Ultrasound Scanning Images of the 4 Most Common Kidney Diseases

Ultrasound Scanning Images of the 4 Most Common Kidney Diseases

Renal ultrasonography is an important method for diagnosing and treating kidney disease. This article summarizes the most common ultrasonographic findings for kidney disease for reference.

Normal Kidney

Longitudinal scan with an ultrasound probe showed that the kidney was broad bean-shaped, and the right kidney was lower than the left kidney; the left kidney showed a single hump because it was close to the spleen. The kidney can be divided into the renal parenchyma and the renal sinus; the renal sinus is hyperechoic on ultrasound imaging and the renal parenchyma is hypoechoic: this can be divided into an outer cortical area and an inner medullary area (cone echo). Between the medulla is the renal column.

Kidney Scanning
Normal adult kidney ultrasound scan image: *renal column, **renal pyramid, ***renal cortex, ****renal sinus
child kidney ultrasound scan image
Normal child kidney ultrasound scan image: *renal column, **renal pyramid, ***renal cortex, ****renal sinus

The normal adult kidney is about 10-12 cm long, and the right kidney is slightly longer than the left kidney. Kidney size correlates with individual size and age. The renal cortical thickness is measured from the base of the renal vertebral body and is typically 7-10 mm. If the renal vertebral body is poorly demarcated, the thickness of the renal parenchyma can be measured and is 15-20 mm.

Renal measurements: L=length; P=parenchymal thickness; C=cortical thickness.

Renal Doppler ultrasonography is widely used in clinical practice and can accurately assess vascular perfusion. Spectral Doppler examination of renal arteries and interlobular arteries can evaluate peak renal artery systolic blood flow, resistance index and blood flow velocity curve, such as renal artery systolic peak blood flow ≥ 180 cm/s, which is renal artery stenosis ≥ 60. % predictors, resistance index ≥ 0.70 indicates abnormal renal vascular resistance.

Doppler ultrasound image of a normal adult kidney
Doppler ultrasound image of a normal adult kidney. Red: blood flow into the transducer; blue: blood flow out of the transducer.

Renal Cyst

Most renal cysts are simple renal cysts that are round in shape and filled with fluid. The incidence of simple renal cysts in people over 50 years old is ≥50%. It is a benign lesion and no further evaluation is required.

Adult cyst
Adult simple cyst, dashed distance: kidney length

Features of complex renal cysts: septation, calcification, and irregular thickening of the cyst wall. Doppler ultrasonography is feasible for further evaluation. Bosniak grading and follow-up of complex renal cysts can be performed with contrast-enhanced ultrasonography or enhanced CT. The Bosniak classification can be divided into grades I-IV, grade I: simple cyst, grade IV: cystic malignancy risk 85%–100%.

Adult complex renal cyst
Adult complex renal cyst with wall thickening in the lower pole, +, dashed distance: kidney length and complex cyst

In patients with polycystic kidney disease, multiple cysts of varying sizes can be seen. In patients with advanced polycystic kidney disease, the kidneys are enlarged, with no obvious demarcation between cortex and medulla.

Advanced polycystic kidney disease
Advanced polycystic kidney disease with multiple renal cysts

Hydronephrosis

The primary indication for renal ultrasound is to evaluate the renal collecting system. Dilation of the renal collecting system is often associated with obstruction of the urinary tract (including renal pelvis, calyces, and ureters). There is no echo in the hydronephrotic area, and renal sinus dilatation can be seen.

Hydronephrosis in children can be caused by obstruction of the ureteropelvic junction, ectopic ureteral orifice, primary megaureter, and posterior urethral valves (below). In adults, hydronephrosis can be caused by urolithiasis, obstruction of the renal pelvis or ureter, and ureteral compressions, such as pregnancy and retroperitoneal fibrosis. Urolithiasis is the most common cause of hydronephrosis in adults, with a prevalence of 10%-15%.

Hydronephrosis due to obstruction of the ureteropelvic junction in children

Normally, the ureter cannot be seen on ultrasound imaging. However, in the setting of urinary tract obstruction and vesicoureteral reflux with ureteral dilatation, the ureteropelvic junction can be seen, as well as the dilated ureter (below).

Bilateral ureteral dilatation due to vesicoureteral reflux in children
Bilateral ureteral dilatation due to vesicoureteral reflux in children

Hydronephrosis can be classified into five different grades from mild dilatation of the renal pelvis to thinning of the cortex based on macroscopic findings (Figure A). Hydronephrosis can also be assessed by measuring the level of the neck in the longitudinal section of the renal pelvis, the level of dilation in the transverse section, and cortical thickness (Figures B, C).

A: Late hydronephrosis with cortical thinning; +, dashed line distance: the dilated size of the renal pelvis
B: Renal pelvis, calyx dilation with cortical atrophy; +, dashed line distance: the width of the calyx in longitudinal section
Renal pelvis dilated size in transverse section
 C: Renal pelvis dilated size in transverse section

If abnormal echoes are seen in the collection system, clinical examination, blood analysis, and puncture or drainage should be performed to exclude pyonephrosis if necessary. Hydronephrosis can also be caused by non-obstructive diseases, such as taking diuretics, pregnant women, and children with vesicoureteral reflux.

Renal ultrasonography is an important method for diagnosing and treating kidney disease.

Chronic Kidney Disease

Ultrasound is an important method for diagnosing chronic kidney disease and judging prognosis. Whether it is glomerulosclerosis, tubular atrophy, interstitial fibrosis, or inflammation, echogenic cortical enhancement is seen on ultrasound imaging. Normal kidney echoes are similar to those of the liver or spleen. In addition, renal atrophy and cortical thinning are common, especially as the disease progresses. However, kidney size correlates with height, and patients with short stature have smaller kidneys; therefore, kidney size should not be used as the sole criterion.

Chronic kidney disease due to glomerulonephritis: thinning of the cortex and increased echogenicity. +, dotted line: kidney length
Nephrotic syndrome: echogenic demarcation of renal cortex and medulla
Chronic pyelonephritis: renal atrophy, focal cortical thinning. +, dotted line: kidney length
End-stage renal disease: echogenic, homogeneous structure, inability to distinguish renal parenchyma from renal sinus with the naked eye. +, dotted line: kidney length

Acute Kidney Injury

Ultrasound is the method of choice for the detection of acute renal lesions; CT and magnetic resonance imaging (MRI) are options for evaluation when ultrasonography is difficult to detect. When evaluating acute renal lesions, renal echo, renal imaging, renal vascularity, renal size, and focal lesions should be observed.

Acute pyelonephritis: cortical echogenicity, ill-defined superior renal pole
Postoperative renal failure: increased cortical echo and enlarged kidneys. Kidney biopsy revealed acute tubular necrosis.

CT is the method of choice for evaluating renal trauma, and ultrasound is used for follow-up, especially in patients with suspected urethral tumors (below).

Renal trauma: Infrarenal pole laceration, subcapsular effusion.

Ultrasound Guided Therapy

Kidney biopsy, percutaneous nephrostomy, or abscess drainage can be performed under ultrasound guidance. In the past, thermal ablation of renal tumors was guided by CT, because ultrasound-guided intervention was difficult to clearly display the intestinal distribution, resulting in a higher risk of peripheral intestinal injury. However, the latest guidelines for renal interventional therapy recommend ultrasound guidance as the preferred choice for radiofrequency, microwave, and cryoablation.

(A) Percutaneous nephrostomy with a fistula placed through the renal calyx into the hydronephrosis at the lower pole of the kidney. (B) Pigtail catheter placed in the calyceal dilatation. White arrows: fistula and pigtail catheter.

Percutaneous nephrostomy and abscess drainage can be performed using the one-step or Seldinger technique. Clinicians can choose one-step or Seldinger techniques based on preference, experience, and equipment conditions.

Summary

Renal ultrasonography is simple, convenient, rapid, and low-cost, and is an important method for diagnosing renal disease and guiding treatment. However, it still has certain limitations, and CT and MRI can be used to assist evaluation.

EagleView Ultrasound Review from Dr.Mustafa Taha

EagleView Ultrasound Review from Dr.Mustafa Taha

Shared by Dr. Mustafa Taha(@مصطفى محمود السيد from Facebook)

I am so happy to  provide you a number of videos of multiple interested in medical cases that were done by my EagleView probe.

This 40- year male patient presented to ER with acute confusion rapidly admitted to ICU.

On ICU ,the patient was in deep coma Glasgow coma scale was 5 and blood pressure was 80/50, JVP was raised and radial pulse was rapid and irregularly irregular, cardiac auscultation showed pan systolic murmur, spleen hugely enlarged and there are peripheral signs of infective endocarditis(Janeway lesion Osler nodules splinter hemorrhages and finger ulcerations), investigations are done and CT of brain show ischemic CVA.

I provide rapid bedside echo by EagleView, and the result was big mitral valve vegetations with rapid heart rate due to atrial fibrillation.

The case was diagnosed as Infective endocarditis with splenic and brain ischemic infarction due to vegetation emboli.

This 50 year male pt come with SOB and cough with lower limbs swelling, pt admitted to ICU and mechanically ventilated,on examination pt was in respiratory distress,Bp 90/50 ,JVP elevated.

The shape of chest wall showed pectus excavatum with thoracic scoliosis with coarse crepitations on auscultation, bedside echo was done by EagleView US and show hugely dilated right atrium together with right ventricle with evidence of D shape interventricular septum provides severe pulmonary hypertension with severe tricuspid regurge, inferior vena cava was congested and poorly collapsed which give hint about elevated pressure in the right atrium, case diagnosed later as core pneumonia due to chest wall deformity complicated by a chest infection.

Eagleview Ultrasound Review of Detecting Gallbladder Polyp

Eagleview Ultrasound Review of Detecting Gallbladder Polyp

-From Dr. Mohamed Omer Khider Ahmed

Gallbladder Polyps – are present in 4 to 6 percent of the population.4,5 An estimated 90% are benign cholesterol polyps, less than 10 mm in size and are incidental findings. The remaining 10% are adenomatous polyps that have malignant potential.

Most polyps are spherical (attached by a pedicle to the gallbladder wall). Less common are the broad based (sessile) polyps.

Sonographically a polyp appears as a hyperechoic nodule (more echogenic than the surrounding bile) attached to the gallbladder wall. The polyp is nonmobile and remains in a fixed position regardless of changes in patient position. The polyp is non-shadowing.

We have 36years old man sent to our clinic complain of right upper quadrant pain for an abdominal ultrasound, the study done using a handheld ultrasound devise from EagleView and gallbladder wall shows multiple immobile polypoid ingrowths into gallbladder lumen with no vascularity at color doppler which denotes gallbladder polyp.

image (1) sagittal view of the gallbladder demonstrated non-shadowing polypoid ingrowth into gallbladder lumen by the white arrow. gallbladder wall demonstrated by the black arrow.

image (2) transverse view of the gallbladder demonstrated non-shadowing polypoid ingrowth into gallbladder lumen by the white arrow. gallbladder lumen demonstrated by the black arrow.

image (3) color doppler over the gallbladder polyp (white arrow) demonstrated no color flow.

5 Eagleview Ultrasound Cases in Whole-body Scanning from Dr. Diego Scarpetta

5 Eagleview Ultrasound Cases in Whole-body Scanning from Dr. Diego Scarpetta

“It’s an opportunity to promote the use of clinical ultrasound.”

Dr. Diego Scarpetta, an internist from Colombia in South America, ordered his ultrasound probe from geteagleview.com and shared us with some cases of clinical scans using Eagleview Ultrasound.

From: IG: dr.pocus,https://www.instagram.com/dr.pocus/

Eagleview Ultrasound Case 1: Burns by Gas Cylinder Explosion

Dr.pocus-Eagleview case-1.2
Dr.pocus-Eagleviewcase1.1

A 51-year-old male with a history of hypertension. He was admitted at 21:30 to ER for burns of 18% of the TBS (face, left hemithorax, both arms) after being exposed to a gas cylinder explosion. Nasal hair was partially burned, without burning of the oral mucosa, carbonaceous sputum, or hoarseness. It was performed a CT scan of the abdomen and thorax did not appear to have shock wave injuries (pneumothorax or pneumoperitoneum).

Infusion of intravenous fluids (Baxter, PMH) was started, and vaseline dressings with chlorhexidine were applied. He was admitted to airway surveillance in ICU. He arrived with O2 sat > 96%, stable vital signs, controlled pain, soft and depressible abdomen, preserved diuresis. Normal lab tests.

He remained stable overnight, SatO2 is ok. However, at 06:20 the patient began to complain of abdominal pain and nausea. Additionally, he looked pale, had tachycardia, and with a tendency to hypotension.

07:10 am, 50 mmHg Adrenergic vasopressors were started through a subclavian CVC.

07:20 am, He remained with a soft abdomen but complained of mild pain (3/10), an urgent control of total blood count was requested due to suspected bleeding.

07:30 am, A FAST protocol was performed, finding abundant free fluid in Morrison’s space and rectovesical pouch; no observation was made in the splenorenal recess because he had dressings in that location. The patient was evaluated by a surgeon minutes later, and despite the abdomen wasn’t painful or with peritonitis signs, massive retroperitoneal bleeding was suspected.

09:45 am, a lab call was received to report a decrease in hemoglobin from 12.9 to 8.9 g / dl.

10:00 am, Official report of CT scan: Liver: diffuse fatty infiltration. The gallbladder, bile duct, pancreas, kidneys were ok. Spleen with irregular margins with perisplenic hematoma. No pneumoperitoneum. A moderate amount of fluid with blood density in a left paracolic leak that extends into the pelvis, contacting the external iliac vessels on the left side and the urinary bladder.

10:30 am, the patient was transferred to surgery. Op findings: Drainage of 3000 ml of blood material. Splenic vessel injury was ligated.

Eagleview Ultrasound Case2: COPD

67 years-old woman with COPD (chronic obstructive pulmonary disease). She was admitted to the emergency room for exacerbation of respiratory symptoms (Anthonisen I) one week ago.

LUCI on the right side shows multiple B lines, while the left side shows a consolidation, compatible with the CT scan findings.

The patient was intubated and required vasopressors and antibiotics for little more than a week. Now she is ending her recovery in the intermediate critical care unit.

Eagleview Ultrasound Case3: Perdicardial Effusion

74 years-old man with a history of arterial hypertension and poorly controlled type 2 diabetes mellitus. Diarrhea for a week, anuria in the last 24 hours.

Blood urea nitrogen (bun) = 137 mg/dL (22.8 mmol/L), K= 8.5 mEq/L, uremic frost, and perdicardial effusion, PTH 278 pg/ml.

Hemodialysis was started, achieving a good response.

Eagleview Ultrasound Case 4: Lung Ultrasound in the Critically Ill

60 years- old man with type 2 diabetes, arterial hypertension, heart failure (AHA C NYHA II caused by coronary disease). He was transferred to ICU after consulting for 11 days of dyspnea, cough, fever, and anosmia. He refused to get the SARS-CoV-2 vaccine. The RT-PCR was positive.

Lung ultrasound in the critically ill (LUCI): B lines suggestive of the alveolar – interstitial syndrome.

CT Scan: Ground-glass opacification areas in both lung fields (greater in peripheral, and lower lobes).Some interesting publications about the relevance of ultrasonography in the early assessment of Covid 19 patients.

Eagleview Ultrasound Case5: Hypertensive Cardiomyopathy

86 years-old man with chronic arterial hypertension and heart failure consults to ED for exacerbation of dyspnea.

EagleView Ultrasound Review and Comparison with Butterfly iQ & GE Vscan

EagleView Ultrasound Review and Comparison with Butterfly iQ & GE Vscan

Masters of Ultrasound,an educational account on Youtube, focused mainly on Echo Cardiography, POCUS, and FOA Med,has just released his video of EagleView Ultrasound Complete Review recently. In his video, he showed the EagleView operation process, usage method, image quality and compared it with other portable ultrasound products on the market, and also objectively enumerate their respective advantages and disadvantages. Read his article to learn more.

UNBOXING

So this is how it came directly from the package, and as you can see, it somehow reminds me of an Apple product. So if we open it the first we see is the quick operation guide, which is a small book with instructions, then we find the probe in this translucent plastic bag. Then we find on the bottom of the box the cable which is a micro USB for the wireless charger, and finally, the wireless charger and a stand, to put the iPhone tablet or whatever or even the probe itself.
As you can see, it’s a wireless, dual-head probe, that connects to iOS 9 or later and Android 10 or later smartphones and tablets. Given it is multipurpose and has the ability to scan both very superficial structures with the linear probe and deeper ones with the curved, I will compare at the end of the video some of its most remarkable features versus the Butterfly IQ+ and Vscan Air, the two most popular multipurpose out there in the market. It doesn’t make sense to compare them with specific ones, since they are usually tailored towards a specific target and therefore they usually have higher performance in that narrower specter of situations, whereas these probes are able to handle a wider range of circumstances.

EXTERNAL

It measures 156 x 60 x 20mm (equivalent to 6.1 x 2.4 x 0.8 inches), has a glossy finish, and weights 260g equivalent to 0.6lbs, which lies in between the Butterfly which is heavier with 309g, and the Vscan Air which is lighter with 205g. It has an integrated battery of 4200 mili Amperes hour and in my case, it allowed approximately 30 minutes of continued use until it overheats, and almost 3.5 hours of total scan time before recharging it. Bear in mind this time can vary substantially based on the scan mode you use and how long the image is frozen (their official webpage states between 3 and 5 hours of total scan time). Color doppler drains the battery more quickly, then the remaining imaging modes, and finally a frozen screen while doing measurements or entering patient info and so on. As I’ve been testing it intensely I must admit I have used color doppler for quite long periods. Simply placing your EagleView portable doppler ultrasound over the wireless charger that comes in the same box will recharge the battery. In my case, it required approximately 2:30h for a full charge and it cannot be used while charging. It doesn’t have any port so everything is wireless (including charging and exporting). As mentioned initially, it has two probes integrated with the same device, with the linear end tailored towards shallow exams, such as MSK, vascular, thyroid, lung, breast, nerves, aesthetic medicine and interventionism in general and the curved end towards deeper exams such as the cardiac, abdomen, ob/GYN and urology. The footprints are the usual ones of linear and curved probes, same as Vscan but contrary to Butterfly. The only button it has, which switches on and off the device and freezes the image, also changes between both probes and the light indicates which one is being used currently. It is not fully waterproof, only 1-2cm from the footprint, video speed is 18 frames per second, the linear probe is 128 elements. Probes frequencies are: 3.5MHz and 5MHz for the curved one,  7.5MHz and 10MHz for the linear one. Scan depth: arriving up to 30cm for the curved one, arriving up to 10cm for the linear one. Bear in mind the cardiac preset concentrates all the ultrasound beams in the center to be able to go through the ribs and obtain an image. Because it’s bigger than usual PA cart machine probes, it can be tricky sometimes to obtain some views (such as apical 4 chambers for example), because of the lack of space between the bed and the patient.

SOFTWARE

Now you’ll see the bootup and pairing process. It connects via WiFi network in less than 17 seconds from pressing the power button to being ready for the scan. It has 15 presets for the different organs, 5 imaging modes (B, M, color doppler, power Doppler and pulsed wave doppler), and several advanced image settings such as TGC, DYN, Focus, Harmonic, and Denoise, as well as the typical depth and gain. It stores the images directly in your device as a .jpg or .avi and it can also use DICOM. This has some pros, such as not needing any cloud service to store your info nor pay any annual subscription as well as cons such as only having the images in the device they were taken, although you can always share them via your favorite apps, such as Whatsapp, messages, telegram, email, AirDrop and so on. Now you’re gonna see some recorded clips with the device and live demos because I could say it’s really good or bad but I prefer you assess it by yourself and obtain your own conclusions.

PROS/CONS

And, as usual, to sum up, let’s put the pros and cons all together and compare them with the Butterfly and Vscan. On the pros column, we have: – Lowest price in the market. The main one. It provides comparable results to more expensive options, and here lies its greatest value. – Great image quality and advanced imaging settings – Several imaging modes (B, M, color doppler, PDI, PWD). – Aesthetic, somehow light and not clunky. – Long battery duration and fast charging. On the other hand, on the cons column, we find: – Color doppler scale up to 40cm/s only, suboptimal for cardiac velocities. – Gain adjustment is made by buttons, not with a left or right slide, which would be easier. – Relative: (Manual image quality settings. Good for experienced people, but this can be daunting for inexperienced ones, that might prefer that an algorithm adjusted the image by itself) Size and weight:
Battery life:
Imaging modes: Overall:
Overall, EagleView portable doppler ultrasound got 3 golds in this product competition with multiple imaging modes and powerful battery life.

COMPARISON

Now let’s compare the EagleView ultrasound with Butterfly iQ+ vs GE Vscan Air.

We’re gonna compare the size and weight, battery, imaging modes, image quality, advanced image settings, and price, which are the most important features for most of you. If someone wants any further detail, please let me know in the comments. 1. Size and Weight: It lies between the Vscan Air and the Butterfly IQ+ both in size and weight. 235g for the EagleView vs 205g for the VscanAir and 309g for the ButterflyIQ+. 2. Battery: This extra weight and size vs Vscan Air allow it to have a bigger battery (4200mAh). It has better than the Butterfly IQ+. 3. Imaging modes: Neither the Vscan Air nor the Butterfly IQ+ has the same amount of modes outside of the US, with Vscan Air only having B mode and color doppler, and Butterfly having B, M, color doppler, power doppler and, only in the US, pulsed wave doppler. It also has additional tools such as the auto calculator, bladder volume calculator, needle enhancer, and bi-plane tool for interventionism, that any other hand-held device has. 4. Image quality: IMHO, the Vscan Air has the best B-mode image quality, then I would say the EagleView and then the Butterfly. This applies especially to the heart, which is what I scanned the most but can relate to the rest of the body.
EagleView Ultrasound Complete Review I Dual-Head Hand-Held Pocket Multipurpose Ultrasound Device