basic steps in renal sonographic imaging and basic anatomic review

1. ULTRASOUND OF URINARY TRACT
Dr.Tayseer jamal Aldeen , Radiologist
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2.  The urinary tract consists of the kidneys,
ureters, bladder, and urethra
 Each kidney consists of two parts, which
are the renal parenchyma and the renal
sinus.
 The renal parenchyma includes the renal
medulla and the renal cortex, and it
includes the renal pyramids.
 The renal sinus includes the renal collecting
system, including the calices and the renal
pelvis.
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 Renal Ultrasound Indications
• Unilateral flank pain, low back pain, lower abdominal pain, or groin pain
• Undifferentiated abdominal, flank, groin, or genital pain
• Dysuria (pain with urination)
• Hematuria
• Anuria or Oliguria (decreased urinary output)
• Urinary incontinence or problems voiding

4.  The kidney can be divided into an upper or superior pole, midportion,
which includes the renal hilum, and a lower or inferior pole.
 The kidneys perform many vital functions, including detoxification and
filtration of the blood, blood pressure regulation, and maintaining
normal pH, iron, and salt levels in the blood.
 Ureteral anatomy: The bilateral ureters are small tubes that connect
the kidney to the bladder.
 Bladder and urethral anatomy:
 The urinary bladder, located in the anterior pelvis, is a temporary
storage organ for urine.
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5. PATIENT PREPARATION FOR SONOGRAPHY OF THE
URINARY TRACT
 A distended urinary bladder is warranted to
best evaluate for intraluminal abnormalities
and wall thickening.
SUGGESTED EQUIPMENT
 3.5–5-MHz transducer:
 General abdominal or renal setting (most
machines)
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6. SUGGESTED PROTOCOL
 Start on the right side of the patient and complete the entire kidney protocol before moving to
the left kidney or bladder.
 Ask the patient to extend his or her left arms up above his or her head in order to expand the
intercostal spaces
 Suspended or deep inspiration may be helpful to evaluate the kidneys.
 With the patient in the supine position, obtain a brief survey of the kidney by scanning superiorly
and inferiorly (transverse) or medial to lateral (longitudinal).
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7. Longitudinal (right or left) kidney (repeat
on contralateral side):
 Lengthen the kidney in the longitudinal plane,
which may require the transducer to be
slightly obliqued.
 Note the echogenicity of the kidney
compared to the liver or spleen
 Measure the length of the kidney
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 The spleen not being as large as
the liver offers a poor window
for the left kidney, which is also
close to the stomach. As such
visualization can be more difficult
of the left kidney. Having the
patient holding their inspiration
can help as can using a sector
probe and scanning through the
intercostal spaces. Another
technique is asking the patient to
turn right lateral oblique.

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10.  Transverse (right or left)
kidney upper, mid and
lower poles, Scan
completely through the
kidney
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11.  As on the right so goes the left,
take superior, mid and inferior pole
shots of the left kidney, compare
the echogenicity of the left kidney
to the spleen. The spleen should
be more echogenic than the
kidney.
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13.  In adults, the normal kidney is 10-14 cm
long in males and 9-13 cm long in
females, 3-5 cm wide, 3 cm in antero-
posterior thickness and weighs 150-260
g. The left kidney is usually slightly larger
than the right.
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14. Urinary bladder ..
Longitudinal urinary bladder scan :
 Image the bladder in the longitudinal plane.
 Scanning medial to lateral completely through the
bladder, evaluate the lumen of the urinary bladder and
the urinary bladder wall.
Transverse urinary bladder scan :
 Scanning superior to inferior completely through the
bladder, evaluate the lumen of the urinary bladder and
the urinary bladder wall
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15.  Square shape = transverse view
 Pear shape or triangular = longitudinal view
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16.  Tranverse view longitudinal view
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17. NORMAL MEASUREMENTS OF THE URINARY TRACT
Renal length (adults):
 8–13 cm in length
 2–3 cm in anteroposterior dimension
 4–5 cm in width
Renal volume:
 Length × Width × Height × 0.523 = mL
Renal cortex (adults): 1 cm or more
Bladder volume: Length × Width × Height × 0.52 = mL
Bladder capacity is between 150–600 mL
Bladder wall thickness:
 3 mm or less when distended
 5 mm or less when empty
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18. Thankyou
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