How Do You Assess a Renal Ultrasound

axis. As with all paired organs, comparison with the opposite side is essential for the evaluation of the images. Finally, cast an eye on the (hopefully) fluid-filled bladder.

The renal US should always be performed in combination with a complete upper abdominal ultrasound. Why? Because on the next ward round nobody will remember that the "normal" ultrasound was a limited investigation of the kidneys and bladder only.

Renal US is usually performed in supine position. The side to be examined can be slightly elevated. After visualizing the kidney from a posterior and lateral angle, the long axis of the transducer is aligned with the long axis of the kidney. The resulting longitudinal cross sections are best suited to determining renal size and assessing cortical thickness as well as the configuration and size of the renal pelvis (Fig. 10.1a). The transducer is then rotated by 90° to scan up and down the kidney perpendicular to its long n m

Have You Memorized the Renal Size?

The normal adult kidney measures approximately 13 cm in length and 4-6 cm in width. The thickness of the renal cortex can be 12 mm. The renal pelvis measures about 4 cm in length.

I See an Abnormality—What Do I Do Now?

If you see a renal mass on US, its echogenicity provides important diagnostic clues.

• A simple renal cyst is anechoic (black).

• A stone is quite echogenic (white) and shows a posterior acoustic shadow (black).

• If you see a solid parenchymal structure in the interpolar (middle) kidney, this often represents a column of Bertin, a normal variant (Fig.10.1b).

• Any other mass requires further investigation by CT scan.

Check for mobility of the kidney on the psoas muscle during respiration. If it is restricted or reversed, a renal tumor may have extended through the renal capsule.

Psoas Muscle Ultrasound

Fig. 10.1 a The US shows a longitudinal image of the kidney. This is the best way to assess size, parenchymal thickness, and configuration of the renal pelvis. b If there is segmentation of the renal pelvis into an upper and lower part, the parenchyma in between can appear very prominent (column of Bertin; arrow). This is a normal variant without pathological significance.

Fig. 10.1 a The US shows a longitudinal image of the kidney. This is the best way to assess size, parenchymal thickness, and configuration of the renal pelvis. b If there is segmentation of the renal pelvis into an upper and lower part, the parenchyma in between can appear very prominent (column of Bertin; arrow). This is a normal variant without pathological significance.

Now that you know the basic rules of ultrasound, we will approach our first patient.

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Responses

  • TIZIANO
    How often should you have a renal ultrasound?
    4 years ago
  • Selam
    Do I note prominent column of bertin on ultrasound report?
    2 years ago

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