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Fascia that surrounds each kidney and adrenal gland
Gerotas fascia
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Adrenal gland is intra or retro peritoneal?
Retro peritoneal
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Where are the adrenal glands found?
Ant/Sup aspect of kidneys @ the level of the 12th thoracic vertebra
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Adrenal glands endocrine or exocrine
Endocrine
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How are Adrenal glands divided?
- Cortex (Outer 80%)
- Medulla (Inner 20%)
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What does the Adrenal Cortex produce
- Cortisol
- Corticosterone
- Aldosterone
- Androgens
- Hormones that have an affect on metabolism
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What does the Adrenal Medulla produce
- Epinephrine
- Norepinephrine
- "Fight or flight"
- Help us cope with physical/emotional stress
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Adrenal Hypofunction (insufficiency)
Addison's disease
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Signs/Symptoms of Addison's disease
- Fatigue
- Brownish discoloration of skin
- GI disturbances
-
Adrenal Hyperfunction
- Cushing's Syndrome
- Conn's Syndrome
- Pheochromocytoma
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Pheochromocytoma
Tumor that secretes adrenaline
-
Signs/Symptoms of Pheochromocytoma
- Uncontrollable Hypertension
- Tachycardia
- Excessive Sweating
- Flushing
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Neuroblastoma
Childhood tumor of the adrenal glands that has a poor prognosis
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Typical locations for Lymph nodes
- Para-aortic
- Porta Hepatis
- W/in Mesentery bowel (small)
- Around Iliac Vessels (groin)
- Axilla
- Neck
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Are Lymph nodes typically seen on U/S?
No, too small to be seen in U/S
-
USA of Benign Lymph node
- Hypoechoic w/ echogenic, fatty hilum
- Oval
- >1 cm
-
USA of Malignant Lymph node
- Oblong masses
- Uniform Low to mid amplitude echoes
- Extensive enlargement assoc w/ decr echogenecity
- Post. Shadowing
- No Fatty hilum
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Clinical signs & symptoms of Adrenal disease
- Hypertension
- Weakness of muscle
- Fatigue
- Flank Pain
- Hirsutism
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Hirsutism
- Masculinizing features in women
- Incr of androgens causes a male pattern of body hair, Chest, Abdomen, Back & Face
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Excessive hair growth in men/women is known as:
Hypertrichosis
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Splenomegaly
- Most common cause is Portal Hypertension
- Heart failure, cirrhosis, Portal or Splenic Vn thrombus, cystic fibrosis
- Splenic infections
- > 13 cm in cranial caudal dimension
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Normal measurement of Spleen
- 8-12 cm (SAG)
- Similar size to Lt Kidney
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Norma USA of Spleen
- Similar echogenicity to LIVER
- Homogenous echo texture
- Med-Mid gray level echoes
- Isoechoic or slightly hypoechoic to liver
- Highly echogenic Lt Hemidiaphragm
- Smooth contour
- Splenic vessels in hilum
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Functions of Spleen
- Filters blood
- Plays a part in immune function
- Initiates antibody production and production of lymphocytes
- Macrophages
- Phagocytose old RBC's
- Blood reservoir
- Hematopoesis (forms RBC's in embryonic life)
- Produces plasma cells
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Anatomic location of structures adjacent to the spleen
- Intraperitoneal
- Lt Kidney lies inferior and medial to spleen
- Inf/Ant to Diaph
- Lat to tail of panc, splenic flexure of colon, Lt Kidney and adrenal gland
- Post/Lat to stomach
- Encapsulated
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Cysts of the Spleen are:
- Infectious
- Usually aquired
-
Accessory Spleen
- Most common near hilum and panc tail
- Prominent bulge along medial surf of spleen
- Well-defined, encapsulated nodular mass
- Small like a donut hole
- Isoechoic to splenic tissue
- 1 cm in size
-
Splenic Infarct
- Occlusion of splenic art
- Most common benign neoplasms in spleen
- Emboli usually originate in Heart
-
Early Splenic infarct USA
Hypoechoic or isoechoic to spleen
-
Late Splenic Infarct USA
- Hyper/Hypoechoic
- May be wedge-shaped w/ base toward splenic capsule
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Cystic Lymphangiomas
- Lymphatic malformation
- USA Similar to hemangioma
-
Hamartoma
- Rare
- Lymphoid tissue
- Solitary or mult.
- USA: Echogenic and well-define
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Metastases of Spleen
- Common fr Melanoma
- Possible fr primary in lung, breast, colon and ovary
-
USA of Spleen METS
- Variable (hypo/hyperechoic)
- bulls-eye or target lesions
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Abdominal Lymphoma
- Malignant
- Assoc w/ Hodgkin's and non Hodgkin's lymphoma
- Splenomegaly indicates intrinsic involvement of spleen
-
USA of Abdominal Lymphoma
Hypo/hyperechoic lesions w/in spleenCa++ or Splenomegaly may or may not be present
-
Ectopic Spleen
- AKA: Wandering spleen, aberrant spleen, floating spleen
- Not where it's supposed to be
- Prone to torsion
- Asymptomatic abdominal or pelvic mass
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Subcapsular Hematoma of Spleen
Splenic Capsule remains intact
-
USA of Intracapsular Hematoma of Spleen
Variable or complex as related to age
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Retroperitoneal space is between:
- Posterior portion of the parietal peritoneum
- Posterior to abdominal wall muscles
-
Retroperitoneum structures
- Aorta
- IVC
- Adrenal glands
- Kidneys
- Lymph nodes
- Panc
- Uterus
- Crus and psoas muscles
-
Retroperitoneal Hemorrhage
- An anechoic mass w/irregular borders
- Can be caused by trauma or iatrogenic
- Decr blood
-
USA of Retroperitoneal Hemorrhage
- Variable
- Hypoechoic,
- Internal echoes
- Residual Ca++
-
Best imaging modality for Splenic trauma and suspected rupture
CT
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Splenic Ca++ Causes
- Healed granulomas-punctuate echogenic foci
- Splenic Art/aneurysm Ca++
- Splenic Infarct
- Old Hematomas
- Cysts w/ Ca++ walls
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Thyroid Adenoma
- Benign neoplasm
- <4 cm in diameter
- Most common Thryoid mass
- AKA: Nodules
- Usually mult.
- Encapsulated by fibrous tissue (well-defined borders)
-
USA of Thyroid Adenoma
- Varies
- Majority solid and hypoechoic
- May also be isoechoic or hyperechoic
- Classically has peripheral Echolucent halo
- May be complex for degenerating adenomas
-
USA of Hashimoto's Thyroiditis
- Hypofunction
- Enlarged
- Heterogeneous
- Hypoechoic Coarse texture
- Hypervascularity
- May have discrete nodules
- Might have Ca++
- Difficult to distinguish from Multinodular goiter
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Hashimoto Thyroiditis
- Most common cause of Hypothyroidism
- Lymphocitic inflammatory disease
-
Grave's Disease signs and symptoms
- Hyperfunction
- Wt loss
- Incr. heart rate
- Anxiety
- Excess Energy
- Exophthalmos (bulging eyes)
-
Parathyroid Adenoma
- Benign
- Produces excess PTH (Parathyroid Hormone)
- Produces excess Ca++ (labs)
- Assoc w/ Nephrocalcinosis
- Genetic mutations
-
Esophagus
Most Likely to be mistakenly interpreted as a mass in the thyroid or parathyroid gland
-
Papillary Thyroid
- Most Common type of Thyroid Carcinoma
- 60-70%
-
USA of Thyroid Carcinoma
- Irreg. borders
- Tiny Ca++
- Hypoechoic
- Cystic and solid components
- Thick incomplete halos
-
Isthmus of Thyroid Gland
- Connects the Rt/Lt lobes of thyroid gland
- Mid Line anterior to trachea
-
Hypothyroidism
- Common in 40-50 y/o women
- Low T3 and T4
- Thyroid under produces thyroid hormone
- Assoc w/ non-toxic goiter
-
Signs and Symptoms of Hypothyroidism
- Fatigue
- Flakey dry skin
- Weight gain
- Heavy menstrual period
- Intolerance to cold
-
Pyramidal Lobe
- Finger-like lobe of tissue that extends
- Ant/Sup of the Isthmus
- More often on Left side
- 40% of population has a third thyroid lobe
-
Thyroid Gland Function
- Endocrine gland
- Secretes hormones T4 (Thyroxine), T3, TSH
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