may indicate renal dysfunction resulting from AIDS.
Sonographic Appearance: An echogenic parenchymal pattern is present on ultrasound. Cortical echogenicity is increased. Kidneys are normal in size or enlarged.
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Sickle Cell Nephropathy
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Sickle Cell Nephropathy: abnormalities include glomerulonephritis, renal vein thrombosis, and papillary necrosis.
Sonographic Appearance: In acute renal vein thrombosis the kidneys are enlarged with decreased echogenicity secondary to edema. In patients with subacute cases, renal enlargement is present with increased cortical echoes.
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Hypertensive Nephropathy
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Hypertensive Nephropathy: uncontrolled hypertension can lead to progressive renal damage and azotemia.
Sonographic Appearance: Small kidneys with smooth borders; may have distortion of intrarenal anatomy.
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Papillary Necrosis
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Papillary Necrosis: many conditions can lead to papillary necrosis. Necrosis may develop within weeks or month after transplatation. Patients previously treated for rejection and those with cadaveric kidney are at greatest risk.
Sonographic Appearance: Fluid-filled spaces at the corticomedullary junction, round or triangular; mimics calculi.
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Renal Atrophy
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Renal Atrophy: results from numerous disease processes. Intrarenal anatomy is preserved with uniform loss of renal tissue.
Sonographic Appearance: Hydronephrosis, enlarged hypoechoic kidneys, and renal artery stenosis.
Image provided by:
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Acute Renal Failure
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Acute Renal Failure: may occur in prerenal, renal, or postrenal failure stages. The renal stages may be caused by parenchymal diseases (i.e., acute glomerulonephritis, acute interstitial nephritis, or acute tubular necrosis). This condition is usually the result o outflow obstruction and is potentially reversible.
Sonographic Appearance: Enlarged hypoechoic kidneys, renal artery stenosis, and hydronephrosis.
Image provided by: Philips
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Renal Artery Stenosis
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Renal Artery Stenosis: A stenosed renal artery.
Songraphic Appearance: Absence of blood flow.
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Hydronephosis
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Hydronephosis: is the separation of renal sinus echoes by interconnected fluid-filled areas. In patients with progressive obstruction the renal parenchyma is compressed.
Sonographic Appearance: Fluid-filled renal collecting system, thin parenchyma, hydroureter, and decreased or absent ureteral jets.
Image provided by: www.aloka.at
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Renal Infarction
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Renal Infarction: occurs when part of the tissue undergoes necrosis after the cessation of the blood supply, usually as a result of artery occlusion. Renal function is usually normal. This may result from thrombus, tumor infiltration, or obstruction.
Sonographic Appearance: Lobulated renal contour, with irregular triangular masses in the renal parenchyma.
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Acute Tubular Necrosis
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Acute Tubular Necrosis: is the most common medical renal disease to produce acute renal failure, it can be reversible.
Sonographic Appearance: Bilaterally enlarged kidneys with hyperechoic pyramids. As renal function improves, the echogenicity decreases. It can occur in the cortex or the medulla.
Image provided by: SRS-X (www.radiology.co.uk/srs-x)
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Pyonephrosis
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Pyonephrosis: occurs when pus is found within the obstructed renal system. It is often associated with severe urosepsis and represents a true urologic emergency that requires urgent percutaneous drainage.
Sonographic Appearance: Dilated collecting system with low level echoes or decreased through transmission.
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Xanthogranulomatous Pyelonephritis
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Xanthogranulomatous Pyelonephritis: an uncommon disease associated with chronic obstruction and infection. In involves destruction of renal parenchyma and infiltration of lipid-laden histiocytes. The disease is more common in females and is poorly understood.
Sonographic Appearance: “Staghorn appearance”, destruction of renal parenchyma, increased echogenicity, increased renal size, and dilated calyces.
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Nephrocalcinosis
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Nephrocalcinosis: the patient may present with fever, this may indicate infection with hydronephrosis.
Sonographic Appearance: This disease shows very echogenic pyramids with or without associated shadowing. Renal stones are very echogenic with shadowing posteriorly.
Image provided by: Sononino
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Horseshoe Kidney
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Horseshoe Kidney: Occurs when the kidneys remain joined by a band of fibrous or renal tissue. Usually it occurs at the lower poles.
Sonographic Appearance: Normal echogenicity, ill defined or abnormal appearance of the lower poles
Image provided by: Sononino
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Transplant Kidney
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Transplant Kidney: Kidney was transplanted.
Sonographic Appearance: Renal parenchyma should maintain the same echogenicity. Doppler of the artery and veins, and checking for signs of rejection.
Image provided by: Philips
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Nephrolithiasis
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Nephrolithiasis: Stones in the kidney.
Sonographic Appearance: Hyperechoic foci in the kidney that produce acoustic shadowing.
Image provided by: Medison
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Kidney Cancer
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Kidney Cancer: cancer of the kidney.
Sonographic Appearance: The appearance ranges from hypoechoic, to hyperechoic, to complex. The tumors can cause renal obstruction.
Image provided by: Medison
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