abd

• cortex grows through childhood and pyramids become smaller
• not a large amount of cortical fat
• cortex fairly thin equal or greater echogen than the liver
• 4-6 months decreases to less than liver
• arcuate vessles-specular echos btwn cortex and medulla
• contour lobulated from fetal lobulation

at base of pyramids

• larger in neonate than older infant and young child
• superior to upper pole of kidney
• left is more medial
• looks like inverted V in long, linear in short
• if kidney is absent adrenal gland is still in renal fossa

• 3-5mm wall depending on distention
• color can be used to see distal ureter entering posterior wall of bladder

• dilitation of collecting system
• common causes: obstruction, reflux, abn muscle development
• check other side and ureter and bladder for dilation
• grade hydro

• most common obstruction of urinary tract
• caused by intrinsic narrowing or extrinsic vascular compression
• hydro in kidney with normal ureter
• coronal scan plane best

• ureter obstructed anywhere- can be ureterovesicle junction
• can be caused by abcess or lymphnode
• may see diminished ureteral jet

• bilateral hydro usually bladder or outlet
• can be neurogenic bladder, pelvic mass, or congen. anom. like uretheral valves
• thick bladder wall, urinary ascites, urinoma at kidney

• most common cause of bladder outlet obstruction in neonate male
• can be pelvic mass or tumor

• females, left side
• ectopic insertion and dilitation of distal ureter in completely duplicated collecting system
• fluid mass within bladder inferiomedially to urethral insertion of lower pole ureter

• abdominal deficiency syndrome
• three things: hypoplasia or deficency of abd musculature, cryptorchidism, urinary tract anomolies
• dilated tortuous ureters, large bladder
• reflux common problem
• can be very severe with fatal pulmonary hypoplasia, dysplastic echogenic kidneys
• wrinkled prune like abdomen physically

• MCDK
• most common cause of renal cystic disease in neonate
• congenital- interference with ureteral bud function in first trimester
• ureteral atresia
• unilateral mass resembling a cluster of grapes
• bilateral is fatal
• may resemble ureteropelvic juncion obst
• involute and disappear completely or are small echogenic kidney

• indistinguishable from juvinile nephronophthisis
• small echogenic kidney variable sized cysts at corticomedullary junction

• aka infantile polycystic disease
• not common
• female
• diffuse enlargement
• associated with biliary ectasia and hepatic fibrosis
• most severe in neonatal- less in infant/juv
• third trimester-kidneys protrude in abd
• hyperechoic enlarged with hypo outter rim (cortex)
• juv form- later on hepatic fibrosis and portal htn, gi bleeding
• overall bilateral enlarge echogenic kidneys with loss of definintion btw parts
• oligohydraminos 16-18wks inutero

• adult form usually appears during middle ages
• 40s- htn, hematuria, enlarged kidneys
• cysts can be in liver, spleen, panc
• increased rcc
• well defined cysts on both kidneys

like with adults can be associated with various syndromes (tuberous sclerosis- 40% incidence of cysts- and vonhippel lindau)

• fever flank pain tenderness
• usually begins with bladder and ascends
• thickening of pelvis and ureter
• abcess forms as infection walls itself off
• can follow pts after antibiotic therapy

• repeated episodes of acute
• kidneys become scarred and decrease size
• cortex becomes more echogenic than liver
• pyramids difficult to separate from parenchyma

• most likely in dehydrated or septic infant
• in infants of diabetic mothers
• renal enlargement, low platelet, proteinuria, hematuria
• thrombus starts in intrarenal venous branches if reaches renal vein or ivc may be visualized in vascular structures
• calcification may result

• most common renal tumor of neonate
• aka fetal renal hamartoma or congential Wilms tumor
• rare
• connective tissue replaces parenchyma
• benign but looks like wilms, nephrectomy
• can extend through capsule into retroper.
• children less than 1 yr

• most common intraabdominal malignant renal tumor in children
• 2-5 yrs
• unilateral usually
• distortion and displacement of collecting system
• can be monitored during chemo- surgery best
• liquification when necrosis and hemorrhage
• tumor may spread through renal veins, ivc, and into right atrium of heart. Also to other kidney

• malignant tumor in adrenal medulla
• second most common tumor 2mo-2yr
• highly echogenic
• may have calcifications
• increased vascularity
• many pts have mets. check liver
• neuroblastoma is poorly defined whereas wilms is well encapsulated

• difficult delivery, large size, diabetic mother, stress/hypoxia at delivery, septicemia, predispose to adrenal hemorrhage
• abd mass, jaundice, anemia
• usually secondary to other complications
• ovoid enlargement of gland
• blunting of sup pole of kidney with inf placement
• looks like neuroblastoma