Renal Sonography (2° Éd., 2nd ed. 1987. Softcover reprint of the original 2nd ed. 1987)

Renal sonography forms a basic part of routine diagnostic strategy. This textbook summarizes eighteen years of experience in diagnostic ultrasound. We want it to serve as a guide to both imagers and mere consumers of information. That is why we shall emphasize practical advice and diagnostic pitfalls; it is also why we shall often deal with the relations of sonography with other diagnostic procedures, which it may complement or replace, precede or follow, the purpose being to achieve efficiency at low cost. We shall limit our subject matter to the kidney itself and the neighboring retroperitoneal compartments, dealing only briefly with the lower urinary tract, which requires specialized procedures. We devoted considerable space to renal sonography in our book Clinical Atlas of Ultrasonic Radiography, published in 1973. Since then, nothing has changed and everything has changed. Nothing, because even then the differential diagnosis between a solid and a cystic mass, the etiologic diagnosis of a nonsecreting kidney, and the positive diagnosis of a traumatic juxtarenal hematoma were quite reliable, making possible drastic reductions in the indications for instrumental roentgenologic examinations. Everything, be­ cause improved resolution and grey scale imaging (already partially achieved in 1973, thanks to real time) have profoundly refined both anatomic and pathologic ultrasonic studies. And now high resolution real time imaging has revolutionized renal examination techniques, whereas Doppler is entering routine ultrasonic diagnosis.

1 Echoanatomy: Tissue Echopatterns.- 1.1 The Kidney Itself.- Shape.- Size.- Pyelovascular Central Area. Renal Pelvis.- Renal Parenchyma.- 1.2 The Kidney as a Part of the Retroperitoneal Compartment.- Juxtarenal Compartments.- Bone and Muscle.- Vessels.- Adrenal Gland.- Retrocaval Kidney.- Pancreas.- 1.3 Less Direct Renal Relationships.- Right Side.- Left Side.- 1.4 Basic Tissue Echopatterns: Pitfalls and Artifacts.- Tissue Echopatterns.- Artifacts.- 2 Examination Techniques.- 2.1 Technical Data.- Contact Scanning.- Real Time.- Peroperative Sonography.- 2.2 Technological Prospects.- 2.3 Technical Factors of Image Quality.- Suppression of Kinetic Blurring.- Axial and Lateral Spatial Resolution.- Total Gain and Time Gain Compensation Settings.- 2.4 Positioning and Scanning Directions.- Real Time.- Contact Scanning.- 2.5 Particular Problems.- Critically III Patients; Recently Operated Patients;.- Traumatized Patients.- Newborn and Infant.- Puncture Techniques.- 2.6 General Management of Ultrasonic Examinations.- 3 Hydronephrosis.- 3.1 Beginning Hydronephrosis.- 3.2 Frank Hydronephrosis.- 3.3 Major Hydronephrosis.- 3.4 Differential Diagnosis.- 3.5 Ureteral Dilatation.- 3.6 Complementary Pelvic Examination.- 3.7 Renal Lithiasis.- 4 Renal Cysts.- The Renal Cystic Pattern.- 4.1 Benign Cysts.- Diagnostic Circumstances.- Ultrasonic Pattern.- Multiple Benign Cysts.- Atypical Cysts — Tumoral Cysts.- Parapelvic Cysts.- Differential Diagnosis.- Clinical and Radiological Management.- 4.2 Polycystic Processes.- Polycystic Processes of the Neonate and Child.- Infantile and Juvenile Polycystic Disease.- Polycystic Disease of the Adult (PCD).- Echinococcal Cysts.- Differential Diagnosis of Multiple Cysts.- 5 Renal Tumors.- 5.1 Malignant Tumors.- Renal Cell Carcinoma.- Oncocytomas.- Urothelial Carcinomas.- Wilms’ Tumors and Mesoblastic Nephromas.- Renal Sarcomas.- Renal Metastases.- Renal Lymphomas.- Diagnosis.- 5.2 Benign Tumors.- 5.3 Differential Diagnosis.- Large Tumors (Over 10 cm in Diameter).- Medium-Sized Tumors (4–10 cm in Diameter).- Small Tumors (Under 4 cm in Diameter).- Reliability.- 6 Evaluation of Tumoral Spread: The Retroperitoneal Space.- 6.1 Direct Spread.- 6.2 Lymphatic Spread.- 6.3 Intracaval Extension.- 6.4 Metastatic Spread.- 6.5 Clinical and Radiological Policy.- 6.6 Particular Cases.- Urothelial Tumors.- Tumors in Children.- Local Recurrences After Nephrectomy.- Other Retroperitoneal Abnormalities.- 7 Infections and Inflammatory Processes.- 7.1 Abscesses.- Bacterial.- Tuberculous.- Differential Diagnosis — Xanthogranulomatous Pyelonephritis.- 7.2 Bacterial Nephritides.- 7.3 Pyonephrosis.- Recently Infected Hydronephrosis.- Older Pyonephrosis.- 7.4 Tuberculosis.- 7.5 Differential Diagnosis of Chronic Inflammatory Processes.- 7.6 Chronic Pyelonephritis.- 7.7 Nephrocalcinosis, Papillary Necrosis, and Cortical Necrosis.- Nephrocalcinosis.- Papillary Necrosis.- Cortical Necrosis.- 7.8 Nephritides.- Renal Size.- Echotexture.- 7.9 Postnephrectomy Abscesses.- Ultrasound and IVU in Chronic Inflammatory Processes.- 8 Hunchbacks, Dwarfs, and Giants.- 8.1 Horseshoe Kidneys.- 8.2 Miscellaneous Anomalies.- 8.3 Absence of Kidney; Ectopic Kidneys.- 8.4 Renal Hypoplasia.- 8.5 Nephromegaly.- Nephromegaly with Normal Differentiation.- Nephromegaly with Loss of Parenchymal-Central Differentiation.- Heterogeneous Nephromegaly.- Multinodular Nephromegaly.- 8.6 Abnormalities of Vascular Origin.- Renal Vein Thrombosis.- Renal Artery Occlusion.- 8.7 The Transplanted Kidney.- Rejection.- Arterial Thrombosis.- Renal Vein Thrombosis.- Hydronephrosis.- Liquid Collections.- Cancerization..- 8.8 Ultrasound in Renal Failure — Anuria.- 9 Ultrasonic Differential Diagnosis and Diagnostic Policies: Synopsis.- 10 Renal Trauma and Juxtarenal Collections, Traumatic and Nontraumatic.- 10.1 Examination Procedure in the Traumatized Patients.- 10.2 Renal Lesions.- Contusion.- Renal Wounds and Fractures — Intrarenal Hematomas.- 10.3 Juxtarenal Abnormalities.- Hematomas.- 10.4 Traumatic Urinomas (Uriniferous Cysts) and Nontraumatic.- Collections.- Trauma and Preexisting Lesions.- 10.5 Associated Lesions.- 10.6 Radiological Policy.- 11 Adrenals.- 11.1 The Normal Adrenal.- Examination Procedure.- 11.2 The Pathological Adrenal.- Tumors.- Pheochromocytomas.- Other Tumors.- Metastases.- Bilateral Tumors.- Tumoral Spread.- Hematomas.- 11.3 Diagnosis.- 11.4 Reliability and Diagnostic Policy.- 12 Lower Urinary Tract.- 12.1 Bladder.- True and False Diverticula-Stones.- Ureteroceles.- Intramural Ureter.- Tumors.- Urachus.- Urethra.- 12.2 Prostate.- Scanning Technique.- Normal Prostate.- Tumors.- Prostatitis.- Seminal Vesicles.- Diagnostic Policy in Prostatic Swellings.- 12.3 Testis and Its Covering.- Examination Procedure.- Normal Testis.- Miscellaneous Abnormalities.- Varicoceles.- Trauma.- Orchitis and Epididymitis.- Tumors.- References.