Hypertrophy kidney - what does this pathology behave? Ultrasound kidney anomalies Fetal lucrative.
Anomalies of Relationship (Fingering Kidney)
With this kidney anomaly can be fascinated symmetrically and asymmetrically.
To the symmetric forms of the battle (the battle occurs with the same poles - lower or upper) attributes and galete-shaped kidneys.
Horseshoe kidney
In our observations, 0.2% of patients was revealed, moreover, in most cases, boys. Eightgnostics presents certain difficulties that increase with the combination of this anomaly with various diseases (hydronephrosis, cysts, polycystic, hematoma, paranefritis, tumors, injuries).
An unaffected horseshoe kidney is always located lower than normal kidney, has large sizes, but never gains the sum of two normal renal sizes, the parenchyma zone and a cup-laughter system is well distinguished. Visualization and differentiation are improved when applying an aqueous load, which allows you to differentiate extended lochkins. It should be noted that it is very difficult to determine how the poles are smashed by the kidneys, except when when inspection through the front abdominal wall, the adrenal glands on opposite poles can be locked, and this is possible only with the left kidney abnormalities.
Galeto-shaped kidney
This anomaly occurs very rarely and is formed as a result of a uniform action of the forces of the small intestine during the period of renal motion of the small pelvis into the lumbar region. With their delay in the pelvis, a battle occurs throughout. The kidney is locked low in the pelvis as a flat-end-elongated formation with clear contours, with the distinction of the parenchyma zone and a cup-making system without differentiation of the battleship. It may be mistaken for a tumor. The incidence of galete-shaped kidneys is difficult when combined with various diseases. Priority for excretory urography.
The asymmetric forms of the battle include kidneys that have grown in the form of Latin letters S, I and L. With this kidney anomaly, the opposite poles are fought by the opposite poles due to the uneven effects of the forces of the small intestine during the period of promoting them from a small pelvic to the lumbar region. The longitudinal axes of S and 1-shaped intestinal kidneys are parallel. S-shaped kidney is located to the pelvis in a horizontal or oblique position, and the I-shaped kidney is located vertically and parallel to the lower hollow vein and abdominal Aorte.
Anomalies of quantity
Two kidney
The most common kidney number anomaly (approximately 4%) is the doubling of the kidney, which is unilateral and double-sided, full and incomplete.
Paired kidney
With full doubling there are two collective systems - two magnifiers, two ureter and two vascular beams. On the echogram, the leggings are clearly visible, the beginning of the ureters, sometimes it is possible to allocate vascular bundles.
Difficulties in echographic differentiation occur during pyelonephritis, hydronephrosis, urolithiasis and tumors of one of the half of the doubled kidney. A complete anatomical picture of double kidney can only be seen x-ray.
This pathology is extremely rare. Paired kidneys can be single and double-sided, identical or different in size. According to our data (in the available literature, the description of this pathology was not met), one-sided paired kidney revealed 5 women aged 19-34 and two-sided in 2 pregnant women aged 21 and 28 years. In 6 out of 7 cases that we identified, paired kidneys were the same value, an average of 8.2-3.6 cm. For the width of the kidneys, they were taken only to / 2 hosts of the parenchyma zone in the controversial part of the kidneys.
A characteristic feature is their longitudinal battle by side surfaces. The echostructure of paired kidney does not differ from such a normal kidney, that is, the parenchyma zones and a cup-making system are very clearly distinguished. A feature is that the width of the parenchyma zone at the site of the battle does not exceed the magnitude in the unsolved part of the kidneys. By echocartine, it can be assumed that the battle is at the level of the entire thickness of the parenchyma of both kidneys. The variant of the full longitudinal doubling of the kidney is not excluded. Ureterals behave in the same way as with full doubled kidney.
Anomaly kidney parenchyma
The anomalies of the renal parenchyma include Agenesia, Aplasia, hypoplascent kidney, the addition (third) kidney, additional slicing and cystic anomalies of parenchyma - polycystic, multicastosis, solitary cyst, multi-culture cyst, spongy kidney, megakolikosis and cups of cups.
Agnesia
Congenital absence of one or both kidneys. With one-sided Agensia, the specificity of the kidney structure does not hide on this side, but sometimes it is possible to loking an increased adrenal gland. On the opposite side, hypertrophored, defective in the echosor of the kidney.
However, it should be remembered that the lack of the kidney location in an anatomical place does not indicate the presence of Agenesia. The final diagnosis can be delivered only after detailed echographic and radiological studies. Bilateral Agensia is very rare and diagnosed by the fetus in the II and III period of pregnancy, when all organs are developed. In this case, a thorough echographic study does not reveal the echostructure of the kidneys and bladder. The study is carried out with difficulty, since at this anomaly there is always a small one. Fruits with this anomaly are born dead.
Aplasia
Deep underdevelopment of renal parenchyma with frequent cases of the absence of a ureter. One and double-sided one can meet.
With a one-sided Aplasia, there is no specificity of the structure of the kidney and the oval-extended formation with fuzzy erased contours, heterochogenic (different acoustic density), although small cysts and calcifications can be locked. It is not clinically manifested and is a echographic find in the study of the kidneys.
A bilateral aplasia is extremely rare. At the same time, the fetus cannot identify the image of the kidneys and bladder.
Gimoplascent kidney
Congenital reduction in kidney sizes. The kidney echoogram is reduced in size (on average it has a length of 5.2 cm, a width of 2.4 cm), the parenchyma zones and a cup-lowering system are narrowed, but the specificity of the structure of these zones is preserved.
In 3 patients, we observed a dwarf kidney with a value of 3-2 cm. Kidney contours of the worst, parenchyma is heterogeneous on echogenic; There is no division on the zone.
It should be remembered that it is very difficult to distinguish the hypoplascent from the wrinkled kidney, in which the dimensions are also reduced, but the latter has an elevation of the contours and separation into zones; Such a kidney is poorly rewarded from the fabrics surrounding it.
Additional (third) kidney
It is extremely rare. We have identified 2 cases. The added kidney is usually located below the main and can be somewhat less. In our cases, the main and added kidneys were located in the horizontal plane and had the same dimensions, but somewhat less generally accepted averages for this age (7.1-2.8 cm). Parenchima and a cup-making system in both kidneys are distinguished clearly. The ureter of the added kidney can be included in the main ureter or independently in the bladder.
An additional slicing of one of the kidneys can be one (or more) and is located more often at the poles, it is located as a small oval formation with clear contours; The echostructure of the polek is similar to the main kidney fabric. Sometimes additional slices are easy to adopt for the adrenal gland, although their echo structure varies somewhat, sometimes they can be confused with a volume formation growing exofite.
Anatomical variations of normally functioning kidney
There are anatomical variations in the structure of the parenchyma and a cup-making kidney. Immediately it should be noted that they do not have clinical significance, however, some of them in front of the researcher can supply diagnostic problems.
The parenchyma defect is rare and located in the form of an echogenic triangular zone, the base of which is associated with the fibrous capsule, and the top with the wall of the kidney sinus.
Kidney with oval-convex uneven outdoor contour
Overlooking kidney
Usually occurs in children up to 2-3 years. Rarely, such a phase of the embryonic structure remains in adults. It is characterized by a uniform separation by 3-4 sputtering on the outer surface of the low echogenic zone (Parenhima Lake).
Kidney with an isolated zone of hypertrophy parenchyma inside
This anomaly of Parenhima meets quite often, it is characterized by isolated hypertrophy and empty in the form of a pseudopod between two pyramids to a cup-making system, which, in the absence of a clinic, we tend to consider an individual norm. It can be accepted for a tumor, in connection with which patients with exophytic and endophyte additional growth of parenchyma should be subjected to invasive research methods.
Polycystic kidney
Congenital, always bilateral cystic anomaly kidney parenchyma.
Prior to the introduction of echography, especially in real time, the diagnosis of polycystosis represented great difficulties, since the percentage of proper diagnosis of radiological methods does not exceed 80. In our observations, more than 600 patients, echographic diagnostics turned out to be correct in 100% of cases. The polycystic kidney is always increased in size, the contours are uneven, oval-convex, the echorate structure is not differentiated, only the strips of parenchyma are visible and many rounded different sizes of anechogenic formations (cysts) separated by thin echogenic strips of partitions. Sometimes polycystic kidney acquires a bunch of grapes. But in most cases, slightly large, up to 5-6 cm in diameter, cyst, surrounded by many small ones. Sometimes with dynamic observation of the patient, you can observe the disappearance of large cysts, their gaps.
The study is carried out on the side of the back, but the visualization of the right kidney is better carried out through the liver. It should be noted that with significant kidney sizes and the presence of a set of cyst, the liver is visible only partially or not visible at all, and you can mistakenly diagnose the liver polycystic plant, which is extremely rare.
Multi-call dysplasia
Congenital anomaly, which is more often unilateral, as the bilateral is not compatible with life. The cartoon kidney is usually large, distinguished by the irregularity of contours, the parenchyma is not differentiated and completely substituted by cysts of various sizes, more often than 2-3 large. In order to differential diagnosis Polycystrosis and multi-mounted radiographic research methods. For the kidney multipleness is characterized by high borders of the ureter.
Solitary cyst
There are congenital and acquired kidney cysts. Congenital cysts are detected from the fetus in the II and III trimesters of pregnancy or more often in childhood. Acquired cysts are detected more often after 40 years. There are single, but not more than 2-3 in one kidney. Located as rounded formations of different sizes: minimum - 0.5 cm, maximum - over 10 cm in diameter. The kidneys come from parenchyma and have clear contours, devoid of echo signals are located both on the surface and in different kidney departments.
A certain difficulty represents the refinement of the location of the cyst; First of all, this refers to parapelvicious cysts located in the field of kidney gates. In some cases, they are difficult to differentiate from an extended jelly, hydronephrosis, which may have a similar oval form. In this regard, it should be remembered that in the case of hydronephrosis, the interruption of liquid education contours of liquid education is almost always detected in different scans, that is, a bond with a loyalty and a lokhano-ureter segment and cups, whereas with parapelvic cysts of the interruption of the loly-liquid liquid education cysts is not observed. It should be remembered that the image of the cyst image is possible on the right kidney right Share The liver or the right half of the abdominal cavity, in particular the bowlage of the intestine during the disease of the crown or ovary. Over the estate of the left kidney erroneously can be taken by the cyst of the lower pole of the spleen, the tail of the pancreas, the left half of the abdominal cavity, the left ovary or the liquid in the stomach with its poor evacuation. Such diagnostic errors are not allowed, because they lead to serious complications, as accesss for surgical intervention with these pathologies are different. To avoid errors, it is necessary, changing the position of the body, in different echographic scans to carefully differentiate the kidney contours. In doubtful cases, repeated ultrasound studies and laparoscopy are shown.
Echography allows you to conduct dynamic observation of the growth and state of the cyst (suppuration, breaking, resorption). The dynamics of the cyst development has a great clinical value, since their growth is associated with the atrophy of the kidney parenchyma leading to the impaired hemodynamics and arterial hypertension. Echography helps to clarify the moment of possible surgical intervention or conservative treatment, provides conditions for conducting aiming diagnostic or with the medical goal of biopsy.
Dermoid cysts
These are congenital single-chamber, rarely multi-chamber rounded formations outlined by an echogenic capsule. May be located in various parts of the body, rarely in internal organs And very rare in the kidneys. More often in girls in early childhood, although they can also meet in adults, moreover to be a random find. Depending on their content (hair, fat, bone tissue, etc.) the content of education has different echogenicity - part of the cyst may be high, and a part is low (liquid). The wall of the dermoid cyst is thickened, has high echogenicity, and sometimes exposed to occurrence and lokilas as a rounded high-cooping ring, clearly visible on an x-ray. It should be noted that sometimes a dermond cyst is difficult to distinguish from chronic abscess, decay of cavity and tumors, hypenephromas and Wilms tumors. The diagnosis in such cases may be confirmed by means of a valuable aspiration biopsy or in surgical intervention.
Multalocular cyst
Very rare anomaly (2 cases identified), characterized by the replacement of the kidney parenchyma portion of multi-chamber, which is located as a multi-chamber anechogenic formation separated by narrow echogenic partitions. When the larger sizes of echocartine achieve the same as with a multi-chamber echinococcal cystic. Differentiation is very difficult. The only distinctive feature is an active echinococcal cyst gives a rapid growth compared to a multilocular cyan (in household Patient usually there are animals - echinococcosis carriers). 
Suffer more often male face. At the same time, the kidney can be increased in size, characterized by a uniform cystic lesion of the pyramids, as a rule, two-way, without engaging in the pathological process of the cortical substance. Cysts are usually small sizes, diameter from 3 to 5 mm, directed to the center of the kidney. Although many small cysts can occur on the surface of the kidney, making it uneven. In the area of \u200b\u200bthe pyramid there is a lot of small stones. With the joining of pyelonephritis, the fergity is difficult.
Megakolikosis (renal cup dysplasia)
On the echoogram, all cups are significantly expanded, they have a rounded shape, a pyelonephritis, as a rule, if the pyelonephritis has not joined, is not expanded, the ureter is fluidally passable for a contrast agent during a radiographic study.
The accumulation of uricular salts and small stones can be locked. The echography allows this pathology only to assume, the final diagnosis for the excretory urography and retrograde pyelography, where the cavity of the cyst, a narrow course communicating with the renal cup is clearly visible.
Cheschoe diverticul
Congenital cystic education associated with a low renal cup with a narrow channel.
Megaureter
Congenital unilateral, less often two-way segmental expansion along the entire length of the ureter, from 3 mm to 2-3 cm and more, ureter is locked as an uneven width of anechogenic tube over a narrowed distal segment.
The length of the ureter can vary from 0.5 to 4-5 cm, the left ureter is affected more often. Megaureter can be primary obstructive (congenital), secondary obstructive (acquired) due to inflammatory processes, postoperative scars And other reasons and primary unstructive (idiopathic). Megaureter, especially primary obstructive, always leads to hydronephrosis and hydrochloriaciasis.
Ureterocele
One of the rare ureteral anomalies arising due to the narrowness of its mouth, in which the expansion of all layers of the intramural ureter's impact department occurs, sputtering in the form of oval echonegative formation into the urinary bubble cavity from one or two sides. The ureterocele cavity may contain urine - from several milliliters to the volume of the bladder.
Ureterocele is difficult to differentiate from the diverticula or echinococcal cyst, located at the mouth of the ureter.
Early diagnosis The ureterocela is of great importance, as it allows you to get rid of the patient from the possible dilatation of the upper urinary tract and the development of pyelonephritis and secondary cystitis.
Anomaly of renal vessels
This area of \u200b\u200bpathology for modern echography, even with the use of Doppler, is little or, more precisely, only partially available. It allows us to only assume the presence of any vascular pathology in comparison of structural changes in the renal parenchyma.
Source: Health-Medicine.info.
- The accumulated accumulation of pus in the cortex or cereal brainstab. With computed tomography without contrast, it looks like an education with fuzzy contours, containing a liquid component in the center, as well as gas bubbles (when infected with the gas-forming flora). The pyrogen membrane has a property intensifying in contrasting to a large extent.
Agnesia kidney
- Complete absence of kidney, as well as uretera, renal arteries and veins on the one hand.
Adenoma Kidney
- Chasts Nakhodka with CT studies of the organs of retroperitoneal space. When conducting computer tomography of kidneys (with a contrast or without it), the adenoma cannot be clearly differentiated from the renal-cell cancer, it looks similar - as a hypo-or hypervascularized assembly in a kidney parenchyma, an inhomogeneous - cystic and solid structure that is amplifying in contrasting.
Angiomiolipoma kidney
- a tumor consisting of fatty, muscular and vascular proliferative tissue. The KT of the retroperitoneal space looks like the formation of an inhomogeneous density (low-density areas -20 ... -60 units of Hounsfield on the background of heavy, soft-tanned density), with uneven edges, deforming the kidney contour. Angomolypoma is the only kidney tumor, the benign character of which can be argued without carrying out any other studies.
Angiomiolipoma kidney during computed tomography looks like the formation of a rounded form with an inhomogeneous density due to the fact that it contains fat, muscle and vascular tissue in various proportions. In the presented example, the average density of education near the lower pole of the right kidney is -20 HounSfield units.
Aneurysm of renal artery
- Local expansion of the lumen of the renal artery as a result of weakening and stretching its wall. Diagnosed with CT-angiography of the renal artery, while the expansion of the lumen is well noticeable, in which thrombus can also be detected.
Aplasia kidney
- Reducing the scope of the kidney and the violation of its normal structure. When aplasy in the kidney, the number of pyramids is less than normal, a cup-making complex may have the appearance of the "bulbs."
Atresia of the ureter
- Lack of a scope of the ureter, congenital pathology.
Veziko-Ureteral Reflux
- The condition in which the return current of urine from the bladder in the ureter takes place. This type of reflux can only be detected during retrograde cystography (with the filling of the bladder by contrast from outside) to contrast the distal diversion of the ureters.
Substance cortical kidney
- A complex of structures containing renal vessels, tubules and gloves. With CT of the retroperitoneal space, the renal cortex is isolated by the kidney cerebral substance, with a contrast gain becomes hypertensive (due to greater vascularization).
On the axial scan, the arrows marked the renal cake, which looks hypertensive to the arterial phase of contrast, due to better vascularization.
Men Brain Kidney
- a structure consisting of renal pyramids separated by a cortical substance (Berrtini pillars). The peaks of the pyramids, merging, form renal papillas, carrying out the urine into the cup-laughter system.
Empty of the kidney contour
- With CT kidney without contrast, the local area on which the kidney contour swells the dust, is always suspicious on the tumor and requires contrast gain.
Local swelling of the left kidney contour with native CT. Suspicion of Hypernefrom. It is necessary to study with contrasting.
Galeto-shaped kidney
- Anomaly, characterized by the full merge of both kidneys with the location of the formed galete-shaped kidney, is preverted (median) or near the sacrum - in the cavity of the small pelvis.
Hematoma kidney
- The result of the traumatic impact (most often - the blow of a blunt object in the lower back region or falling onto the back), in which the application of the strength occurs to break the vessels and blood output. Kidney parenchyma hemorrhage looks like CT as hypertensive areas, the density of which remains approximately the same for a long period of time. Hematomas can be intraparenhimatous, podkapsulny; Can also break into the urinary tract.
Hematuria
- A condition in which the hemorrhagic component is determined in the urine. With CT of the urinary system organs, you can identify hypertensive blood clots in the bladder or in an extended ureter.
Hemorrhagic kidney cyst
- high density formation in the kidney (60-70 Houncefield units), containing fresh or partially lysed blood. All hemorrhagic cysts refer to category 3 by Bosniak classification.
An example of a hemorrhagic cyst of the right kidney during computed tomography (marked with an arrow). Hemorrhagic kidney cyst is more dense (60 ... 65 Hounsfield units). In this case, the patient has a kidney polycytosis with the presence of a cyst of various structures and density.
Hydronephrosis
- the state manifested by the expansion of the kidney cup-looscopic complex during computed tomography as a result of obstruction or obturation of the ureter during urolithiasis, with tumors, squeeze the ureter.
Left-sided hydronephrosis in computer tomography of the kidneys is manifested by an expansion of a cup of kidney cup. Nephrographic phase of contrast.
Hydronephrotic bag
- A condition characterized by an extremely pronounced expansion of cups and renal pelvis, in which the brain and cortical substance of the kidneys during computed tomography are visualized as a fine strip of tissue. Final stage of hydronephrosis.
Hydrocalix
- expansion of only one group of cups, a private variant of hydronephrosis.
Hydrometer
An example of a sharp unilateral expansion of the ureter due to its obstruction of stones in the area of \u200b\u200bthe mouth of the right-sided hydrometer.
Left-sided hydrometer on axial sections with CT pelvis (in different patients).
Hypernefroma
- Sin. Renal-cell cancer - malignant kidney tumor of various histological structure (The lateral kidney cancer occurs with a frequency of up to 80%, papillary-cell cancer - with a frequency of 10-15%, chromophobic cellular cancer of the kidney - about 5%). Hypernefrome causes the deformation of the kidney contour, it looks like a solid assembly, isolation of the renal parenchyma, which can also contain calcinates and hemorrhages in the structure. In the arterial phase of contrasting, hypernefromes are noticeably amplified due to their high vascularization, after which it becomes well distinguishable by their inhomogeneous structure - with the presence of solid and cystic components.
The classic example of hypernefromes with CT organs of a retroperitoneal space in the form of volumetric formation in the upper left-handed kidney sections having an inhomogeneous structure due to different contrasts of solid and liquid (cystic) components, as well as the presence of hemorrhages.
An example of a renal-cell cancer at CT kidney without contrast, in the arterial, venous phase of contrast, as well as to the nephrographic phase.
Changes are extremely suspicious on the hypernefrom, with CT kidney without contrast.
Hypertrophy of renal pillars
- An embodiment of the kidney, in which the thickened poles of bertini can imitate the tumor process.
Hypertrophy kidney functional
- One-sided increase in the size of the organ arising in connection with nephrectomy. On the rest, the only kidney accounts for a large load on blood filtering, as a result of which its compensatory hypertrophy occurs.
Glomerulonephritis
- in acute stage Glomerulonephritis Computer tomography of kidney does not reveal any changes in chronic - one can detect atrophy of the renal bark with an increase in renal sinus.
Cortical Presentation defect
- Local area on which there is no bark resulting from operational treatment - Regional resection. In computed tomography of the kidneys, small pre-section defects are difficult to detect due to filling them with retroperitoneal fat.
Distopia kidney
- The location of the kidneys in an atypical place for it, for example, in a small pelvis or in a chest cavity (an extremely rare version of dystopia is an intrathorad kidney).
An example of the pelvic dish dystopia. On computer tomograms, polycysticly modified kidneys with multiple large calcined stones, localized in the cavity of a small pelvic, pressed - near the sacrum.
Cross Distopia with merger
- Anomaly for the development of the kidneys, in which dystopia is observed by one of the kidneys with moving it one way from the spine and merging with another kidney. With CT-urography, you can reveal two uretera, one of which is typically, and the other crosses the average line and flows into the bladder from the opposite side. With kvidny CT, you can visualize the only kidney big size On the one hand from the spine.
Cross Distopia without merger
- A rare anomaly, in which the kidney fusion does not occur during dystopia of one of them. When CT, both kidneys are visualized on one side of the spine, however, they lie completely separately from each other, have a separate fat capsule.
Infarction kidney
- The death of the renal parenchyma on a limited area (the size of which depends on the degree and level of occlusion of the arterial vessel), manifested during the computer tomography of the scanitoneal space organs in the form of the absence of contrasting the renal parenchyma section - most often a wedge-shaped form.
Lack of contrasting of the cortical substance of the right kidney in the middle and upper sections due to circulatory disorders in this area - an example of a kidney infarction.
Calcinated kidney stone
- The most frequently detected type of renal concrekrins, for which is characterized by high (up to 1000 units of Hounsfield) density.
An example of calcined kidney stones with CT.
An example of a highly cute stone (calcinate) in the renal pelvis.
Stone in the lower group of cups of the left kidney (calcinate).
Xanthin kidney stone
Xanthin kidney stone
Kidney kidney subcapsular
- Renal cyst, localized under the capsule.
Cortical kidney cyst
- Cyst with localization in the cortical coil layer.
Kiset Kidney Medullar
- Localized in the curse brainstab.
Examples of ordinary cyst of the right kidney, localized mainly in its brain layer.
Parapelvikal kidney cyst
- Localized near the cup-glass complex, it can cause its compression with a violation of urine outflow (rarely).
The huge cyst of the sinus of the right kidney (parapelvical), causing pronounced compression and deformation of the renal pelvis and cups, as well as leading to a violation of urine outflows.
Echinococcus kidney cyst
- Cystic kidney damage due to echinococcus. The kidney echinococcosis is manifested in the form of a cyst with clearly defined contours, with often detectable occasions, with septs. The walls of echinococcal cyst and septa are enhanced after the addition of contrast.
Bosniak Kistan Classification
- implies the conditional separation of all renal cysts on grade 4, depending on the degree of their oncological alertness - from the 1st (uncompressed ordinary cysts) to the 4th (reliable malignant neoplasm).
On the images - an example of a simple cyst of the lower pole of the right kidney, which does not contain a soft-tissue component in its structure, partitions, hemorrhages and calcifications. This cyst refers to the 1st category of Bosniak.
Complex Chescho-Lohank
- Structure consisting of kidney cups and renal pelvis.
Contusion kidney
- Traumatic kidney damage, in which the leading sign is swelling, manifested in the form of an increase in the size of the kidney, the fuzziness of its contours, the narrowing of the cup-loching complex.
Cortico medullary phase
- One of the phases of contrast in computed tomography of the kidneys, obtained by scanning 20-30 seconds after the addition of contrast, performed in order to visualize the renal vessels, as well as well-vascularized kidney tumors.
CT urography
- The mapping of a cup of the kidney and ureterals, obtained with kidney CT after the addition of contrast to Vienna.
Kidney lymphoma
- more often, the secondary disease of the kidneys occurring at a non-Khodgkinsky lymphoma, as well as in post-transplant lymphoma. Kidney lymphoma on CT may look like: a solitary assembly, deforming the kidney contours and infiltrating perigeneous fat; Multiple nodes of both kidneys of up to 5 cm, which are well distinguishable after contrasting amplification; diffuse changes kidneys in the form of a decrease in the degree of increased renal parenchyma into the nephrographic phase and reducing renal excretion; Ankrainny knot - with an effusion of kidney sinus and ureter.
The lesion of the lymph nodes in the kidney gates during lymphoma.
Lipoma kidney
- A tumor containing only fatty tissue (-80 ... -120 density of Hounsfield units).
An example of a small lipoma of the left kidney is a peripherally located hypodense section of a rounded form, having a density of fat (in this example -100 HounSfield units).
Mesenchimal tumors of kidneys
- A collective term, which includes such tumors like lipomas, fibromes, leiomyomes, histiocytes - rare tumors that have no specific signs with kidney CT.
Metastasis in the kidneys
- Secondary kidney damage during tumors of another localization. For example, bronchogen cancer can be metastable in the kidneys. At CT, renal metastases may look like multiple hypodense into the nephrographic phase of education. It is also characteristic of the presence of metastases in other organs - adrenal glands, liver.
Native KT kidney
- Computer tomography kidneys, made without the introduction of a contrast agent. It is used to diagnose urolithiasis, obstructive lesions of the SLK and ureters to identify high-detailed counters.
Nephritis chronic interstitial
- The disease of the renal interstice caused by the intake of analgesics for a long time. In computed tomography of the kidneys, changes are detected in the form of a decrease in the size of the kidneys and the formation of calcinates of renal papillars.
Atrophic changes of both kidneys against the background of an interstitial disease.
Nephoblastoma
- Sin. Wilms's tumor is a tumor from the renal parenchyma, most often found in childhood (up to 5 years). The NUGROBLASTOM CT is visualized as a hypodense formation, a deforming kidney contour having an inhomogeneous density due to hemorrhages and necrotic focus, less often fat and calcinates. Metalizes in lymph nodes in the gates of the kidney, into para -orthal lymph nodes.
Nephrographic phase
- One of the phases of the contrasting amplification with KT kidney, into which the cortical and brainstant of the kidney have the same density. This phase occurs after 80-120 seconds after the addition of contrast, it is most likely the likelihood of tumor detection, especially small.
Nephrollocosnosis
- Total occasion of the brain and cortical substance kidneys, which, with computed tomography, become sharply hyperdissive, extremely dense.
Nephroptosis
- Low kidney location, low resolutions of the renal artery with the appropriate side, atypically long and convoluted ureter.
On the reformation in the coronal plane, moderately expressed right-sided nephroptosis was demonstrated. Pay attention to what level is the right and left kidney - right at least 2/3 of the altitude of the lumbar vertebra below.
Nephrectomy
- Operational kidney removal. At the same time, a scar cloth in the renal bed is found on the CT, if the operation was performed for a long time, and fresh blood and swelling with recent interference.
Observation demonstrating right-sided nephrectomy. On CT is visualized by the only left kidney, and on the right vascular bundle of the kidney - a metal clip.
Lower hollow vein tumor thrombosis
- A condition that may occur during the germination of the kidney tumor (right) into the lower hollow vein. Specifies to the neglence of the tumor process and is the T4 stage marker according to the TNM classification.
The germination of the tumor of the upper pole of the right kidney into the lower hollow vein, in which multiple gas bubbles are also visualized. The forecast in this case is extremely unfavorable.
Opportion of a loancast-urete joint
- Congenital kidney anomaly, manifested by a narrowing in the field of the transition of a loyalty in a ureter, not leading to the development of hydronephrosis.
Oncocytoma
- a benign kidney tumor from the epithelium of the renal tubules. With computer tomography of kidney looks like a single formation with an expansive growth, equal to the density of the hepatic parenchyma with native studies and amplifying after the addition of contrast in the form of "wheels with the spokes" due to the presence of a central scar of the characteristic (star) form.
PERL-MANN tumor
- Sin. Cystaudoma Kidney, Multalocular Cystic Nephoram.
Papilloma kidney
- a frequent tumor characterized by the defeat of any department of the urinary tract - renal pelvis, ureter, bladder. It is a precancerous state.
Pararegional space front
- an anatomical area containing fatty tissue, directly adjacent to the front fascia gerota on one side, and to the spleen capsule, pancreas - on the other hand.
Paradial space rear
- an anatomical area in which a fatty fiber is located, limited by the rear fascia of the gerot, on the one hand, lumbar muscles on the other.
Periodspace
- The area bounded by the front and rear fascia is a gerot containing pergeneal fat (fat "capsule" of the kidney).
Persistent embryonic lucidity kidney
- Option of development, in which the defects of the kidney parenchyma contour are detected towards renal columns.
Pyelonephritis
- Inflammation of the renal interstice with the involvement in the process of loyal, due to the infectious agent. When pyelonephritis on the CT, it is possible to detect an increase in the kidneys, the vague of its contours due to the edema of the renal parenchyma and the perigeneic fiber, as well as the local thickening of the fascia of the gerot - in the case of the dissemination of the inflammatory process on them.
Changes in kidney on CT with pyelonephritis.
Pyelonephritis emphysematosis
- a heavy version of the inflammatory process in the kidney, due to the development of the gas-forming flora, with computed tomography of the kidneys, showing itself the presence of gas bubbles in the panefral tissue, under the kidney capsule, in lochanks, as well as signs of edema.
Pyelonephritis Xantoganulmatosny
- a chronic inflammatory process in korea kore and in a brainstant, which occurs again - against the background of the urinary tract obstruction during urolithiasis. It is found mainly in women. In the xanthronumatous pyelonephritis, stones in renal loins are very often revealed, sometimes coral, as well as signs of hydronephrosis, with the expansion of cups and the presence of Derita and Xantomic tel in their cavities.
Pionephrosis
- The condition evolving when infecteding the kidney against the background of already existing hydronephrosis. A significant expansion of the pionephrosis is a significant expansion of the pionephone system of the kidney with the presence of an infected liquid in it with a density of 20 ... 30 HounSfield units.
Casomic pionephrosis
- The final stage of the development of the kidney tuberculosis, in which its caseous purulent melting occurs, and then wrinkling and diffuse occasion.
Piokalix.
- infection of one group of cups under the existing hydronephrosis or hydrocalce - local version of the pionephrosis.
Flake carcing kidney cancer
- malignant kidney formation with a tendency to invasive growth. The tumor is localized in the renal laughter, has the appearance of a node with a pillable structure. It may cause hydronephrosis due to the obturation of the urinary tract. In the urinary bubble with a flat-stacked kidney cancer you can see hypertensive bunches of blood.
Horseshoe kidney
- The fusion of the kidneys in the field of the lower pole due to the presence of a coastal consisting of connective or renal fabric. The kidney has a characteristic appearance of the horseshoe.
An example of visualization of horseshoe kidney during computed tomography with contrasting enhancement in the arterial and excretory phase. At the right image, the arrows marked renal artery (two of them - one on each side of the horseshoe kidney), on the left and in the middle of the arrows, separate ureters were marked.
Renal veins thrombosis
- Violation of the patency of the renal vein as a result of its occlusion thrombus. At CT, the renal vein is sharply expanded, full-blooded (sometimes more than 2 cm), the degree of contrast enhancement of veins is lower compared to the other side. In some cases, you can directly visualize the thrombus in the lumen of the vein. When the thrombus is enhanced in the arterial phase, the tumor of the renal vein can be suspected.
Kidney Page
- the kidney compression by large hematomas located podcapsally, and the development of secondary renal hypertension.
Simple kidney cyst
- hypodense formation with a density of 10 ... 15 Houncefield units in a kidney, which does not contain a solid component, ordinary, septa, blood. Frequent find at CT kidney. In contrasting, simple cysts are not enhanced.
Pseudo-turn kidney
- the surrounding process of the kidney, imitating tumor growth, but is a mapping of normal anatomical renal structures, for example, an enlarged bertiniyev pillar - renal bark.
Tensile kidney
- damage to the cortical and (or) curse brainstant, expressed to varying degrees depending on the attached traumatic force, the conditions for obtaining injury.
Kidney break, AAST classification
- 1 tbsp. - contusion or kidney hematoma; 2 tbsp. - breaking the renal cortex less than 1 cm without extravasia of urine; 3 tbsp. - breaking the renal cortex more than 1 cm without damaging the collecting system and without extracting urine; 4 tbsp. - the rupture of the renal parenchyma (cortical and brainstatus of the kidney, as well as collecting system); 5 tbsp. - Parenhim gap as in the case of 4 tbsp., But with the separation of the vascular beam of the kidney and its devascularization.
Rak ureter
- Looks like a Moral CT as the formation of a soft-detachable density that causes the obstruction of the lumen and the development of the hydraulicoeter, and then hydroephosis, or as thickening the wall of the ureter. The distal part of the ureter at this state is stretched, filled with urine density 12 ... 20 units of Hounsfield.
Renal cortical necrosis
- A condition in which the death of the kidney bark occurs on a limited area is either diffuse against sepsis, septic shock. With CT kidney with a contrast with a renal necrosis, it is possible to detect the absence of contrasting of the renal cortex, and in the subsequent - after a week and more - the origin of the cortical layer and the progression of atrophic changes in the kidneys begins.
Symptom of a soft rings
- Displays the thickened wall of the ureter when it is obstructed by a high density countertop. In computed tomography, the ureter on axial sections looks like a ring structure with a hypodense wall (ring) and a hyperene center (blade).
Observation illustrating the symptom of a "soft-wanted ring" when obstruction of the ureter of a calcined stone is a highly discovered center and a low-blooded soft "rim" by periphery.
Stage T Renal Cancer Cancer
(According to TNM classification) - determined on the basis of the size of the tumor node and germination of the surrounding tissues. T1 - node less than 7 cm the largest size is localized in the renal parenchyma; T2 - a node is more than 7 cm the largest size, localized in the kidney; T3 - there is an invasion of perinephral fiber, as well as nearby vessels; T4 - there is germination of the tumor of the anterior or rear fascia of the gerot.
An example of renal-cell cancer in various phases of contrast gain: native, arterial and sharp. The tumor node corresponds to the T1 stage according to TNM, as it has a size of less than 7 cm in the diameter and does not germinate into the surrounding tissues.
Stage n renal cell cancer
(According to TNM classification) - displays the lesion of lymphatic nodes. N1 - There is a single enlarged lymph node less than 2 cm with the greatest size; N2 - there is a single lymph node more than 2 cm with the greatest size, or multiple lymph nodes of less than 5 cm in size; N3 - There are lymphatic nodes of more than 5 cm.
Stricture of the ureter
- A condition manifested by the narrowing of the scope of the ureter due to its injury, inflammation, ionizing irradiation (radiation therapy). Stricks of the ureter are the cause of the development of hydronephrosis.
Tuberculosis kidney
- One of the frequently encountered forms of the extravalic location of tuberculosis infection. With computed tomography tuberculosis kidney usually does not give specific symptomatics And manifests itself in the form of a productive form (with the presence of multiple tubercles in the cortical layer, hypodenistic in relation to the parenchyma), or a peppercine-cavernous form (in the form of destructive changes in the kidneys with the development of multiple abscess, the appearance of occasions, atrophically changes from the kidney parenchyma).
The gravity of the perigital fat
- a sign of the obstruction of urinary tract, due to urolithiasis.
Doubling kidney
- Anomaly of development, which consists in the presence of two separate fully formed kidneys on the one hand, blood supply to individual renal arteries, the outflow of venous blood from which is carried out according to individual renal veins.
Doubling renal lohanok
- Optional development, in which two separate pelvis (and often two ureterals) in one kidney are intensified.
Doubling the ureter
- Option of development, manifested by the presence of two separate underlying ureters (at the same time, the doubling of kidney pelvis can also be revealed). The doubling of the ureter can also be detected only in the upper departments - t. N. Ureter Fissus.
Urolithiaz
- term denoting the presence of urinary stones in a cup of kidney and (or) in the ureter.
Urotal cancer
- a malignant tumor of the renal pelvis, often also with the damage to the ureter and bladder.
Fascia gerot front
- Sin. The front renal fascia is a connective tissue septum separating the retroperitoneal tissue in which the kidneys are located, from the fatty tissue of the abdominal cavity.
The fascia of the gear rear
- Sin. The scene of Zuckerkandla is a connective tissue partition, a fathest kidney capsule from behind.
Fibrolipomatosis of Lohanki
- the formation of a renal pelletium with a density corresponding to the density of fat and above - depending on the ratio of the connective tissue and body components. For fibrolipoomatosis, a non-intensive inventive contrast gain is characterized.
Cystadomoma kidney
- a benign tumor consisting of a large number of cyst filled with a mixture content. When the kidney CT is visualized in the form of a large tumor (at least 3 cm, consisting of a set of cyst, sharply delimited from the surrounding tissues. At about half of the cases, calcinates are found; hemorrhages and necrosis are much less likely.
Excretory phase
- One of the phases of the contrasting strengthening (late) with KT kidney, in which a cup of bread complex, ureterals and bladder are contrasted. Performing more than five minutes after the start of the addition of contrast.
Excretory phase delayed
- Performed 15 or more after the start of the introduction of contrast to Vienna, is used to identify urin, and also allows you to estimate the delay time in the kidney channels.
Extravasation of urine
- a condition resulting from a violation of the integrity of the wall in any separation of the urinary tract and the impact of urine into the surrounding tissue.
Urography
- mapping of the urinary system organs obtained during their contrasting X-ray or tomographic study.
Urography excretory
- X-ray study of the urinary system organs (CT or classical radiography), the purpose of which is visualizing the organs of the urinary system after the introduction of water-soluble contrast to Vienna.
All human bodies are able to decrease or increase in size. In most cases, this happens as a result of the pathological process in the authority, but sometimes it is also found as a physiological process. Why does kidney hypertrophy develop and how does this affect the human body?
The structure of the organ
Kidney, as you know, the organ pair. They are not absolutely identical to each other, but perform one function - blood purification and removal from the body of unnecessary substances with urine. The kidneys are located in the retroperitoneal space, the left kone at the level of the 12 breast vertebrae, the right - at level 11. The right kidney can be a little more left - this is an option of the norm.
The kidney has a layered structure - a brain and cortical substance. The brain substance is formed by the functional units of the kidney - nephron. It is they who are responsible for the formation of urine and blood filtering. The cortical substance consists of output structural elements - these are the pyramids of the kidney. They open with their peaks into a cup-laughter system.
The reasons
The organ may increase in size as a result of two processes - hypertrophy and hyperplasia. Hyperplasia is an increase in the number of cells while maintaining their size. Hypertrophy - the opposite process - the size of the cells increases, and their number does not change.
Why occurs hypertrophy kidneys:
Vicor hypertrophy of the kidney is the process of adapting the body to life with one kidney. The body is hypertrophy in order to maximize the function of blood filtration. In most cases, he copes with this.
The symptomatic hypertrophy is not a useful process, since in fact the functioning tissue disappears and the kidney ceases to filter blood and form the urine.
Clinic
No symptoms of vicar hypertrophy gives. There are no pain, no urination disorders - in cases where this kidney is healthy. Outwardly no changes either. Therefore, with such a pathology, a person can live a full-fledged life subject to some rules.
The symptomatic hypertrophy of the left kidney or the right manifests itself with the corresponding symptoms - pain in the lower back, signs of intoxication, problems with urination. The state is worsen if the second kidney is also damaged.
Diagnostics
Detect hypertrophy kidney easily with ultrasound examination. To assess its functional abilities, the following blood and urine indicators are tracked:
- The level of creatinine and urea in the blood - the filtering ability of the kidney;
- The amount of protein and salts in the urine, the proportion of the urine is the concentration ability of the kidney.
What to do a person with hypertrophied kidney?
Vicar hypertrophy does not require treatment, since this is a process of device. However, it is important to maintain the health of this single kidney. This requires compliance with several rules:
In compliance with these activities, the only kidney will remain healthy, will perform the function in full and the person will forget that he lives with one kidney.
Treatment of hypertrophy of the kidney is required if it is damaged:
- Elimination of inflammation with the help of antibacterial drugs;
- Restoration of the volume of functioning tissue;
- If the treatment is inefficient, you have to consider the issue of removal of the body.
In conclusion, we can say that kidney hypertrophy can be both a useful, adaptive process and pathological condition. The life expectancy of a person with hypertrophied kidney depends on the full compliance with their recommendations on a healthy lifestyle.
In the literal translation from the Greek "Parenchima" means: filling something, or stuffing. Medical interpretation is stricter: This is a tissue structure that allows you to carry out a specified function.
Since the functions of the organs are usually not limited to any one task, their structure is distinguished by complexity, and the parenchyma of the kidney is no exception to this rule.
Given that the kidney is concluded in a rather dense connective tissue capsule that prevents the organ stretching, its parenchyma, how it is impossible to match the literal meaning of the word - filling.
Structure and destination Parenhim
Under the capsule, there are several layers of a dense substance of parenchyma, characterized in both their colors, and according to the consistency - in accordance with the presence of structures in them that allow you to perform the problem facing the problem. 
In addition to its most famous destination - to be part of the excretory (excretory) system, the kidney also performs the functions of the organ:
- endocrine (intrasecrete);
- oSMO and ion-regulating;
- participating in the body both in the overall metabolism (metabolism) and in blood formation - in particular.
This means that the kidney performs not only blood filtering, but also regulates its saline composition, the water content is optimal for the needs of the body, affects the blood pressure level, and in addition - produces erythropoietin (biologically active substance regulating the erythrocyte formation rate) .
Cork and brain layers
According to the generally accepted position, two kidney layers are customary:
The layer that occurs directly under the density capsule, the most outdoor in relation to the center of the organ, the most dense and most light-cooled, is called cortical, the same under it, the more dark and close to the center is a cerebral layer.
Fresh longitudinal cut is even an unarmed tear.
In the purely external monolithization, the kidney is characteristic of the pyramid, due to the existence of pyramids, delivered by natural structures - renal pillars formed by the cortical substance separating the brain on the share.
Urine Treecuffs and Education
For the possibility of cleaning (filtration) of blood in the kidney, there are zones of direct natural contact of vascular formations with tubular (hollow) structures, the structure of which allows the use of osmosis and hydrodynamic laws (resulting in fluid current) pressure. These are nephrons whose arterial system forms several capillary networks. 
The first is a capillary tangler, fully immersed in a bowl-shaped deepening in the center of the flask-shaped expanded primary element of the nephron - Capsules of the Sillyan-Bowman.
The outer surface of the capillaries consisting of one layer of endothelial cells here is almost completely covered by intimately firmly adjacent cytopodies. These are numerous sandy processes, the beginning of its boring cytotracks from the centrally passable beam, in turn, which is the cell of the cell-undercite.
They arise due to the walking of the "legs" of some kind of noise in the intervals between the same proceedings of other, neighboring cells with the formation of a structure resembling a lock-zipper.
The narrowness of filtration (or slit diaphragms), due to the degree of abbreviation of the "legs" of the noise, serves as a purely mechanical obstacle for large-sized molecules, which does not allow them to leave the capillary channel.
The second wonderful mechanism that ensures the subtlety of filtration is the presence of proteins with electrical charges on the surface of the slit diaphragm, which has a charge of the molecules approaching them in the filter blood. Such an electric "curtain" also prevents unwanted unwanted components into the primary urine.
The mechanism for the formation of secondary urine in other departments of the renal channel is due to the presence of osmotic pressure directed from the capillaries into the lumen of the station, braided by these capillaries to the state of the "sticking" of their walls to each other.
Parenchym thickness at different ages
In connection with the onset age-related changes It comes to the fabric arthrophy with thinning of both cortical and brain layer. If at a young age, the thickness of the parenchyma is from 1.5 to 2.5 cm, then by reaching 60 or more years, it is thinned up to 1.1 cm, leading to a decrease in the size of the kidney (its wrinkling, usually amused).
Atrophic kidney processes are associated with both a certain lifestyle, and with the progression of disease acquired during the life.
To states causing a decrease in the volume and mass of the renal tissue, they lead both overall diseases of the sclerosing type and the loss of renal structures the ability to carry out their functions in mind:
- voluntary chronic intoxication;
- lifeline lifestyle;
- the nature of activities related to stress and production harm;
- accommodation in a certain climate.
Column Bertini
Here are also referred to as bertinium columns, or renal pillars, or BERTEN pillars, these having the appearance of the cable tissue beams passing between the kidney pyramids from the cortical layer to the cerebral, divide the organ on the shares in the most natural way. 
Because within each of them there are blood vessels that ensure the metabolism in the body - renal artery and vein, at this level of their branching having the name of the interdolevous (and the next - dolkov).
Thus, the presence of berten columns, differing in a longitudinal section from the pyramids by a completely different structure (with the presence of sections of the tubules passing in various directions), allows the connection between all zones and the formations of the renal parenchyma.
Despite the possibility of existence within a particularly powerful BREDEN post, the fully formed pyramid, the same intensity of the vascular pattern in it and in the cortical layer of parenchyma indicates their single origin and purpose.
Parenchimato jumper
The kidney is a body that can take any form: from the classic besebid to the horseshoe or even more unusual.
Sometimes the ultrasound of the organ reveals the presence of a parenchymathous jumper - a connective tank in it, which, starting at its dorsal (rear) surface, reaches the level of the median renal complex, as if making the kidney across two more or less equal "semi-infansolines". Such a phenomenon is explained too strong inclusion of Burten pillars to the kidney cavity.
With all the apparent unnaturalness of such a form of the organ with the unability of its vascular and filter structures, this structure is considered an option for the norm (pseudopathology) and the testimony for surgical treatment is not, as well as the presence of parenchymal halves that dividing the renal sinus into two words would be separate, but Without full doubling of the pelvis.
Regeneration ability
The regeneration of the kidney parenchyma is not only possible, but also safely carried out by the body in the presence of certain conditions, which has been proven by long-term observation of patients, transferred glomerulonephritis - an infectious-allergic-toxic disease of the kidney with mass damage to the kidney taurus (nephrons). 
Studies have shown that the restoration of the organ function does not occur due to the creation of new ones, and by the mobilization of already existing nephrons, which were in a canned state. Their blood supply remained sufficient solely to maintain minimal activity in them.
But the activation of neurohumoral regulation after the eknation of the acute inflammatory process led to the restoration of microcirculation in zones, where the renal tissue was not subjected to diffuse sclerosis.
These observations make it possible to conclude that the key point for the possibility of regeneration of the renal parenchyma is the ability to restore blood supply in areas where it for any reason has decreased significantly.
Diffuse changes and echogenicity
In addition to glomerulonephritis, there are other diseases that can lead to the emergence of focal atrophy of the renal tissue having a different degree of extensity, called medical terms: diffuse changes in the structure of the kidneys.
These are all diseases and conditions leading to the sclerosis of the vessels.
The list can be started with infectious processes in the body (influenza, streptococcal infection) and chronic (familiar household) intoxications: alcohol reception, tobacco. 
Its production and non-carrying noble service (in the form of work in an electrochemical, electroplating workshop, activities with regular contact with high-oxic lead compounds, mercury, as well as associated with high-frequency electromagnetic and ionizing radiation).
The concept of echogenicity implies the heterogeneity of the structure of the body with different degrees of permeability of its individual zones for ultrasound research (ultrasound).
Just like the density of various fabrics is different for "translucent" by X-rays, on the way of ultrasonic ray, both the formation of hollow and areas with high tissue density are also found, depending on which an ultrasound picture will differ in a large variety, giving an idea of inner structure organ
As a result, the ultrasound method is a truly unique and valuable diagnostic study, which is not able to be replaced by any other, allowing to give a complete picture of the structure and work of the kidneys, without resorting to an opening or other traumatic actions against the patient.
Also an outstanding ability to restore in case of damage, it is possible to largely regulate the lifespan of the body (as by way of its savings by the owner of the kidney and the provision of medical assistance in requiring the intervention cases).
Are hyperheogenic inclusions dangerous for life?
Hyperehogenic inclusions are usually detected during the ultrasound of the kidneys. They are a certain kind of tissue areas with large acoustic seals, which may be simple stones from urolithiasis or be hazardous formations in the form of a benign or malignant tumor. These are structures, more dense compared to the surrounding tissues of the body, perfectly blending ultrasound and thereby creating hyperhehogenicity. On the monitor of the Uzi apparatus, they are indicated by white spots.
What are hyperheogenic inclusions?
On the ultrasound of the kidneys, such neoplasms are visualized in the form of small linear, point or volumetric structures with a high indicator of echogenicity. They are located within the renal fabric. In medical practice it is noted that such hyperheogenic inclusions are peculiar calcifications from which microcalcifications are distinguished - point particles without accompanying acoustic shadows. If the presence of microcalcification is diagnosed in the nodule formation, many doctors talk about the development of a malignant tumor.
Quite often, experts come precisely to such a view, since hyperehogenic formations are mainly beginning to manifest themselves in tumors of malignant orientation. In a malignant tumor, three varieties of structures are distinguished:
- pesammomy Taurus - make up half of echogenic education;
- calcificent - only 30%;
- sections of sclerosis - 70%.
In a benign kidney tumor, there are no psammomy tales, calcifications can also be found quite rarely. These are mainly sclerosis.
Varieties of hyperechogenic inclusions. Diagnostics
Only a specialist is able to detect hyperehogenic inclusions in the kidney during diagnostics. It can be stones or sand in the kidneys. Today, several varieties of such inclusions are known:
- spot inclusions that are visualized quite brightly: they are small and do not have acoustic shadow;
- large education, which also lacks an acoustic shadow. In kidneys, they are rarely formed, doctors mainly diagnose them during the ultrasound of the kidneys. They can be localized not only in malignant, but also a benign tumor;
- large formations, which contains an acoustic shadow. They fully correspond to sclerotic parts.
Hyperehogenic inclusions in the kidneys can be found with the help of kidney ultrasound or suspect their presence by pronounced symptoms:
- elevated temperature
- a change in urine color
- frequent coliks in the field of kidneys
- strong pain in the stomach or below the belt or permanent pain in the groin,
- vomiting and nausea.
These symptoms are similar to the manifestations of other diseases, so at first suspicions of kidney stones, you should immediately consult a doctor. In order not to launch the disease, it takes every six months to pass a full examination, donate blood, urine, cal. Thus, it is possible not only to prevent the development of any diseases, but also to avoid some diseases.
For the prevention of stones in the stomach, it is necessary to use liquid more often: water, rosehip, tea with herbs (mint, oregano, rowan, etc.). This will make it possible to clean the body from slags and salts by means of frequent urination.
Diseases caused by hyperahogenic inclusions of the kidneys. Treatment
In most cases, hyperheogenic kidney inclusions are manifested in the form:
- inflammatory process: carbuncoon, kidney abscess.
- cystricular growths (usually in its composition have liquid).
- kidney hemorrhage (peculiar hematomas).
- kidney tumors (benign or malignant).
If the doctor suspected the above diseases, he sends the patient to a comprehensive examination with the use of MRI. In some severe cases, kidney biopsy is required.
Hyperehogenic inclusions cure not easy, but perhaps. Stones are displayed in two main ways. The first method is based on a frequent urination, for which special diuretic herbs or drugs are used that the doctor prescribes. The second method is the removal of stones using laser rays when their crushing occurs. Using the first method, you can treat small formation of stones, not more than 5 mm. In case of running disease, the kidney is removed, then prescribed chemotherapy in order to remove the remaining formations. In such radical situations it is necessary to constantly comply with the diet.
Remember: only a specialist will be able to put an accurate diagnosis. Based on the ultrasound of the kidneys and analyzes, it will assign appropriate treatment. Never engage in self-medication - so you can exacerbate the situation.
Parenchima kidney and its pathology
It happens that you heard the word and even intuitively understand what we are talking about, but you can't clearly formulate your knowledge. It seems to me that "Parenchima" is just from such words.
The emerging uncertainty can be understood, because this term does not indicate something defined. Historically, it was so far that the term "parenchyma" was introduced for the differences between the tissue of tissues that fill the organ, from its outer shell and internal jumpers, which depart from this shell. This term describes the different structure or functionality of the structure that are located in the space between the connecting jannabase of the organ, which is called the stroma. Schematically, the structure of the organ can be represented as: outside the organ is covered with a shell of connecting tissue, often containing smooth muscle fibers.
From this shell into the thickness of the organ, partitions - trabecules, for which the nerves, lymphatic and blood vessels penetrate inside penetrate. The lumen between these partitions is filled with a working part of the organ - Parenkhima. It is different in different kinds of organs: the liver parenchyma is a glanded fabric, the spleen is a reticular coupling. Parenchima may have a different structure and within the same organ, for example, as a cork and brain layer. Parenchima rich organs are called parenchymal.
Internal kidney organization
Based on the above, you can say for sure that the kidney is a parenchymal organ. Outside, she has a fibrous capsule containing many myocytes and elastic fibers. From above of this shell there are still capsule from fatty fiber. All this complex together with adrenal glands is surrounded by a finely connected fascia.
Parenhim kidney, what is it? On the longitudinal section you can see that the flesh of the organ is presented as if two layers, different in color. Outside there is a lighter cortical layer, and the darker brain is located closer to the center. These layers mutually penetrate each other. Piece of the brainstant in cortex is called "Pyramids" - they look like rays, and parts of the cortical parenchyma forms between them "Burten poles". With its wide part of the pyramid addressed to the cortical layer, and a narrow part (renal papilla) - to the inner space. If you take one pyramid with the adjacent cortical substance, then we will get a renal share. For up to 2-3 years old, due to the fact that the cortical layer is still not developed sufficiently, the slices are well defined, i.e. The kidney has a prayer structure. Adults almost disappear in adults.
Both renal parenchyma layers are formed by various departments of nephron.
Nephron is a mini filter consisting of different functional departments:
- renal calf (tank in the capsule - "Bowman capsule");
- the tube (it defines the proximal department, a loop with a downward and upward part - "Loop Genla" and the distal department).
The cortical substance is formed by renal calves, proximal and distal parts of the nephron. The brain layer and its protrusion in the form of rays is formed by descending and rising parts of the loops of cortical nephrons.
In the middle you can see a cup-loaning system. After filtration and reverse absorption occurring in nephrons, urine through the renal papillas falls into small, and then into large renal cups and a locher, moving in the ureter. These structures are formed by mucosa, muscle and serous tissues. They are located in a special shower, which has the name "renal sinus".
Measured indicators
Like any body, the kidneys have their own norms of health indicators. And if the renal functionality is used by laboratory methods of urine research and observation of urination rhythm, then the integrity of the body acquired or congenital anomalies It can be judged according to the survey of the ultrasound, CT (computed tomography) or MRI. If the obtained indicators fit into the norm, it means that the renal fabric did not suffer, but it does not make an occasion to talk about the preservation of its functions.
Normally, the size of this organ of an adult is reached 10-120 mm in length and 40-60 mm wide. Often the dimensions of the right kidney are less than the left. With a non-standard physique (too large or fragile), it is estimated not to size, but the volume of kidney. Its normal indicator in digital expression should twice the mass of body ± 20 ml. For example, when weighing in 80 kg, the volume rate of 140 to 180 ml.
Kidney echostructure
Uzi estimates organs and tissues by their ability to reflect or skip ultrasound waves. If the waves are freely passing (the structure of the hollow or liquid is filled), then they are talking about its anechogenicity, echonegability. Than dense fabricThe better it reflects ultrasound, the better its echoism. Stones, for example, show themselves as structures in which echogenicity is increased (hyperhekin).
Normally on ultrasound kidney inhomogeneous structure:
- pyramids - hypooechogenne;
- cork substance and pillars - isohogen (the same interchangeable);
- sinuses - hyperhekinny due to connective, fibrous, adipose tissues and vessels located there and vertices of the pyramids. A cup and male complex is normal not visualized.
Pseudopathology
In some cases, with ultrasound, the fact that, at first glance, it seems pathology, it is not. So, often enlarged Burten pillars are deeply overlooking the parenchyma into the renal sinus. It seems that this parenchymal jumper literally divides the kidney in half. However, all the structures from which the jumper consists are normal kidney cloth. Often enlarged BERTEN pillars or such jumpers are taken for the tumor.
Different variants of the structure of the cup-laughter system should not be attributed to pathology. The options for their configuration are a great set, even one person has the structure of the right and left kidney - individually. This also applies to the anatomical structure of kidney parenchyma.
In ambiguous can be considered partial doubling of the kidney. At the same time, the parenchymal hauling divides sinus into two as part of the separated departments, but the whole split of the loching does not occur. This condition is considered an option for the norm and mainly discomfort does not bring.
Diseases reflected in kidney parenchyma
Tuberculosis
Usually defeat kidneys occurs on the background common disease organism. Mycobactercerezes is in the kidneys with a blood current, less often lymph or through the urinary tract. As a rule, the disease affects both organs at once and when it progresses in one of the kidneys, then at this time is in a dormant state.
The specific change in parenchyma is characterized by the appearance of tuberculous tuberculos in the cortical matter. Next, the process goes to the brainstatus and renal nipples. Fabrics are ulcerated, cavity (cavities) are formed, tuberculous tuberculos continue around these cavities, creating an even greater area of \u200b\u200bthe decay of the tissue. When this process is transferred to the renal sinus and ureter, the kidney functions are turned off with impairment of urinary.
In addition to direct defeat of kidney parenchyma, tuberculosis provokes the formation of calcinates. Calcinate is the process of replacing damaged tissue, an irreversible change due to the deposition of calcium salts.
The treatment of calcinates does not imply its "crushing" or drug destruction. They themselves are able to resolve after cure from the main disease that caused damage to the tissues.
The therapy of the kidney tuberculosis involves anti-tuberculosis drugs - isoniazide, streptomycin and rifampicindl of intravenous administration, with the transition to oral forms. Treatment is long-year-and-a half. At the same time, surgical removal of damaged kidney fabric.
Tumor process
The kidney tumor is quite common because it can cause a variety of reasons:
Regarding the nature of the kidney tumor can be primary - occur in the kidney itself or secondary - germinate from other organs. By the nature of the growth of the tumor is divided into benign and malignant. Among the malignant kidney neoplasms, the first place is occupied by hypernephroid (renal-cell-cell) cancer, located mainly in the cortical layer. However, it may also be in the brainstant and sinus. Also isolated non-hypernephroid cancer and sarcoma. The difference is in the nature of the tissue from which the tumor develops.
Separately stand mixed tumors. They are most often found in children, since they develop from even undifferentiated tissues in the embryonic stage. In such mixed tumors at the cellular level, the sections of fat, muscular and nervous tissues are determined.
At ultrasound, malignant education has an irregular shape, without clear boundaries with the possible inclusion of vessels. Calcinates and cysts may also be present in Parenhim necrosis places.
It is possible to reliably to distinguish benign swollen from malignant, perhaps only with the help of biopsy.
Urolithiasis disease
The formation of stones is a physico-chemical process, during which crystals are formed from the oversaturated salt solution. In the kidneys, this process is regulated by special enzymes, in the absence of which the function of the nephron tubes is disturbed, there is an increase in the salts in the urine, the conditions of their dissolution are changed and they fall out as a precipitate. Stones cause sclerosis and atrophy of kidney pellets, from where the process can spread to a parenchyma. Its functional units are dying and replaced by a fatty cloth, and the kidney capsule is thickened.
Large stones are capable of blocking the outflow of urine from a loyalty through a ureter. Due to the growing intravenous pressure, the ureter expansion occurs, and then the cup-pyrene complex. With long blockage of the ureter's duct, not only the affected kidney loses its functional ability, but also the second organ too.
Symptoms of the defeat of parenchyma and treatment perspectives
Damage to the renal parenchyma affects its functions - filtering and excretory, which is immediately displayed in the state of the whole organism.
Weakness and signs of intoxication appear; The temperature rises; The skin color changes, it becomes dry; violated rhythm and urination volume; blood pressure increases; Evenkers on the face, hands and legs are formed; Laboratory urine indicators change, and the naked view in it is determined by turbidity, pus or blood.
A urologist has a variety of instrumental and laboratory research methods in his arsenal to determine the cause of the kidney disease and appoint adequate treatment.
The best news is that the kidney is capable of functioning while maintaining even 1/3 of the body. The recovery of parenchyma occurs not due to the formation of new nephrons, but by increasing the preserved under the action of neurohumoral regulation. To do this, it is necessary to stop the damage to the damage. Then the organs create conditions for the restoration of microcirculation and hemodynamics, which underlies the resumption of the kidney function. Unfortunately, if the kidney cloth is sclerized and there is no possibility of its vascularization (vessel germination), then it is impossible to restore the functions.
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Introduction
Kidney tumors make up 2-3% of all malignant neoplasms. Most often they arise aged 40-60 years. Among all kidney tumors in 80-90%, renal and cellular cancer is noted. In recent years, the likelihood of its detection increases, which is associated both with an increase in the number of all malignant formations and with early preclinical diagnostics. Recognize malignant formations, first of all, allow constantly improving and widely used ultrasound studies of the kidneys.
The first message on the use of ultrasound in the diagnosis of kidney tumors was published in 1963. J. Donald (J. Donald). Since then, the accuracy of ultrasonic diagnosis of kidney tumors has increased from 85-90% to 96-97.3%. When using modern ultrasound scanners working in fabric and second harmonics modes, as well as the color Doppler and energy mappings and dynamic echocontrase angiography, the sensitivity of ultrasound (ultrasound) is 100% with specificity 92 and the predictability of a positive test 98%, and negative - 100% .
In the literature, there are often publications on errors not only ultrasound, but also other radiation diagnostics methods. There is a point of view that up to 7-9% of all volumetric processes in the kidneys cannot be differentiated to operations on cyst, tumors, abscesses, etc. . The picture of the tumor kidney during ultrasound and other radiation methods Diagnostics can simulate many processes. Among them: a variety of kidney anomalies; "complex" or mixed cysts; Acute and chronic nonspecific inflammatory processes (carbuncoon, abscess, chronic, including xantoganulmatose pyelonephritis); Specific inflammatory processes (tuberculosis, syphilis, fungal damage kidney); changes in kidneys during leukemia and lymphomas, including HIV infection; kidney heart attacks; Organized hematomas and other reasons.
This message will be discussed only about kidney anomalies, which in the literature are determined by the term pseudochuch. With them clinical manifestations It is almost always absent or determined by concomitant diseases, and the establishment of the correct diagnosis is possible only by radiation diagnostics methods (Fig. 1).
but) Fetal ratios, humpback kidney.
b) Burten's hypertrophy, enlarged "lip" over the kidney gates.
Materials and methods
For 1992-2001 177 patients were observed with a different structure of kidney parenchyma according to the type of kidney pseudo-pumping. Everyone has repeatedly been carried out ultrasound kidney scanning, ultrasound dopplerograph (USDG) kidney vessels - 78, including using the second and tissue harmonics and energy dopar modes - 15, excretory urbory \u200b\u200b(EU) - 54, X-ray computed tomography (RTC) - 36, Renal scintigraphy or emission computed tomography (ECT) with 99 m Tc - 21.
Research results
Fetal struts The kidneys (see Fig. 1) with multiple empty in the lateral kidney contour in this message was not considered, since it did not cause the need for differential diagnosis with the kidney tumor. Among the 177 patients with pseudo-pumping kidney in 22 (12.4%), a variant of the porch kidney was identified - "humpback" kidney "(Fig. 2).
b) Series of computer tomogram.
In 2 (1.2%) of patients marked the increased "lip" above the kidney gates (Fig. 3a-B).
b) Excretory Urogram.
in) CT with contrast gain.
The most common cause of pseudo-pump was "hypertrophy" of Burten or "jumper" kidney parenchyma - in 153 (86.4%) of patients (Fig. 3 Mr.). The "lintels" parenchyma were noted not only at various doubling of cup-making kidney systems, but also with different sacrifices and incomplete twists.
e) Excretory Urogram.
e) CT with contrast gain.
In the conduct of differential diagnosis of pseudo -umoplas and kidney tumors, 37 (21%) patients needed. For this purpose, repeated "aimed" ultrasound scans using various additional ultrasonic techniques under the conditions of the urological clinic, as well as other methods of radiation diagnostics mentioned above were carried out. Only one patient with the pseudo-turn of the kidney to exclude the diagnosis of the tumor produced exposive lumbotomy with intraoperative biopsy under ultrasound control. In the other 36 patients, the diagnosis of pseudo-pumping kidneys was confirmed using ruff Research and ultrasound monitoring.
The difficulties and errors of radiation diagnosis in pseudo-obscenities of the kidney usually occurred at the first doggowns of diagnostics. In 34 (92%) patients, they were associated both with the objective difficulties of interpretation of unusual echographic data and their irregular interpretation due to the insufficient qualifications of specialists and a relatively low level of diagnostic equipment. In 3 (8%) patients, an erroneous interpretation of X-ray computer tomography data was noted when there was a discrepancy with the data of repeated ultrasonic scanning and X-ray computed tomography in the urological clinic.
Tumors of the kidneys that had combinations with pseudo-turn in one kidney were verified in 2 patients after nephrectomy, and pseudo-pumping - in one patient with biopsy under ultrasound control during exploratory lumbotomy; In the rest - with ultrasound monitoring on time from 1 to 10 years.
Discussion
One of the most frequent reasonsthat simulate the kidney tumor with an ultrasound study, the so-called pseudo-turn, in the literature is most often determined by the term hypertrophy of Burten's column.
As is known, in the periphery of the ultrasound cutting of the kidin, the cortical substance forms invagination in the form of columns (columnae bertin) between the pyramids. Often Berten's post is deep enough to go beyond the inner contour of the parenchyma in the central part of the kidney - to the renal sinus, making the kidney more or less fully into two parts. The resulting penetrating parenchymal "jumper" is an unprofitable parenchy pole of one of the poles of the kidneys, in the process of ontogenesis of adult adult merging into the kidney. Anatomical substrate "jumpers" are the so-called connective tissue defects of the parenchyma or the latter to the latter in the kidney sinus. It includes a cortical matter, Burten pillars, kidney pyramids.
All elements of the "jumper" are a normal parenchyma cloth without signs of hypertrophy or dysplasia. They are a doubling of the normal kidney cortony or an additional layer of it, located lateral of the cups. The latter is a variant of the anatomical structure of parenchyma, in particular, the corticomallar relations between the parenchyma and the kidney sinus. They can be most clearly traced on ultrasound and on computer-tomographic kidney cuts.
The absence of hypertrophy or dysplasia of parenchyma with the so-called hypertrophy of Burten columns or "jumpers" parenchyma confirmed and carried out histological research The biopsy material in one patient with the "jumpers" parenchyma, taken to the exposive lumbotomy for the kidney tumor, as well as in two patients with a morphological study of the kidneys, remote about the combination in one kidney of the tumor and pseudo-pump ("jumper" parenchyma).
In this regard, in our opinion, the most frequently found in the literature, the term hypertrophy of Burten pillars does not reflect the morphological essence of the substrate. Therefore, we are the same as a number of authors believe that the term "jumper" parenchyma is more correct. For the first time in the domestic literature on ultrasound diagnostics, it was applied in 1991. It should be noted that the term "jumper" parenchyma had in the literature and other names (table).
Many years of experience of an excretory urography showed that cup-making systems have an extremely large number of build options. They are practically individual not only for each person, but also for the left and right kidney in one subject. With the development and ever wider use of ultrasound and RTC, allowing to trace both internal and external contours of kidney parenchyma, in our opinion, a similar position is also formed in relation to the options of the anatomical structure of the kidney parenchyma. Comparison of echo and computer-tomographic data with urographic cases at various embodiments of kidney pseudocholas showed that there is a relationship between the anatomical structure of the kidneys and cup of kidney. It is expressed in the congruence of the medal contour of the parenchyma in an echo or computer-tomographic image with the lateral contour of cup-making systems, conditionally spent on excretory urograms or on computer tomograms with contrasting amplification. This symptom can be traced with the usual structure of parenchyma and cup-making systems, as well as with a "jumper" kidney parenchyma, which is an option of an anatomical structure. With a tumor of the kidney, which is an acquired by the pathological process, the congruence of the contours of the parenchyma and cup-making kidney systems is broken (Fig. 4).
Fig. four. The symptom of the congruence of the contours of the parenchyma and a cup-making kidney system with an incomplete "jumper" parenchyma (explanation in the text).
conclusions
Thus, for the first time, the typical echographic paintings "jumpers" of the kidney parenchyma, the hunchback of the kidney and an enlarged "lip" above the kidney gates without signs of expansion of cup-making systems do not require further surveys.
If necessary, the differential diagnosis of pseudo-diagnosis and kidney tumors, which was required in 37 (21%) patients, we offer the following algorithm for their diagnostics (Fig. 5).
Fig. five. The algorithm of radiation diagnosis during pseudo-pumping kidney.
- Re-ultrasound qualified professionals At higher-class UZ-scanners using UDG, mapping, fabric and second harmonics techniques.
- X-ray computer tomography with contrasting reinforcement or excretory urography with comparison of uro- and echographic data and data of repeated "aimed" ultrasound.
- Selection methods - renal scintigraphy or emission computed tomography with 99 m Tc (False negative results are possible with small tumors).
- With remaining suspected malignant tumors - biopsy under ultrasonic control (only a positive result is a diagnostic value).
- With a negative result of a biopsy or a refusal of a patient from biopsy and operational audit of the kidney, ultrasound monitoring is carried out with a frequency at least once every 3 months in the first year of observation, and then 1-2 times a year.
Literature
- Demidov V.N., Tyaker Yu.A., Amosov A.V.// Ultrasound diagnosis in urology. M.: Medicine, 1989. p.38.
- Hutschenreiter G., Weitzel D. Sonographic: EineWertwolle Erganzung der Urologichen Diagnostic // Aktuel. Urol. 1979. Vol. BD 10 N 2. P. 45-49.
- Nadaryishvili A.K. Diagnostic capabilities of ultrasound research in patients with a tumor kidney // 1st Congress of the Association of Ultrasound Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 22-25, 1991. P.121.
- Büilov V.M. Comprehensive application and algorithms of ultrasound scanning and x-ray diagnostics for kidney and ureteral diseases: dis. . Dokt. honey. science M., 1995. P. 55.
- Modern ultrasound diagnostics of the volume formations of kidneys / A.V. Zubarev, I.Yu. Nanicova, V.P. Kozlov et al. // 3rd Congress of the Association of Ultrasonic Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 25-28, 1999 p.117.
- US, CT, X-Ray Diagnosis of Renal Masses / R.K. Zeman, J.j. CROMAN, A.T. Rosenfield et al. // Radiographics. 1986. Vol.6. P. 351-372.
- Thomsen H.S., Pollack H.M. The Genitourinary System // Global Textbook of Radiology. (ED.) Petterson H. 1995. P. 1144-1145.
- Lopatkin N.A., Lulko A.V. Anomalies gOOD SYSTEM. Kiev: Healthy, 1987. P. 41-45.
- Mindel H.J. Pitfalls in Sonography of Renal Masses // Urol. Radiol. 1989. 11. 87. N 4. R. 217-218.
- Burys M.P., Akimov A.B., Stepanov E.P. The echoograph of the kidney and its cup-glass complex in comparison with the data of anatomical and radiological research // ARH.Anat.Histol.Embirol. 1989. T.97. N9. P.82-87.
- Junctional Parenchyma: Revised Definition of Hypertrophic Column of Bertin / H-CH. Yeh, P.h. Kathleen, R.S. Shapiro et al. // Radiology. 1992. N 185. R.725-732.
- Bobrik I.I., Dugan I.N. Anatomy of human kidney with ultrasound examination // Doctor. a business. 1991. N 5. P. 73-76.
- Khitrova A.N., Mitkov V.V. Ultrasonic renal research: clinical guide to ultrasound diagnostics. M.: Vidar, 1996. T. 1. P. 201-204, 209, 212.
- Builov V. Junctional Parenchyma or Hypertrophic Column of Bertini: The Congrunce of their Contours and Calyceal-Pelvic System // Abstracts of Ecr'99, March 7-12. 1999. Vienna Austria.-EUROP. Radiol. Supp.1. Vol.9. 1999. S.447.
- Büilov V.M., Turzin V.V. Echotic and excretory urography in the diagnosis of "jumpers" kidney parenchyma // Vestn. X-ray .radiol. 1992. N 5-6. P. 44-51.
- Büilov V.M., Turzin V.V. Diagnostic value Atypical "jumpers" Parenhima with kidney sonography // Congress of the Association of Ultrasonic Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 22-25, 1991. P. 121.
- Büilov V.M. Questions of terminology and symptom of congruence of contours of "hypertrophied" columns of bertini or "jumpers" parenchyma and cup-making kidney systems // Vestn. X-ray. and radiol. 2000. N 2. P. 32-35.
- Büilov V.M. The algorithm of radiation diagnosis of pseudo-pumping kidneys // Abstracts Dokl. 8th Vsview. Congress of radiologists and radiologists. Chelyabinsk-Moscow. 2001. P. 124-125.
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In our observations, 0.2% of patients was revealed, moreover, in most cases, boys. Eightgnostics presents certain difficulties that increase with the combination of this anomaly with various diseases (hydronephrosis, cysts, polycystic, hematoma, paranefritis, tumors, injuries).
An unaffected horseshoe kidney is always located lower than normal kidney, has large sizes, but never gains the sum of two normal renal sizes, the parenchyma zone and a cup-laughter system is well distinguished. Visualization and differentiation are improved when applying an aqueous load, which allows you to differentiate extended lochkins. It should be noted that it is very difficult to determine how the poles are smashed by the kidneys, except when when inspection through the front abdominal wall, the adrenal glands on opposite poles can be locked, and this is possible only with the left kidney abnormalities.
Galeto-shaped kidney
This anomaly occurs very rarely and is formed as a result of a uniform action of the forces of the small intestine during the period of renal motion of the small pelvis into the lumbar region. With their delay in the pelvis, a battle occurs throughout. The kidney is locked low in the pelvis as a flat-end-elongated formation with clear contours, with the distinction of the parenchyma zone and a cup-making system without differentiation of the battleship. It may be mistaken for a tumor. The incidence of galete-shaped kidneys is difficult when combined with various diseases. Priority for excretory urography.
The asymmetric forms of the battle include kidneys that have grown in the form of Latin letters S, I and L. With this kidney anomaly, the opposite poles are fought by the opposite poles due to the uneven effects of the forces of the small intestine during the period of promoting them from a small pelvic to the lumbar region. The longitudinal axes of S and 1-shaped intestinal kidneys are parallel. The S-shaped kidney is located to the pelvis in a horizontal or oblique position, and the i-shaped kidney is located vertically and parallel to the lower hollow vein and abdominal aorta.
With L - shaped kidney, the longitudinal axes are perpendicular and lokilan in the pelvis in a horizontal position. It should be noted that this anomaly is easy to confuse with horseshoe kidney. Typically, abnormal kidneys have clear contours with a well differentiable parenchyma zone and often zones of two cup-making systems. Sometimes, with S-shaped kidney, it is possible to highlight the experiencing (sobbing place). Despite the fact that echography reveals the presence of abnormal kidney, priority in their differential diagnosis for excretory urography.
Anomalies of quantity
Two kidney
The most common kidney number anomaly (approximately 4%) is the doubling of the kidney, which is unilateral and double-sided, full and incomplete.
Paired kidney
With full doubling there are two collective systems - two magnifiers, two ureter and two vascular beams. On the echogram, the leggings are clearly visible, the beginning of the ureters, sometimes it is possible to allocate vascular bundles.
Undoubted kidney differs from the full that is powered by one vascular beam. The ureter can be doubled at the top and fall into the bladder with one mouth or two guests. On the echoogram, the double kidney looks extended and presents the characteristic sign of the disagreement of the zones of the parenchyma and a cup-making system.
Difficulties in echographic differentiation occur during pyelonephritis, hydronephrosis, urolithiasis and tumors of one of the half of the doubled kidney. A complete anatomical picture of double kidney can only be seen x-ray.
This pathology is extremely rare. Paired kidneys can be single and double-sided, identical or different in size. According to our data (in the affordable literature, the description of this pathology was not met), one-sided paired kidney revealed 5 women in the erase and two-way in 2 pregnant women aged 21 and 28 years. In 6 out of 7 cases that we identified, paired kidneys were the same value, an average of 8.2-3.6 cm. For the width of the kidneys, they were taken only to / 2 hosts of the parenchyma zone in the controversial part of the kidneys.
A characteristic feature is their longitudinal battle by side surfaces. The echostructure of paired kidney does not differ from such a normal kidney, that is, the parenchyma zones and a cup-making system are very clearly distinguished. A feature is that the width of the parenchyma zone at the site of the battle does not exceed the magnitude in the unsolved part of the kidneys. By echocartine, it can be assumed that the battle is at the level of the entire thickness of the parenchyma of both kidneys. The variant of the full longitudinal doubling of the kidney is not excluded. Ureterals behave in the same way as with full doubled kidney.
Anomaly kidney parenchyma
The anomalies of the renal parenchyma include Agenesia, Aplasia, hypoplascent kidney, the addition (third) kidney, additional slicing and cystic anomalies of parenchyma - polycystic, multicastosis, solitary cyst, multi-culture cyst, spongy kidney, megakolikosis and cups of cups.
Agnesia
Congenital absence of one or both kidneys. With one-sided Agensia, the specificity of the kidney structure does not hide on this side, but sometimes it is possible to loking an increased adrenal gland. On the opposite side, hypertrophored, defective in the echosor of the kidney.
However, it should be remembered that the lack of the kidney location in an anatomical place does not indicate the presence of Agenesia. The final diagnosis can be delivered only after detailed echographic and radiological studies. Bilateral Agensia is very rare and diagnosed by the fetus in the II and III period of pregnancy, when all organs are developed. In this case, a thorough echographic study does not reveal the echostructure of the kidneys and bladder. The study is carried out with difficulty, since at this anomaly there is always a small one. Fruits with this anomaly are born dead.
Aplasia
Deep underdevelopment of renal parenchyma with frequent cases of the absence of a ureter. One and double-sided one can meet.
With a one-sided Aplasia, there is no specificity of the structure of the kidney and the oval-extended formation with fuzzy erased contours, heterochogenic (different acoustic density), although small cysts and calcifications can be locked. It is not clinically manifested and is a echographic find in the study of the kidneys.
A bilateral aplasia is extremely rare. At the same time, the fetus cannot identify the image of the kidneys and bladder.
Gimoplascent kidney
Congenital reduction in kidney sizes. The kidney echoogram is reduced in size (on average it has a length of 5.2 cm, a width of 2.4 cm), the parenchyma zones and a cup-lowering system are narrowed, but the specificity of the structure of these zones is preserved.
In 3 patients, we observed a dwarf kidney with a value of 3-2 cm. Kidney contours of the worst, parenchyma is heterogeneous on echogenic; There is no division on the zone.
It should be remembered that it is very difficult to distinguish the hypoplascent from the wrinkled kidney, in which the dimensions are also reduced, but the latter has an elevation of the contours and separation into zones; Such a kidney is poorly rewarded from the fabrics surrounding it.
Additional (third) kidney
It is extremely rare. We have identified 2 cases. The added kidney is usually located below the main and can be somewhat less. In our cases, the main and added kidneys were located in the horizontal plane and had the same dimensions, but somewhat less generally accepted averages for this age (7.1-2.8 cm). Parenchima and a cup-making system in both kidneys are distinguished clearly. The ureter of the added kidney can be included in the main ureter or independently in the bladder.
An additional slicing of one of the kidneys can be one (or more) and is located more often at the poles, it is located as a small oval formation with clear contours; The echostructure of the polek is similar to the main kidney fabric. Sometimes additional slices are easy to adopt for the adrenal gland, although their echo structure varies somewhat, sometimes they can be confused with a volume formation growing exofite.
Anatomical variations of normally functioning kidney
There are anatomical variations in the structure of the parenchyma and a cup-making kidney. Immediately it should be noted that they do not have clinical significance, however, some of them in front of the researcher can supply diagnostic problems.
The parenchyma defect is rare and located in the form of an echogenic triangular zone, the base of which is associated with the fibrous capsule, and the top with the wall of the kidney sinus.
Kidney with oval-convex uneven outdoor contour
It is often found. It is characterized by isolated hypertrophy (swelling in the form of a hump) Parenhima toward the outer edge of the middle third of the kidneys. An inexperienced specialist can mistakenly take it for a tumor with exofite growth or carbuncoon (with the latter there is an acute clinic).
Overlooking kidney
Usually occurs in children up to 2-3 years. Rarely, such a phase of the embryonic structure remains in adults. It is characterized by a uniform separation by 3-4 sputtering on the outer surface of the low echogenic zone (Parenhima Lake).
Kidney with an isolated zone of hypertrophy parenchyma inside
This anomaly of Parenhima meets quite often, it is characterized by isolated hypertrophy and empty in the form of a pseudopod between two pyramids to a cup-making system, which, in the absence of a clinic, we tend to consider an individual norm. It can be accepted for a tumor, in connection with which patients with exophytic and endophyte additional growth of parenchyma should be subjected to invasive research methods.
Polycystic kidney
Congenital, always bilateral cystic anomaly kidney parenchyma.
Prior to the introduction of echography, especially in real time, the diagnosis of polycystosis represented great difficulties, since the percentage of proper diagnosis of radiological methods does not exceed 80. In our observations, more than 600 patients, echographic diagnostics turned out to be correct in 100% of cases. The polycystic kidney is always increased in size, the contours are uneven, oval-convex, the echorate structure is not differentiated, only the strips of parenchyma are visible and many rounded different sizes of anechogenic formations (cysts) separated by thin echogenic strips of partitions. Sometimes polycystic kidney acquires a bunch of grapes. But in most cases, slightly large, up to 5-6 cm in diameter, cyst, surrounded by many small ones. Sometimes with dynamic observation of the patient, you can observe the disappearance of large cysts, their gaps.
The study is carried out on the side of the back, but the visualization of the right kidney is better carried out through the liver. It should be noted that with significant kidney sizes and the presence of a set of cyst, the liver is visible only partially or not visible at all, and you can mistakenly diagnose the liver polycystic plant, which is extremely rare.
Multi-call dysplasia
Congenital anomaly, which is more often unilateral, as the bilateral is not compatible with life. The cartoon kidney is usually large, distinguished by the irregularity of contours, the parenchyma is not differentiated and completely substituted by cysts of various sizes, more often than 2-3 large. For the purpose of differential diagnosis of polycystic and multi-storey, X-ray research methods are used. For the kidney multipleness is characterized by high borders of the ureter.
Solitary cyst
There are congenital and acquired kidney cysts. Congenital cysts are revealed from the fetus in the II and III of trimesters of pregnancy or more often in childhood. Acquired cysts are detected more often after 40 years. There are single, but not more than 2-3 in one kidney. Located as rounded formations of different sizes: minimum - 0.5 cm, maximum - over 10 cm in diameter. The kidneys come from parenchyma and have clear contours, devoid of echo signals are located both on the surface and in different kidney departments.
A certain difficulty represents the refinement of the location of the cyst; First of all, this refers to parapelvicious cysts located in the field of kidney gates. In some cases, they are difficult to differentiate from an extended jelly, hydronephrosis, which may have a similar oval form. In this regard, it should be remembered that in the case of hydronephrosis, the interruption of liquid education contours of liquid education is almost always detected in different scans, that is, a bond with a loyalty and a lokhano-ureter segment and cups, whereas with parapelvic cysts of the interruption of the loly-liquid liquid education cysts is not observed.
It should be remembered that the image of the cyst of the right lobe of the liver or the right half of the abdominal cavity is possible on the right kidney, in particular the intestinal mesentery in the crown disease or ovary. Over the estate of the left kidney erroneously can be taken by the cyst of the lower pole of the spleen, the tail of the pancreas, the left half of the abdominal cavity, the left ovary or the liquid in the stomach with its poor evacuation. Such diagnostic errors are not allowed, because they lead to serious complications, as accesss for surgical intervention with these pathologies are different. To avoid errors, it is necessary, changing the position of the body, in different echographic scans to carefully differentiate the kidney contours. In doubtful cases, repeated ultrasound studies and laparoscopy are shown.
Echography allows you to conduct dynamic observation of the growth and state of the cyst (suppuration, breaking, resorption). The dynamics of the cyst development has a great clinical value, since their growth is associated with the atrophy of the kidney parenchyma leading to the impaired hemodynamics and arterial hypertension. Echography helps to clarify the moment of possible surgical intervention or conservative treatment, provides conditions for conducting aiming diagnostic or with the medical goal of biopsy.
Dermoid cysts
These are congenital single-chamber, rarely multi-chamber rounded formations outlined by an echogenic capsule. May be located in different parts of the body, rarely in the internal organs and very rarely in the kidneys. More often in girls in early childhood, although they can also meet in adults, moreover to be a random find. Depending on their content (hair, fat, bone tissue, etc.) the content of education has different echogenicity - part of the cyst may be high, and a part is low (liquid). The wall of the dermoid cyst is thickened, has high echogenicity, and sometimes exposed to occurrence and lokilas as a rounded high-cooping ring, clearly visible on an x-ray. It should be noted that sometimes a dermond cyst is difficult to distinguish from chronic abscess, decay of cavity and tumors, hypenephromas and Wilms tumors. The diagnosis in such cases may be confirmed by means of a valuable aspiration biopsy or in surgical intervention.
Multalocular cyst
Very rare anomaly (2 cases identified), characterized by the replacement of the kidney parenchyma portion of multi-chamber, which is located as a multi-chamber anechogenic formation separated by narrow echogenic partitions. When the larger sizes of echocartine achieve the same as with a multi-chamber echinococcal cystic. Differentiation is very difficult. The only distinguishing feature is an active echinococcal cyst gives rapid growth compared to multilocular wet (in the household of the patient, there are usually animals - carriers of echinococcosis).
Spongy kidney
Rare anomaly at which collective renal tubes are expanded.
Suffer more often male face. At the same time, the kidney can be increased in size, characterized by a uniform cystic lesion of the pyramids, as a rule, two-way, without engaging in the pathological process of the cortical substance. Cysts are usually small sizes, diameter from 3 to 5 mm, directed to the center of the kidney. Although many small cysts can occur on the surface of the kidney, making it uneven. In the area of \u200b\u200bthe pyramid there is a lot of small stones. With the joining of pyelonephritis, the fergity is difficult.
Megakolikosis (renal cup dysplasia)
Congenital increase in renal cups associated with underdevelopment of renal pyramids. Usually this anomaly is unilateral, although cases of bilateral lesion are described. At the same time all cups are affected.
On the echoogram, all cups are significantly expanded, they have a rounded shape, a pyelonephritis, as a rule, if the pyelonephritis has not joined, is not expanded, the ureter is fluidally passable for a contrast agent during a radiographic study.
The accumulation of uricular salts and small stones can be locked. The echography allows this pathology only to assume, the final diagnosis for the excretory urography and retrograde pyelography, where the cavity of the cyst, a narrow course communicating with the renal cup is clearly visible.
Cheschoe diverticul
Congenital cystic education associated with a low renal cup with a narrow channel.
Megaureter
Congenital unilateral, less often two-way segmental expansion along the entire length of the ureter, from 3 mm to 2-3 cm and more, ureter is locked as an uneven width of anechogenic tube over a narrowed distal segment.
The length of the ureter can vary from 0.5 to 4-5 cm, the left ureter is affected more often. Megaureter can be primary obstructive (congenital), secondly obstructive (acquired) due to inflammatory processes, postoperative scars and other reasons and primary unstructive (idiopathic). Megaureter, especially primary obstructive, always leads to hydronephrosis and hydrochloriaciasis.
Ureterocele
One of the rare ureteral anomalies arising due to the narrowness of its mouth, in which the expansion of all layers of the intramural ureter's impact department occurs, sputtering in the form of oval echonegative formation into the urinary bubble cavity from one or two sides. The ureterocele cavity may contain urine - from several milliliters to the volume of the bladder.
Ureterocele is difficult to differentiate from the diverticula or echinococcal cyst, located at the mouth of the ureter.
The early diagnosis of the ureterocele is of great importance, as it allows you to get rid of the patient from possible dilatation of the upper urinary tract and the development of pyelonephritis and secondary cystitis.
Anomaly of renal vessels
This area of \u200b\u200bpathology for modern echography, even with the use of Doppler, is little or, more precisely, only partially available. It allows us to only assume the presence of any vascular pathology in comparison of structural changes in the renal parenchyma.
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Difficulties and mistakes of ultrasonic and X-ray diagnosis of pseudo-pumping kidneys
State Medical Academy,
MySono-U6.
Introduction
Kidney tumors make up 2-3% of all malignant neoplasms. Most often they arise in an eating. Among all kidney tumors in 80-90%, renal and cellular cancer is noted. In recent years, the likelihood of its detection increases, which is associated both with an increase in the number of all malignant formations and with early preclinical diagnostics. Recognize malignant formations, first of all, allow constantly improving and widely used ultrasound studies of the kidneys.
The first message on the use of ultrasound in the diagnosis of kidney tumors was published in 1963. J. Donald (J. Donald). Since then, the accuracy of ultrasonic diagnosis of kidney tumors has increased from 85-90% to 96-97.3%. When using modern ultrasound scanners working in fabric and second harmonics modes, as well as the color Doppler and energy mappings and dynamic echocontrase angiography, the sensitivity of ultrasound (ultrasound) is 100% with specificity 92 and the predictability of a positive test 98%, and negative - 100% .
In the literature, there are often publications on errors not only ultrasound, but also other radiation diagnostics methods. There is a point of view that up to 7-9% of all volumetric processes in the kidneys cannot be differentiated to operations on cyst, tumors, abscesses, etc. . Many processes can simulate many processes in the tumor picture of the kidney tumor at ultrasound and other radiation methods of diagnostics. Among them: a variety of kidney anomalies; "Complex" or mixed cysts; Acute and chronic nonspecific inflammatory processes (carbuncoon, abscess, chronic, including xantoganulmatose pyelonephritis); Specific inflammatory processes (tuberculosis, syphilis, fungal damage kidney); changes in kidneys during leukemia and lymphomas, including HIV infection; kidney heart attacks; Organized hematomas and other reasons.
This message will be discussed only about kidney anomalies, which in the literature are determined by the term pseudochuch. With them, clinical manifestations are almost always absent or determined by concomitant diseases, and the establishment of the correct diagnosis is possible only by the methods of radiation diagnosis (Fig. 1).
Fig. 1. Options for pseudo-pumping, imitating the tumor.
Materials and methods
For gg 177 patients were observed with a different structure of kidney parenchyma according to the type of kidney pseudo-pumping. Everyone has repeatedly been carried out ultrasound kidney scanning, ultrasound dopplerograph (USDG) kidney vessels - 78, including using the second and tissue harmonics and energy dopar modes - 15, excretory urbory \u200b\u200b(EU) - 54, X-ray computed tomography (RTC) - 36, Renal scintigraphy or emission computed tomography (ECT) with 99 m Tc - 21.
Research results
Fetal lucrative kidney (see Fig. 1) With multiple emptyings on the lateral contour of the kidney in this message, it was not considered, since it did not cause differential diagnosis with the kidney tumor. Among 177 patients with pseudo-pumping kidneys in 22 (12.4%), a variant of the porching kidney is revealed - "humpback" of the kidney "(Fig. 2). In 2 (1.2%) of patients marked the increased "lip" above the kidney gates (Fig. 3a-c). The most common cause of pseudo-pumping was "hypertrophy" of Burten poles or "jumpers" of kidney parenchyma - in 153 (86.4%) of patients (Fig. 3 Mr.). The "lintels" of Parenhima were noted not only for various doubling of cup-making kidney systems, but also with different sacrifices and unfinished turns of the kidneys.
In the conduct of differential diagnosis of pseudo -umoplas and kidney tumors, 37 (21%) patients needed. To this end, it was carried out first of all, repeated "aimed" ultrasound scans using various additional ultrasound techniques under the conditions of the urological clinic, as well as other methods of radiation diagnostics mentioned above. Only one patient with the pseudo-turn of the kidney to exclude the diagnosis of the tumor produced exposive lumbotomy with intraoperative biopsy under ultrasound control. In the remaining 36 patients, the diagnosis of pseudo-pumping kidneys was confirmed by radiation research and ultrasound monitoring.
Fig. 2. Echogram (a) and a series of computer tomograms (b) with the "humpback" with the left kidney.
Fig. 3. Echogram, an excretory urogram, a computed tomogram with a contrasting strengthening with the increased "lip" of the kidney on both sides (A-B) and hypertrophy of the Burten post (incomplete "jumper" parenchyma) in the middle department of the right kidney (Mr.), respectively.
The difficulties and errors of radiation diagnosis in pseudo-obscenities of the kidney usually occurred at the first doggowns of diagnostics. In 34 (92%) patients, they were associated both with the objective difficulties of interpretation of unusual echographic data and their irregular interpretation due to the insufficient qualifications of specialists and a relatively low level of diagnostic equipment. In 3 (8%) patients, an erroneous interpretation of X-ray computer tomography data was noted when there was a discrepancy with the data of repeated ultrasonic scanning and X-ray computed tomography in the urological clinic.
Tumors of the kidneys that had combinations with pseudo-turn in one kidney were verified in 2 patients after nephrectomy, and pseudo-pumping - in one patient with biopsy under ultrasound control during exploratory lumbotomy; In the rest - with ultrasound monitoring on time from 1 to 10 years.
Discussion
One of the most frequent reasons simulating the kidney tumor during an ultrasound study, the so-called pseudo-turn, in the literature is most often determined by the term hypertrophy of Burten's post.
As is known, in the periphery of the ultrasound cutting of the kidin, the cortical substance forms invagination in the form of columns (columnae bertin) between the pyramids. Often Berten's post is deep enough to go beyond the inner contour of the parenchyma in the central part of the kidney - to the renal sinus, making the kidney more or less fully into two parts. The resulting peculiar parenchymal "jumper" is an unprofitable parenchy pole of one of the poles of the kidneys, in the process of the ontogenesis of adult adult in the kidney. The anatomical substrate "jumpers" are the so-called connective tissue defects of the parenchyma or the latter prolusion in the kidney sinus. It includes a cortical matter, Burten pillars, kidney pyramids.
All elements of the "jumpers" are a normal parenchyma cloth without signs of hypertrophy or dysplasia. They are a doubling of the normal kidney cortony or an additional layer of it, located lateral of the cups. The latter is a variant of the anatomical structure of parenchyma, in particular, the corticomallar relations between the parenchyma and the kidney sinus. They can be most clearly traced on ultrasound and on computer-tomographic kidney cuts.
The lack of hypertrophy or dysplasia of the parenchyma with the so-called hypertrophy of Burten pillars or "jumpers" of parenchyma confirmed and conducted histological studies of biopsy material in one patient with "jumpers" of parenchyma, taken to exposive lumbotomy for the kidney tumor, as well as in two patients with a morphological study of the kidneys, Remote about the combination in one kidney tumor and pseudo-pump ("jumpers" of parenchyma).
In this regard, in our opinion, the most frequently found in the literature, the term hypertrophy of Burten pillars does not reflect the morphological essence of the substrate. Therefore, we also believe that the term "jumper" of Parenhima is more correct. For the first time in the domestic literature on ultrasound diagnostics, it was applied in 1991. It should be noted that the term "jumper" parenchyma had in the literature and other names (table).
The term table applied to the description of the "jumpers" of kidney parenchyma (by YEH HC, Halton KP, Shapiro RS et al., 1992)
Wolfman NT et al., 1991
LEEKMAN RN et al., 1983
Many years of experience of an excretory urography showed that cup-making systems have an extremely large number of build options. They are practically individual not only for each person, but also for the left and right kidney in one subject. With the development and ever wider use of ultrasound and RTC, allowing to trace both internal and external contours of kidney parenchyma, in our opinion, a similar position is also formed in relation to the options of the anatomical structure of the kidney parenchyma. Comparison of echo and computer-tomographic data with urographic cases at various embodiments of kidney pseudocholas showed that there is a relationship between the anatomical structure of the kidneys and cup of kidney. It is expressed in the congruence of the medal contour of the parenchyma in an echo or computer-tomographic image with the lateral contour of cup-making systems, conditionally spent on excretory urograms or on computer tomograms with contrasting amplification. This symptom can be traced in the usual structure of parenchyma and cup-making systems, as well as with the "jumper" of the kidney parenchyma, which is a variant of an anatomical structure. With a tumor of the kidney, which is an acquired by the pathological process, the congruence of the contours of the parenchyma and cup-making kidney systems is broken (Fig. 4).
Fig. 4. The symptom of the congruence of the contours of the parenchyma and the cup of the kidney with an incomplete "jumper" parenchyma (explanation in the text).
conclusions
Thus, first identified with ultrasound typical echographic patterns of "jumpers" of kidney parenchyma, "humpback" kidney and increased "lips" over the gates of the kidney without signs of expansion of cup-making systems do not require further surveys.
If necessary, the differential diagnosis of pseudo-diagnosis and kidney tumors, which was required in 37 (21%) patients, we offer the following algorithm for their diagnostics (Fig. 5).
Fig. 5. The radiation diagnostic algorithm for pseudo-pumping kidney.
- Repeated ultrasound with qualified specialists at higher-class UZ-scanners using UDG, mapping techniques, fabric and second harmonics.
- X-ray compressive tomography with contrasting strengthening or excretory urography with comparison of uro- and echographic data and data of repeated "aimed" ultrasound.
- Selection methods - renal scintigraphy or emission computed tomography with 99 m Tc (False negative results are possible with small tumors).
- With remaining suspected malignant tumors - biopsy under ultrasonic control (only a positive result is a diagnostic value).
- With a negative result of a biopsy or a refusal of a patient from biopsy and operational audit of the kidney, ultrasound monitoring is carried out with a frequency at least once every 3 months in the first year of observation, and then 1-2 times a year.
Literature
- Demidov V.N., Tyaker Yu.A., Amosov A.V.// Ultrasound diagnosis in urology. M.: Medicine, 1989. p.38.
- Hutschenreiter G., Weitzel D. Sonographic: EineWertwolle Erganzung der Urologichen Diagnostic // Aktuel. Urol. 1979. Vol. BD 10 N 2. P. 45-49.
- Nadaryishvili A.K. Diagnostic capabilities of ultrasound research in patients with a tumor kidney // 1st Congress of the Association of Ultrasound Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 1991. P.121.
- Büilov V.M. Integrated use and algorithms of ultrasound scanning and x-ray diagnostics for kidney and ureteral diseases: dis. . Dokt. honey. science M., 1995. P. 55.
- Modern ultrasound diagnostics of the volume formations of kidneys / A.V. Zubarev, I.Yu. Nanicova, V.P. Kozlov et al. // 3rd Congress of the Association of Ultrasonic Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 1999, p.117.
- US, CT, X-Ray Diagnosis of Renal Masses / R.K. Zeman, J.j. CROMAN, A.T. Rosenfield et al. // Radiographics. 1986. Vol.6. P ..
- Thomsen H.S., Pollack H.M. The Genitourinary System // Global Textbook of Radiology. (Ed.) Petterson H. 1995. P ..
- Lopatkin N.A., Lulko A.V. Anomalies of the urogenital system. Kiev: Healthy, 1987. P. 41-45.
- Mindel H.J. Pitfalls in Sonography of Renal Masses // Urol. Radiol. 1989. 11. 87. N 4. P ..
- Burys M.P., Akimov A.B., Stepanov E.P. The echoograph of the kidney and its cup-glass complex in comparison with the data of anatomical and radiological research // ARH.Anat.Histol.Embirol. 1989. T.97. N9. P.82-87.
- Junctional Parenchyma: Revised Definition of Hypertrophic Column of Bertin / H-CH. Yeh, P.h. Kathleen, R.S. Shapiro et al. // Radiology. 1992. N 185. P ..
- Bobrik I.I., Dugan I.N. Anatomy of human kidney with ultrasound examination // Doctor. a business. 1991. N 5. P. 73-76.
- Khitrova A.N., Mitkov V.V. Ultrasonic renal research: clinical guide to ultrasound diagnostics. M.: Vidar, 1996. T. 1. S., 209, 212.
- Builov V. Junctional Parenchyma or Hypertrophic Column of Bertini: The Congrunce of their Contours and Calyceal-Pelvic System // Abstracts of Ecr'99, March 7-12. 1999. Vienna Austria.-EUROP. Radiol. Supp.1. Vol.9. 1999. S.447.
- Büilov V.M., Turzin V.V. Echotomography and excretory urography in the diagnosis of "jumpers" kidney parenchyma // Vestn. X-ray .radiol. 1992. N 5-6. P. 44-51.
- Büilov V.M., Turzin V.V. The diagnostic meaning of atypical "jumpers" parenchyma with kidney sonography // 1st Congress of the Association of Ultrasonic Diagnostic Specialists in Medicine: Abstracts of reports. Moscow. October 1991. P. 121.
- Büilov V.M. Questions of terminology and symptom of the congruence of the contours of "hypertrophied" columns of Bertini or "jumpers" of parenchyma and cup-making kidney systems // Vestn. X-ray. and radiol. 2000. N 2. P. 32-35.
- Büilov V.M. The algorithm of radiation diagnosis of pseudo-pumping kidneys // Abstracts Dokl. 8th Vsview. Congress of radiologists and radiologists. Chelyabinsk-Moscow. 2001. With ..
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3.1. Kidney
Modern ultrasonic diagnosis of kidney disease is impossible without a clear understanding of the normal kidney echo-alastic, based on comparison of the echographic picture and the histomorphological substrate.
The kidneys are located retroperitoneal. Right kidney - at the level of TH-12-L-4, the left kidney is located above - at the level of TH-11-L3 vertebra. However, it is uncomfortable to determine the position of the kidney regarding the vertebrae, therefore hypo echogenic acoustic "shadow" from the twelfth edge, the dome of the diaphragm (or the diaphragm liver contour), the gate of the spleen, control of the kidney are used as a guideline for determining the kidney position. Normally, the acoustic "shadow" crosses from the twelfth rib (with a longitudinal scanning from the back of the back parallel to the long axis of the kidney) right kidney at the level of the boundaries of the upper and middle third, the left kidney is at the level of the kidney gate. The upper pole of the right kidney is located at or somewhat lower than the uppermapramal contour of the right lobe of the liver. The top pole of the left kidney is located at the level of the spleen gate. Distances from the upper pole of the right kidney to the contour of the diaphragm and from the top pole of the left kidney to the gate of the spleen depend on the degree of development of the paranefral fiber of the surveyed.
Kidney sizes, according to N.S. Ignashin, constituted on longitudinal cuts and 3.5 - 4.5 cm, on the cross section - 5-6 cm and 3.5 - 4.5 cm. The total thickness of the parenchyma is 1.2 - 2.0 cm in the middle segment, 2.0 - 2.5 cm in the field of kidney poles. Normal kidney volume is 300 cm3. According to V.N. Demidov, kidney length 7.5 - 12 cm, width 4.5 - 6.5 cm, thickness 3.5 - 5 cm. According to M.P. Burax and specialists who conducted anatomy-echographic correlations, the kidney length is 10.41 + 1.3 cm, the kidney width is 5.45 ± 1.3 cm, the thickness is 3.63 ± 0.5 cm.
The form of a slice of normal kidney in all projections is beanoid or oval. The kidney circuit is usually smooth, and in the presence of the preserved fetal lucrative kidney - a wavy (this is a variant of the normal structure of the kidney). Quite often, the local empty of the contour in the region of the lateral edge of the kidney is determined (while the so-called "humpback" of the kidney) is determined or in the region of the renal sinus, which simulates the kidney tumor. These states are described as pseudo-pumps and are also variants of the normal kidney structure. One of the distinguctive signs of pseudo-pumping "swelling" of parenchyma with the preserved fetal stripping of the kidney, in contrast to the tumor, is to preserve the parallelism of the outdoor and inner contour of the parenchyma, the preservation of the normal echorakructure of the parenchyma.
In fig. 18 shows the echoogram of the normal kidney of an adult.
The echographic characteristics of the renal capsule and the parenchyma of normal kidney are generally accepted. According to the periphery of the ultrasonic cutting of the kidney, a fibrous capsule is visible in the form of a hyperheogenic smooth, continuous structure with a thickness of 2 - 3 mm, then the parenchyma layer is determined. The gates of the kidneys are located echographically in the form of a "gap" of the media contour of the kidney parenchyma, while when scanning from the front abdominal wall At the top of the scanner visualizes the front of the anechogenic tubular structure - renal vein, located behind the hypooechogenic renal artery. Parenchima is heterogeneous and consists of two layers: a cortical substance and medullary (or substance pyramids of the kidney). The morphological substrate of the kidney cotion (kidney bark) is predominantly the glomerular apparatus, convinced tubules, interstitial fabric containing blood, lymphatic vessels, nerves. Medullar substance contains loops Genlen, collective tubes, bellini duks, interstitial fabric. The kidney cortical substance is located along the periphery of the ultrasound cutting of the kidney with a thickness of 5 - 7 mm, and also forms invagination in the form of columns (ColumnAe Bertini) between the pyramids. In fig. 19, 20 shows a schematic image of the layers of parenchyma and the method of measuring the thickness of the elements of the parenchyma. Often, the Berdin column is far enough for the inner contour of the parenchyma in the central part of the kidney - to the renal sinus, making the kidney more or less fully into two parts. The resulting penetrating parenchymal "jumper", the so-called hypertrophic column of bertin, is an unprofitable parenchy pole of one of the robes of the kidneys, which in the process of ontogenesis merge, forming the kidney of an adult. This jumper consists of a cortical substance, columns of bertin, kidney pyramids. All elements of the jumpers are a normal parenchyma cloth without signs of hypertrophy or dysplasia.
Therefore, the name "Hypertrophied Column Botin" existing in the literature does not reflect the morphological essence of the substrate, and probably the definite can be considered the definition of J.K. Ena with co-authors who called this formation by a parenchymal jumper. The echogenicity of the kidney cortical substance is usually slightly lower or comparable to the echogenicity of the normal liver parenchyma. The kidney pyramids are determined in the form of a triangular structures with reduced compared to bark echogenicity. At the same time, the top of the pyramid (pyramid papilla) is addressed to the renal sinus - into the central part of the kidney cut, and the base of the pyramid is adjacent to the cortical substance of the parenchyma, located along the periphery of the cut (see Fig. 19). Kidney pyramids have a thickness of 8 - 12 mm (the thickness of the pyramids is defined as the height of the triangular structure, the vertex of which is facing the renal sinus), although normal dimensions Pyramids are largely dependent on the level of diuresis. Normally expressed echographic differentiation of the crust and pyramids: the echogenicity of the cortical substance is significantly higher than the echogenicity of the pyramids of the kidney. Often, this difference in echogenicity is the cause of the false-positive diagnosis of hydrochlorias, when very dark, low echogenicity of the pyramid is taken by novice doctors of ultrasonic diagnostics for dilated cups. Modern histomorphological studies of kidney parenchyma and comparison of them with an echographic picture suggest that pronounced echographic corticomallar differentiation is due to a significant difference in the amount of bodybuilding vacuoles in the epithelium of the tubular cortex structures and pyramids. However, it is impossible to explain the different echogenicity of the bark and pyramids in the epithelium of the tubular structures, since it is known that the echogenicity of the pyramids of the kidney high level Diurea is much lower than the echogenicity of the pyramids of the same kidney under normal conditions, the amount of fatty vacuoles depending on the level of the diuresis does not change. It is also impossible to explain the low echogenicity of pyramids by the presence of fluid in the tubular structures, since the resolution of the ultrasonic apparatus under any conditions does not allow differentiate the lumen of the tubular and the liquid in it. It can be assumed that low echogenicity of medullary substance is related:
1) S. large content glycosaminoglycans in interstitial tissue, where most functional processes occur, providing ion exchange, reabsorption of water and electrolytes, urine transport; Glycosaminoglycans are able to "link" liquid, according to the authors of the hypothesis, "very quickly swelling and running";
2) the presence of smooth muscle fibers in the interstitial tissue surrounding the output ducts of the renal papilla.
In children, the echogenicity of the cortical substance is significantly higher than in adults, which is explained by the more compact location location and fewer interstitial tissue. Pyramids occupy more space than adults. Morphometric studies have shown that the newborn barks and pyramids occupy about 90% of the kidney volume, in adults percentage decreases to 82%.
In the center of the echographic cutting of the kidney, a hyperheogenic complex of oval or rounded form is determined (depending on the scanning plane), the renal sinus, the dimensions and echogenicity of which are differently differentiated depending on the age of the surveyed and its dietary habits.
If the echographic characteristics and interpretation of the image of normal parenchyma are generally accepted in medical practice and in scientific research, the interpretation of the central echocomplex is significantly different from different authors. In practical work, as well as in scientific articles Some authors occurs the meaningful identification of the central echocomplex and the cup-making kidney. However, the conduct of modern histomorphological and echographic correlations of normal kidney convincingly proved that the central echocomplex is a total mapping of a non-celiac-powder system, but the entire totality of the kidney sinus elements. By comparing the anatomical and echographic data, it was found that it was a kidney sinus, and not a cup-making system, as previously thought, is a morphological substrate of the central echocomplex.
Very little is written about renal sine as an anatomical whole, although there are multiple medical research data that describe the different pathology of the renal sine. Upon receipt of the image, many states give a similar picture. There may be a false diagnosis when trying to form a diagnosis without taking into account various possibilities.
The renal sinus is a certain anatomical structure surrounding and includes a collective kidney system. It borders with a lateral side with kidney pyramids and cortical columns. Medial-renal sinus communicates with the Panephral space through the renal gate. Elements of renal sinus are lymphatic, nervous, renovascular structures surrounded by fatty and fibrous fabric. Reducing the percentage of parenchyma in the scope of the kidney in an adult compared to the newborn occurs precisely by increasing the volume of renal sinus, having a place as a result of the "age" growing of the renal sinus fiber. The adipose tissue of the renal sine is practically absent in the newborn, which is echographically manifested by the absence of reflected echo signals from the renal sine or in a minimally pronounced central echocomplex in the form of a gentle, branch, weaklyogenic structure. Unlike the kidney of an adult, a medullar layer is more pronounced, the central echocomplex is reduced by the area and via echogenicity by a branched structure. By 10 years, the renal sinus is formed almost completely. Similar data was obtained in mP-studies of kidney of healthy children (the intensive signal at T 1-suspended images corresponding to the sinus fiber appears in the age group of children over 10 years.
So, the echogenicity of the central complex is determined primarily by the presence and amount of renal sinus fatty fiber. However, in addition to reflections of high intensity in the central echocomplex, there are minor zones of reduced echogenicity and anechogenic zones. For a long time, it was believed that these zones are reflections of the elements of the cup-laughter system. Extremely contradictory and few data on the normal echographic sizes of the cup-laughter system in adults are examined. Thus, in 1982 A. Dina reports about the "syndrome of the echographic invisibility of a cup-making system." I.S. AMIS calls the dilatation of a cup of a decumbane system any "splitting" of the cup-lowering system with an echonegative strip. Kk Hayden, L.I. Svischuk is permitted in the normal existence of only a thin layer of fluid in a cup-making system. At the same time, the presence of the expansion of pelvis and cup structures and their merger in the form of "wood" is, according to these authors, a sign of hydronephrosis. TS Chihashi, comparing these echographs, dopplerography and excretory urography, came to the conclusion that the classification of hydronephrosis P.Sh. Illenboden describing the echographically detected hydronephrosis in powers as the splitting of the central echocomplex in the form of: a) the branch structure of the tree, b) structure of lily, c) the structure of clover, d) in the form of a rose bud, leads to a false-positive diagnosis of hydronephrosis. According to the data of the authors, the splitting of the central echocomplex in the form of a tree corresponds to normal vascular structures, the echonegative structure in the form of lily corresponds to a normal locher or, possibly, the obstructive process, the structure in the form of a rose bud - the initial form of hydronephrosis, in the form of clover - pronounced hydronephrosis. At the same time, the false positive diagnosis of hydronephrosis took place in 11%, false-negative - in 22% of cases. Quantitative estimates of the size of a normal cup-making system in the data of the authors data is not given. Although I. Khash tried to use the size of the pelleran as an index, which determines the degree of hydronephrosis, the data that determines the front-facing size of the magnifier as the differential-diagnostic criterion of the norm and pathology, was not given. F.S. The villas considers the norm of the front-facing size of a locher in 30 mm, which from our point of view is completely unacceptable. V.N. Demidov, Yu.A. Tower, A.V. Amosov determines the normal front-facing size of a locher in 1 - 2.5 cm. G.M. Imnaishvili believes that the visualization of the cups in the form of anechogenic, rounded form of formations up to 5 mm in diameter is permissible. Lohanka can be visualized in the form of two hyperheogenic linear structures going towards the kidney goal.
Curious data is quite interesting. Tsy and co-authors. The study of these authors was undertaken to establish the echographic sizes of normal renal pelvis in children and determine the correlation between its size and the presence of one or another renal pathology, as well as the dependence of the size of pelvis from age. It was found that the upper boundary of the rate of advanced size in children is 10 mm, and only 1.7% of normal kidney pelvis exceeded the size of 10 mm. Correlation analysis did not reveal statistically reliable differences in the size of the renal loin in different age groups, although the average size of the size in the norm group and in the pathology group were statistically different (p