초음파 자격증 ARDMS abdomen KIDNEY2편

■ renal infection ■

1. acute pyelonephritis[급성신우신염]

 

this type of infection is referred to as an ascending infection

the infection begins in the bladder and refluces up

through the ureters and into the kidney.

 

임상적 증상

1. flank pain 2. bacteriuria 3. pyuria 4. leukocytosis

5. dysuria 6. urinary frequency

 

초음파적 증상

1. may appear normal 2. renal enlargement

3. focal areas of altered echotexture 4. compression of the renal sinus

 

2. pyonephrosis(고름 콩팥증)

 

pyonephrosis describes the condition of having pus,

also referred to as purulent material,

within the collecting system of the kidney.

 

임상적 증상

1. pyuria 2. bacteriuria 3. fever 4. flank pain 5. leukocytosis

 

초음파적 증상

1. hydronephrosis

2. pus and debris appear as internal, layering, and low-level echoes within the dilated collecting system

 

3. chronic pyelonephritis(만성 신우신염)

 

recurrent kidney infections or chronic obstruction may

lead to scarring of the calices and renal pelvis. chronic pyelonephritis

can lead to xanthogranulomatous pyelonephritis and end-stage renal disease.

children with a history of vesicoureteral reflux(VUR)

are at increased risk for developing chronic pyelonephritis.

 

임상적 증상

1. flank pain 2. bacteriuria 3. pyuria 4. leulocytosis 5. dysuria

6. urinary frequency 7. history of VUR

 

초음파적 증상

1. small, echogenic kidneys that have loculated borders

2. renal scar appears as an echogenic area within

the kidney that extends form the renal sinus

through the renal parenchyma

 

* a renal scar will appear as an echogenic area that extends

from the renal sinus through the renal parenchyma.

 

4. emphysematous pyelonephritis(기종성 신우신엽)

 

a rare, and yet life-threatening, complication of pyelonephritis is emphysematous pyelonephritis. although emohysematous pyelinephritis may be the result of a long-standing urinary tract obstruction, it is found more often in patients who have diabetes mellitus or who are immunocompromised.

임상적 증상

1. 당뇨 2. immuncompromised patient(면역력이 약한) 3. fever

4. flank pain 5. leukocytosis

 

초음파적 증상

1. gas or air within the renal parenchyma

2. dirty shadowing or reverberation artifact coming from the renal parenchyma

 

5. xanthogranulomatous pyelonephritis(황색육아종신우신엽)

 

xanthogranulomatous pyelonephritis is uncommon and

is typically caused by a chronic urinary tract obstruction.

 

임상적 증상

1. dull(둔통) or persistent flank pain 2. pyuria 3. hematuria

4. fever 5. leukocytosis

 

초음파적 증상

1. hydronephrosis 2. staghorn calculus 3. perinephric fluid collectiion

 

 

6. glomerulonephritis(사구체 신염)

glomerulonephritis can be caused by a distant infection

such as strep throat, or an autoimmune reaction.

 

임상적 증상

1. recent throat infection(acute) 2. smoky urine 3. hematuria

4, proteinuria 5. fever 6. hypertension 7. azotemia(질소혈증)

 

초음파적 증상

1. enlarged kidney(s) with increased echogenicity

2. prominent renal pyramids

 

■ urinary tract obstruction and stones ■

1. hydronephrosis and renal obstruction

내적 원인

urolithiasis congenital abnormality (vesicoureteral reflux, posterror urethral valves, and ureterovesicular junction obstruction) hematoma(blood clot) neoplasm(신생물 종양) ureteropelvic junction obstruction or ureteral stricture ureterocele(요관낭종)

외적 요인

benigne prostatic hypertrophy neurogenic bladder pelvic masses(uterine leiomyoma, ovarian masses, tubo-ovarian abscess, and bowel masses) pregnancy retroperitoneal fibrosis(후복막 섬유화증) surgery trauma urethritis(요도염)

 

2. urolithiasis(요로 결석증)

 

urolithiasis are kidney stones located anywhere within the urinary tract.

stones within the kidney may be referred to as renal calculi,

kidney stones, renal stones, or nephrolithiasis.

the most common location for a stone to become lodged

in the urinary tract is the ureterovesicular junction, near the urinary bladder.

the sonographic “twinkle sign” or “twinkle artifact” will be noted

as an increased color doppler signal posterior to a kidney stone.

 

임상적 증상

1. hematuria 2. renal colic 3. oliguria(핍뇨) 4. urinary tract infection

 

3. nephrocalcinosis(신석회증) and medullary sponge kidney(수질 해면 신장)

 

nephrocalcinosis is an accumulation of calcium within

the renal parenchyma. there are two forms of nephrocalcinosis

defined by their location:

medullary nephrocalcinosis and cortical nephrocalcinosis.

although medullary nephrocalcinosis is commonly caused

by hyperparathyroidism and associated with hypercalcemia,

it may also be caused by a congenital defect known as

medullary sponge kidney.

medullary sponge kidney is the accumulation of calcium within abnormally

dilated collecting ducts located within the medulla.

clinically, patients with medullary sponge kidney may be asymptomatic

or can have signs of infection and a history of urinary calculi.

 

임상적 증상

1. hypercalcemia(고칼슘혈증)

2. hyperparathyroidism(부갑상선 기능항진증)

3. urinary tract infection

 

 

초음파적 증상

1. medullary nephrocalcinosis - echogenic renal pyramids - medullary sponge kidney

2. cortical nephrocalcinosis – echogenic foci within the cortex

■ benign masses of the kidney ■

1. angiomyolipoma

 

the angiomyplipoma is the most common benign renal tumor.

 

임상적 증상

1. asymptomatic in most individuals

2. patient may have a history of tuberous sclerosis

3. pain, hematuria, and hypertension can occur with hemorrhage of the mass

 

초음파적 특징

1. solid, hyperehoic mass

2. may produce acoustic shadowing

3. tend to be multiple and bilateral with tuberous sclerosis

 

 

2. oncocytoma(호산성 과립세포종)- contain a central scar

 

the oncocytoma is a benign renal tumor that is often found on men on

their 60s and is the second most common renal mass after the angiomyolipoma.

an oncocytoa is often asymptomatic but may produce pain or hematuria.

a stellate(star-shaped) central scar may be noted within an oncocytoma.

this scar results from a previous infarction within an oncocytoma.

 

임상적 증상

1. asymptomatic 2. may produce pain or hematuria

 

3. renal hemangioma

 

like benign hemangiomas found elsewhere in the body,

the renal hemangioma consists of a mass of blood vessels.

they are most often asymptomatic and are encountered during the third or fourth decade of life.

like other solid small hyperechoic mass on the kidney.

like other solid tumors of the kidney, a hemangioma may mimic RCC,

and therefore further imaging, surgical intervention, or a biopsy may be performed.

 

임상적 증상

1. asymptomatic

2. hemorrhage of the mass can lead to pain and hematuria

 

초음파적 특징

1. small, hyperechoic mass

 

4. trauma and renal hematoma(외상, 신장 혈종)

 

hematomas are localized collections of blood. a renal hematoma may

be the result of blunt trauma to the kidney region,

surgical intervention or biopsy, and lithotripsy.

 

임상적 증상

1. history of some form of trauma to the kidney(s)

(blunt trauma, stab wound, biopsy, or lithotripsy)

2. flank pain 3. abdominal pain 4. hematuria

5. decreased hematocrit

 

초음파적 특징

1. variable appearance depending on the stage of the blood an location

2. blood may accumulate under the capsule (subcapsular),

in the perinephric are(in fascia), pararenal are(anterior or posterior),

or intramuscular(in the psoas muscle)

3. chronic hematomas may calcify and produce acoustic shadowing

 

■ malignant renal masses ■

1. renal cell carcinoma

RCC may also be referred to as a hypernephroma or adenocarcinoma of the kidney.

it is a primary form of renal cancer, meaning this form of cancer begins in the kidney,

specifically originating from the renal tubular epithelium.

 

임상적 증상

1. anorexia 2. flank pain 3. gross hematuria

4, hypertension 5. palpable mass 6. smoker 7. weight loss

 

초음파적 특징

1. hypoechoic, isoechoic, or hyperechoic solid mass on the kidney

2. can have a complex cystic appearance as well

3. check the renal vein and IVC for tumor invasion

 

2. renal transitional cell carcinoma(이행세포암종)

 

TCC of the kidney is a malignant tumor

that is most often found in the area of the renal pelvis.

TCC can cause focal dilation of the calices,

and small lesions can be difficult to identify with sonography.

 

임상적 증상

1. gross hematuria 2. pain secondary to renal obstruction

3. history of smoking