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Vascular sonography
Test 4 Abdominal Doppler-Renal
| Question | Answer |
|---|---|
| Kidneys are what type of organs? | Retroperitoneal organs, which means behind the peritoneum |
| Where are the kidneys located? | Between the 12th thoracic and 3rd lumbarvertebrae |
| The right kidney is what to the left? | Right INFERIOR to the left |
| Kidney length and width is what? | Length is 9-13cm, Width is 5-7cm (may ↓ with age) |
| What is the Renal Hilum? | The area through which the renal artery, vein, and ureter enter the kidney |
| What is the Renal Sinus? | The cavity which contains the renal artery and veins and collecting system |
| How does the Renal Sinus appear? | Appears brightly echogenic on sonographic imaging (mostly fat, fibrous tissue) |
| What is the Renal Parenchyma Medulla? | Contains 12-18 renal pyramids (triangular shaped) |
| What is the Renal Parenchyma Cortex? | Outermost area of the kidney (lies just beneath the renal capsule) |
| What is also known as the Columns of Bertin? | Some cortical tissues extends between medullary pyramids |
| Where do the Renal arteries usually arise from? | Lateral or posterolateral from the abdominal aorta |
| The Left Renal Artery is usually more ___ than right? | Left artery more SUPERIOR than Right |
| The right Renal Artery courses ____ to the IVC & right Renal Vein | right Renal Artery courses POSTERIOR to the IVC a& Right Renal Vein |
| After entering the Renal Hilum the Renal arteries do what? | Renal Arteries divides into segmental branches that give rise to interlobar,arcuate, and interlobar arteries within parenchyma |
| Where do the Renal Veins course? | Course ANTERIOR in renal hilum |
| Where does the renal artery lie? | Between the renal vein and ureter |
| The Right Renal Vein has a short course from where? | Short course from the kidney to the IVC |
| The Left Renal Vein courses where? | ANTERIOR to the aorta just below the SMA, it has a much longer course than the right |
| How many people are estimated to be affected by Renovascular HTN? | 50,000,000 people in the United States |
| Up to ___% of hypertensive patients have underlying renal disease? | 6% of hypertensive patients have underlying renal disease |
| In severe diastolic hypertension patients, up to ___% are related to renal artery stenosis? | 40% are related to renal artery stenosis |
| Renal artery stenosis should be suspected with what? | Sudden onset or worsening of chronic HTN, Unexplained renal insufficiency, Hypertensive children |
| Duplex ultrasound is used to detect renal artery stenosis by doing what? | Providing anatomical as well as hemodynamic functional information, and it is low cost without risk of ionizing radiation or use or nephrotoxic contrast agents |
| Etiology of renal artery disease- Atherosclerosis facts | Most common, Lesions often affect origin & prox 3rd of vessel, More common in men than women, Bilateral 30% of the time |
| What are the risk factors for Atherosclerosis? | Age, Hypertension, Smoking, Diabetes,Hyperlipidemia, Past HX of CAD &/or PAD |
| What does CAD stand for? | Coronary arterial disease |
| What does PAD stand for? | Peripheral arterial disease |
| Etiology of Renal Artery Disease- Medial Fibromuscular Dysplasia facts | Second most common cause of renovascular disease, Nonatherosclerotic disease affects mid-to-distal segment of vessel, Occurs more commonly in women aged 25-50 years, Often bilateral, Produces "string of beads" appearance on ultrasound or angiogram |
| What are some other less common disease processes that can impact renal artery include? | Aortic dissection, Aneurysms of main or segmental renal arteries, Aortic coarc Prox to renal arteries, Arteriovenous fistulae, Arteritis, Extrinsic compression by tumor or other mass |
| What probe is used for a Renal scan? | 2-5 MHz TD |
| What can grey scale be used for when doing a renal scan? | Used to localize vessels and organs, and identify atherosclerotic plaque, aneurysmal dilation, and dissection |
| What can color flow and power doppler be used for when doing a renal scan? | To help visualize arteries and veins, and regions of disordered flow, and vessel occlusion |
| Renal arteries lie INFERIOR to that what? | Left renal vein |
| What should the kidney be examined for? | Cortical thinning, renal calculi, masses, cysts, or hydronephrosis |
| What is the normal renal length? | 9-13 cm |
| A renal length of >2-3 cm compared to the contralateral kidney indicates what? | Compromised flow in the smaller kidney |
| How is the renal size measured? | Pole-to-pole, Accuracy is enhanced by averaging 3 separate measurements |
| Abdominal Aorta adjacent to renal level normal findings include what? | Anechoic lumens with smooth arterial walls |
| What will spectral doppler of the proximal aorta show? | Rapid systolic upstroke, sharp systolic peak, and forward diastolic flow |
| What is the normal PSV for an abdominal aorta adjacent to renal level? | Between 60 & 100 cm/s |
| Distalto renal arteries, aortic waveform has a what waveform? | A slightly lower velocity and more triphasic flow pattern |
| What should you identify in the abdominal aorta? | Any areas of aneurysm dilation, dissection, &/or atherosclerotic plaque |
| What will a normal renal artery look like? | Anechoic lumen with smooth walls |
| What will spectral doppler demonstrate with a normal renal artery? | Rapid systolic upstroke with slightly blunted peak, Early systolic peak often seen on upstroke to systole, Forward diastolic flow, with a PSV = 90-120 cm/s |
| EDV exceeds _____ of PSV value? | 1/3 of PSV value |
| PSV and EDV ________ throughout the length of the artery and into parenchyma | decreases |
| Renal artery stenosis of less than hemodynamic significance facts | Represents < 60% stenosis, Mat see atherosclerotic plaque on Bmode, ↑in PSV up to 180 cm/s, No decrease in flow distal to lesion, No poststenotic turbulence |
| Color flow is helpful on identifying what with rena artery stenosis of less than hemodynamic significance? | Helps in identifying regions of disordered flow and narrowing of lumen |
| Flow-reducing renal artery stenosis facts | Represents >60% stenosis, PSV ↑s significantly above 180 cm/s, Post-stenotic turbulence is present |
| With > 80% stenosis, changes include what? | Delayed systolic upstroke, Loss of early systolic peak (ESP), PSV decreased distally |
| Normal renal parenchymal signals demonstrate what? | Continuous high diastolic flow , 40-50% of systolic velocity, Diastolic flow is usually maintained with renal artery stenosis |
| Parenchymal disease results in what? | Impedance to arterial flow, Resistance in parenchymal renal vessels ↑s |
| Diastolic-to-systolic velocity ratio is? | <0.3 |
| How do you get Diastolic-to-systolic velocity ratio? | EDV divided by PSV |
| Normal EDR is what? | >0.2 |
| Resistive index >0.8 indicates what? | ↑ renovascular resistance/medical renal disease |
| Resistive index <0.7 indicates what? | Normal flow in parenchyma |
| Resistive index Normal and Abnormal? | Normal <0.7, Abnormal >0.8 |
| How do you calculate resistive index? | PSV-EDV divided by PSV |
| What is resistive index used often with? | Renal transplant assessment |
| Assessment of arteries in renal hilum and sinus is used as what? | An indicator for renal artery stenosis (usually segmental arteries interrogated; may evaluate arcurate arteries) |
| Acceleration Time (AT) >0.1 indicates what? | PROX renal artery disease |
| What are some pitfalls of indirect assessment for renal hilar evaluatuion? | Accessory renals, AT may remain normal in PTs w/ elevated renovascular resistance, Stenosis in the 60-79% range may not affect hilar wavefrom |
| There is no distinction between renal artery occlusion and what? | Renal artery stenosis |
| What other arterial disease may cause delayed systolic upstroke? | Aortic coarctation or aortic stenosis |
| Should the indirect hilar assessment be the sole indicator of renal artery stenosis? | NO, it is a good tool but should not be the sole indicator |
| What is renal-aortic ratio (RAR)? | Ratio of renal artery PSV to aortis PSV at the level of the SMA |
| a RAR >3.5 is consistent with what? | >60% stenosis |
| What is normal RAR? | <3.5 |
| What are the pitfalls to using RAR? | Aortic PSV >100 cm/s may underestimate stenosis significance , and Aortic PSV<40 cm/s may overestimate stenosis significance |
| What do normal renal veins have? | Anechoic lumens and respiratory phasicity on doppler |
| What type of flow should be noted in the presence of thrombus? | Continuous, nonphasic low velocity flow |
| What are the abnormalities of renal veins? | Acute thrombus, Partial venous obstruction, Recanalization, Collateralization, and Extrinsic compression |
| What are features of renal vein thrombosis? | Renal atrophy, and increased renal parenchymal echogenicity |
| What is "Nutcracker Syndrome"? | High velocity in left renal vein in the presence of compression (vein compressed by mesentary or SMA) |
| If a PT has Renal Vein Thrombosis what may they present with? | Acute renal failure with pain and hematuria or suspicion of renal cell carcinoma with tumor extension |
| What does retrograde, blunted diastolic flow in renal artery also suggest? | Renal vein thrombosis |
| What does the absence of spectral, color, or power Doppler signal suggests what? | Renal vein thrombosis |
Created by:
EmilyGriffin
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