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Ultrasound Quiz 6: Remember The Renal Pelvis

Welcome to another iteration of Musig Mondays! Enjoy the quiz!

If you get an answer wrong, don't worry! There's a detailed explanation for each question (and if it's too much reading, just look at the words in bold).

Yes! This ultrasound is showing hydronephrosis.
Remember that a dilated renal pelvis can help you distinguish hydronephrosis from other conditions. 

Hydronephrosis is the dilatation of the renal calyces and pelvis due to an accumulation of fluid. Notably, a dilated renal pelvis can help you distinguish hydronephrosis from other conditions.
Remember that fluid is anechoic (black), so here we have fluid accumulation in the pelvis and calyces (center of the kidney)

Yes great job!

The pelvis and calyces are normally hyperechoic (white) on ultrasound. If they're anechoic, it might be a sign of a hydronephrosis as there would be fluid backed up into them.
The pelvis and calyces are found at the center of the kidney. Urine will eventually drain from here into the bladder.
The cortex is hypoechoic (grey). The anechoic (black) spots here are the renal pyramids.

Great job! The patient here has Polycystic Kidney Disease (PKD). However, we still cannot rule out hydronephrosis. The key way to do so on ultrasound is to look for a dilated renal pelvis, which would inform you that there is hydronephrosis. This can be quite tricky to do in this case, which is why ordering an MRI scan can help you visualize the amount of fluid in the renal pelvis.
Check out this case here for more info! https://www.kidney-international.org/article/S0085-2538(15)53909-4/fulltext

The patient here has Polycystic Kidney Disease (PKD). However, we still cannot rule out hydronephrosis. The key way to do so on ultrasound is to look for a dilated renal pelvis, which would inform you that there is hydronephrosis. This can be quite tricky to do in this case, which is why ordering an MRI scan can help you visualize the amount of fluid in the renal pelvis.
Check out this case here for more info! https://www.kidney-international.org/article/S0085-2538(15)53909-4/fulltext