Table : US Characteristics of Normal Kidneys

Feature Normal Characteristic Size Length: Adult: 9-13 cm (decreases with age) Male: 11.4 cm median length Female: 10.9 cm median length Volume: (length × width × height × 0.52) Adult: Male: range: 109-194 mL 151 mL median volume Female: range: 91-151 mL 122 mL median volume Parenchymal thickness: Normal >10 mm Echogenicity of cortex Adult: renal parenchyma echogenicity equal to, or slightly less than, normal liver parenchyma Neonate: renal parenchyma echogenicity usually greater than normal liver parenchyma Echogenicity of medulla Adult: slightly less than renal cortex Neonate: much less than renal cortex Surface Smooth, well-defined, slightly lobulated with V-shaped notches between lobes Peak systolic velocity in main renal artery Normal <180> Renal/aortic velocity ratio Normal <3.5 Resistive index–intrarenal arteries and main renal artery Adult: Normal <0.70>0.70 Systolic rise time (time to early systolic peak) in main renal artery

Normal Newborn Infant Kidney. Longitudinal view of the normal right kidney (between cursors, +, x) of a newborn infant demonstrates echogenicity of the cortex to be slightly greater than the echogenicity of the liver (L). The medulla (arrows) is significantly less echogenic.

http://www.msdlatinamerica.com/ebooks/CoreCurriculumTheUltrasound/sid140237.html

Normal Adult Kidney. The renal cortex (short arrow) is equal in echogenicity to the liver parenchyma (l). The renal pyramids (long arrow) are slightly hypoechoic compared to the renal cortex. The septal cortex extends between the medullary pyramids. The central renal sinus (s) is invested with echogenic fat. The contour of the kidney is sharply defined by fat in the perirenal space. The length of the kidney is measured between cursors (+).

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The above B-mode ultrasound image (upper) and Color Doppler image (lower) show a cystic lesion involving the collecting system (middle calyx) of the right kidney. This suggests a calyceal diverticulum /calyceal cyst of the right kidney. The walls of the cystic lesion are thin but irregular and possibly communicate with the renal pelvis. Again, in this case too, the cyst appears to displace blood vessels which surround the lesion.

http://www.radswiki.net/main/index.php?title=Calyceal_diverticulum

Autosomal Dominant Polycystic Kidney Disease (ADPKD) Complications: Berry Aneurysm on CT Scan, Diverticulitis on BE

Findings

• The CT demonstrates a berry aneurysm off the Circle of Willis.
• The BE demonstrates diverticulosis of the sigmoid with eccentric mass effect due to an intramural diverticular abscess i.e. diverticulitis.

Discussion

ADPKD is one of three major inherited cystic diseases of the kidney. The kidneys become markedly enlarged with cysts. These distort the calyces and renal outline and cause mass effect on surrounding organs. The kidneys are abnormal and frequently show dystrophic calcifications. The liver and pancreas frequently contain cysts. There is an increased incidence of diverticular disease of the colon. There is an increased incidence of cerebral artery aneurysms.

Kartagener's Syndrome with Situs Inversus on CXR and CT Scan

Findings
-The CXR demonstrates situs inversus with dextrocardia, right sided aorta, right gastric air bubble, left sided liver, and bronchiectasis. The CT confirms the dextrocardia and bronchiectasis.
-DiscussionKartagener’s syndrome is an autosomal recessive genetic disorder, which presents with a combination of situs inversus, chronic sinusitis, and bronchiectasis. There is an underlying abnormality in ciliary motility.

- The contrast enhanced CTs demonstrate low attenuation ascites around the liver and spleen due to extravasated urine.
-There is high attenuation contrast extravasation leaking from the bladder.

Bladder ruptures are usually classified as intraperitoneal versus extraperitoneal. An intraperitoneal rupture is caused by extreme pressure on a full bladder. The rupture occurs at the dome of the bladder, through the peritoneum, into the peritoneal cavity. An intraperitoneal rupture is more common in children because of the relative intra-abdominal position of the bladder. An extraperitoneal rupture is usually associated with fractures of the bony pelvis.


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There is an air-fluid level evident in the large sliding esophageal hiatus hernia.


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Glass Shards in the GI Tract

Patient 1: This patient presents with radiopaque densities in the descending colon on abdominal plain film and axial CT scan. This patient swallowed shattered glass.
Patient 2: This patient presents with radiopaque densities in the ascending, transverse, and descending colon on abdominal plain film. This patient swallowed fragments of a glass lightbulb.

Discussion
Psych patients and/or prison inmates may purposefully swallow foreign bodies. Not all glass is radiopaque. It is the lead in older glass that makes it radiopaque. If there is a high clinical suspicion for swallowed glass, and no glass is visible on abdominal plain film, a gastrograffin GI study may be helpful. Barium should not be used due to the possibility of the glass causing GI tract perforation.


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Gallstone Ileus on CT Scans

-This CT demonstrates the classic Rigler’s Triad of gallstone ileus: Pneumobilia (air in the biliary tract), low small bowel obstruction with distended small bowel loops, and an impacted gallstone in the terminal ileum.
-Discussion
Gallstone ileus is the name given to the mechanical small bowel obstruction caused by a gallstone impacting in the terminal ileum. The gallstone passes through a cholecystoduodenal fistula, travels the length of the small bowel, and then obstructs just proximal to the ileocecal valve. It is an unusual complication of cholecystolithiasis and chronic cholecystitis.


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Pneumoperitoneum

-The CXR demonstrates crescentic lucent air collections below both hemidiaphragms. This is the classic appearance for free peritoneal air on upright views.
-Note that the air outlines the inferior border of the diaphragms and the superior border of the liver.


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Diverticulitis of the Sigmoid Colon with Fat Stranding on CT Scan

Findings
There are diverticula and thickening of the walls of the sigmoid colon with significant surrounding fat stranding.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Diverticulitis of the Sigmoid Colon with Extraluminal Air on CT Scan

Findings
There are diverticula and thickening of the walls of the sigmoid colon with an adjacent extraluminal air pocket suggestive of local perforation and/or abscess formation.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Diverticulitis of the Sigmoid Colon with Colovesical Fistula on CT Scans

Findings
-The sigmoid shows diverticula and is attached to the dome of the bladder.
-A fistulous tract is seen filled with air and contrast between the sigmoid and the bladder.
-There is air and colonic contrast within the bladder lumen.

Discussion
A fistula between the bladder and colon may occur due to a number of diseases, most notably colon cancer, bladder cancer, Crohn’s disease, and diverticulitis. CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Findings
There are diverticula and thickening of the walls of the sigmoid colon compatible with uncomplicated diverticulitis. Notice the absence of surrounding fat stranding.

Discussion
CT stages diverticulitis from Stage 0 through Stage IV depending on surrounding involvement and severity. Stage 0 shows only minor local colonic wall involvement and may be treated conservatively with antibiotics. The other stages usually necessitate surgical intervention. Stages I and II show contiguous spread of inflammation outside of the colon. Stages III and IV show peritoneal involvement with distant abscesses, ascites, through to frank peritonitis.


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Findings
-This patient presents with an abnormal position of a nasogastric tube (NGT) overlying the left hemithorax.
-This patient demonstrates normally located chest tube and endotrachial tube (ETT).

Discussion
This patient suffered a rupture of the left hemidiaphragm secondary to a motor vehicle accident. The NGT is correctly placed in the stomach, but the stomach is now located in the left chest.


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Bowel Wall Hemorrhage and Obstruction from Coumadin Overdose on CT Scans

Findings
-The proximal small bowel is enlarged with high-density intramural thickening and regularly thickened folds.
-The stomach is dilated with normal wall thickness. The distal small bowel is normal in caliber.

Discussion
This patient overdosed on coumadin and the findings are due to a mural hemorrhage in the duodenum and proximal jejunum causing partial gastric outlet obstruction.


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Bowel Ischemia with Pneumatosis Coli and Portal Venous Gas on CT scans

Findings
-The contrast enhanced CTs show air in the bowel wall and portal venous system, which is classic for bowel ischemia and necrosis.
-Note that some of the gas collections remain in the dependent portion of the bowel i.e. they are not intralumenal, but are trapped in the bowel wall.

Discussion
Interruption of blood flow to the bowel can result in bowel ischemia and necrosis. The CT findings include air in the bowel wall aka pneumatosis coli, mesenteric or portal venous gas, lack of bowel wall enhancement, increased enhancement of the thickened bowel wall, and/or bowel obstruction.


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There is loss of the normal mucosal outline to the large bowel, with an irregular margin and no visible haustral markings, indicating mucosal inflammation and oedema. There is marked dilatation of the large bowel, from the caecum on the right to a loop of sigmoid seen centrally in the pelvis. The appearances and the extent thus indicate a pancolitis. The transverse colon measures more than 5.5cm across, which in the presence of colitis indicates a toxic megacolon, with the risk of imminent perforation.

dilatation of the COLON, often to alarming dimensions. There are various types of megacolon including congenital megacolon in HIRSCHSPRUNG DISEASE, idiopathic megacolon in constipation, and TOXIC MEGACOLON.


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