General ultrasound In the critically ill - part 4

Việc chẩn đoán suy thận cấp tính là sinh học, và lợi thế chính của siêu âm đầu tiên để loại trừ khả năng một trở ngại [1]. Đối số gợi ý suy thận cấp tính sẽ được bình thường hoặc tăng khối lượng (Hình ). Suy thận mãn tính sẽ cung cấp cho thận nhỏ mỏng biên giới nhu mô và không đều (Hình ). | CHAPTER 9 Urinary Tract The study of the urinary tract is vast since mechanical infectious and hemodynamic phenomena are all involved. The normal pattern of the kidney and bladder is described in Chap. 4 Figs. and pp 21-22 . Renal Parenchyma The diagnosis of acute renal failure is biological and the main advantage of ultrasound is first to rule out the possibility of an obstacle 1 . Arguments suggestive of acute renal failure will be normal or increased volume Fig. . Chronic renal failure would give small kidneys with thinning of the parenchyma and irregular borders Fig. . Kidneys can show global dedifferentiation. The parenchyma can resemble the sinus parenchymocentral dedifferentiation or within the parenchyma medullary pyramids and cortex can be hard to detect corticomedullary dedifferentiation . However these patterns do not seem useful in emergency situations. Acute pyelonephritis is usually barely or not accessible to two-dimensional ultrasound but severe forms can sometimes be diagnosed. Figure shows the routine ultrasound of a 52-year-old female admitted for severe sepsis with massive bilateral enlargement of the kidneys with no differentiation. Diagnosis was hemorrhagic pyonephritis with diffuse purulent areas. Parenchymatous candidiasis can sometimes be diagnosed Fig. . Emphysematous pyelonephritis a rare finding gives gas bubbles within the parenchyma. In the case of severe rhabdomyolysis with acute renal failure we can observe enlarged kidneys with complete dedifferentiation. Renal trauma is presented in chap. 24. A renal cyst is a benign finding. In view of its great frequency we insert a characteristic example Fig. and a case of renal polycystic disease Fig. . Fig. . Acute renal failure. The kidney has a homogeneous echoic pattern . complete dedifferentiation. Kidney and liver L have the same echogenicity and the kidney is barely outlined .arrows . This scan as nearly all that follow is longitudinal Fig. . .