2 Kidney Advantage over other modalities? What do you see normally? What can we diagnose?
3 AdvantagesEase with which the extent of the disease can be determined within the kidney for focal diseaseEase of assessment of renal pelvic or ureteral dilation when fluid distendedThe location and relevance of renal mineralization can also be assessedWhen radiographically ID focal renal pelvic or ureteral mineral opacities and the question of whether hydronephrosis is presentBiopsy or fine-needle aspiration can be expedited by ultrasonographic guidance, improving the margin of safety as well.
4 Normals Length in saggital plane Cortex Medullary Papillae Dog: variable with size of dogCat: 2.8 – 4.2 cmCortexIn dogs more bright than the liver, but less bright than spleenIn cats variable, may be equal brightness to that of liver and approach that of the spleenMedullary PapillaeThe renal medulla in dogs and cats is less echogenic than the cortex.Arcuate vesselsPelvic recessRenal vesselsRenal pelvisIf high resolution (7.5 – 10 MHz) transducer is usedThe echotexture (Brightness) consideration is important for assessing diseases that do not alter the kidney architecture (tubular necrosis, FIP)
6 PathologyDistensionDiuresis: bilaterally symmetrical and usually mildHydronephrosis: pelvic dilation may become very gross, with only a think rim of surrounding parenchymal tissue (idiopathic, or secondary to ureteric obstruction)Renal calculus: strongly reflective surface with distal acoustic shadowing also present.Chronic pyelonephritis: the pelvis may dilate while the diverticula remain smallRenal neoplasia: secondary dilation of the renal pelvis and proximal ureter, or mechanical obstruction of the pelvisEctopic ureter: due to stenosis of the ureter ending and/or ascending infectionRenal pelvic blood clot: following renal biopsy, coagulopathy, bleeding neoplasm, idiopathic renal hemorrhage, or trauma
20 Pathology Decreased corticomedullary definition End-stage kidneys Multiple small cysts
21 What can we diagnose? Infarcts Cysts/Abscess/Hematoma Renal calculus Big neoplasiaPelvic Dilation
22 Bladder Advantage over other modalities? What do you see normally? What can we diagnose?
23 Advantages Able to evaluate bladder wall thickness Able to visualize non-radiopaque stones/cyrstals (C U)Cystocentesis
24 NormalsBest when bladder moderately full Ovoid in shape, with slight elongation caudally at trigoneDon’t normally see uretersThree layers (∆ with size)Mucosa: HyperechoicMuscular: Hypo-Serosal: Hyper-Normal wall thickness (cat): 1.7 mm ± 0.56Normal wall thickness (dog): 1.6 mm
25 PathologyCalculiacoustic shadows are observed deep to calculi that exceed the diameter of the beam.echogenicity and acoustic shadow generation are independent of chemical composition (doesn’t matter struvite VS cystine)Ballottement doesn’t move calculi, but let animal stand and calculi will fall.Helps differentiate from mineralized bladder wall and colonic shadowing
27 Pathology Gas bubbles Blood clots Crystalline sediment Will float to the top, to differentiate from calculiBlood clotsnon-shadowingCrystalline sedimentVigorous ballottementSwirling pattern when standing
30 PathologyCystitisChronic cystitis results in diffuse thickening of the bladder wallbladder wall becomes abnormally hypoechoic, and the normal layering becomes less parallelnormal sonographic appearance of the bladder does not rule out the presence of mild or acute cystitis or idiopathic lower urinary tract disease in cats
32 PathologyNeoplasiaTCC: irregularly shaped, broad-based, hypoechoic masses protruding into the bladder lumenecho pattern depends on if if fibrosis, mineralization, and necrosis have developedAn abrupt transition often observed between neoplastic mass & adjacent bladder wall
34 PathologySonographic appearance of polypoid cystitis, adherent blood clots, and mural hematomas is similar to that of neoplasiaObservation of ureter dilation adjacent to the bladder wall mass & focal medial iliac lymphadenopathy tends to support the diagnosis of neoplasiaNeed aspirate, but must weigh that benefit against the possibility of seeding the needle tract with tumor cellsTraumatic catheterization is useful to retrieve cells from the mass
35 What can we diagnose?Crystalline sedimentCalculiBlood clots?Gas