WFUMB Course Book

Basics in Urology - Chapter 21 Media Library

Chapter Images

Fig 21.1a Transvesical examination of prostate (longitudinal scan) with prominent middle lobe
Fig 21.1b Transrectal prostate examination (transversal section)
Fig 21.2 Right (ri) ureter longitudinal. Stones (arrows) in region of crossover iliac vessels
Fig 21.3 Examination of left (le) kidney in important prone position to visualise an echorich tumor dorsal of the kidney
Fig 21.4a Measurement of right kidney longitudinal
Fig 21.4b Measurement of right kidney transversal and sagittal
Fig 21.5a Measurement of bladder and urine in longitudinal
Fig 21.5b Measurement of bladder and urine in transversal axis, used to measure residual urine
Fig 21.6a Transvesical measurement of the prostate
Fig 21.6b Transvesical assessment of the prostate after TUR (part of the prostate missing)
Fig 21.7a Urinary obstruction grade 2 in renal colic caused by ureter stone
Fig 21.7b Twinkling artefact in distal ureter before bladder, but positive urine jet on the right
Fig 21.8a Kidney with megacalices, a rare renal anomaly
Fig 21.8b A blind ending channel is found on the caudal ventral side of the bladder as a remnant of Urachus
Fig 21.9a Acute glomerulonephritis with hepatorenal quotient is 0.76 and the quotient between the cortex and medulla is 2.37, which is significantly increased - post-infectious glomerulonephritis
Fig 21.9b Chronic glomerulonephritis, IgA nephropathy diagnosed by biopsy turned into terminal renal insufficiency
Fig 21.10a Gout kidney. Gout also leads to changes, namely calcifications in both the medullary pyramids and in the cortex
Fig 21.10b Primary oxalosis. Very impressive pictures of a primary oxalosis, practically totally calcified kidney
Fig 21.11a Simple renal cyst. Bosniak I
Fig 21.11b Bosniak II: minimally complex cyst (benign)
Fig 21.12a Bosniak IIf complex renal cyst
Fig 21.12b Bosniak IV complex renal cyst. Arrow shows solid part in cyst
Fig 21.13a Problems are caused by the so-called renal parenchymal cones, which can look like a real tumor (inflammatory pseudotumor)
Fig 21.13b Angiomyolipoma (AML) is usually a hyperechoic tumour made up of adipose tissue, blood vessels and smooth muscles
Fig 21.14 Malignant tumor of lower pole of the left kidney - clear cell renal cell carcinoma (RCC)
Fig 21.15 Clear cell renal cell carcinoma (RCC). In larger tumors, there are larger inhomogeneities in the B-scan. Pseudo cystic or necrotic areas are very clearly visible in CEUS (unenhancing areas)
Fig 21.16 Chromophobic renal cell carcinomas (CRCC) are difficult to distinguish from oncocytomas. They are homogeneous, isoechogenic and they also behave similarly at CEUS
Fig 21.17 Papillary renal cell carcinomas (PRCC) are mostly homogeneous and hypoechoic; in CEUS (left panel, arrows) they are weakly perfused
Fig 21.18 Hemangiosarcoma is a very rare tumor, here observed in a kidney transplant
Fig 21.19 Hematoma - A fresh hematoma can be hyperechoic, later hypoechoic
Fig 21.20a Urinary obstruction Grade 2 dilatation is seen as a dilated ureter and a fornix angle of at least 90 degrees
Fig 21.20b Final stage, i.e. congestion grade IV (hydronephrosis) with practically no kidney cortex
Fig 21.21 Calyx diverticulum, better visualized with CEUS (left panel)
Fig 21.22 Kidney pelvis tumor (marker) can appear relatively hidden in an enlarged calyceal system
Fig 21.23a Hydroureter or dilated ureter caused by ureteric stones
Fig 21.23b Example of ureter tumor, seldom diagnosed by US
Fig 21.24a Bladder diverticula can be congenital or acquired
Fig 21.24b Inflammatory pseudotumor sometimes looks like a tumor
Fig 21.25a Interstitial cystitis is a special form of cystitis with characteristic bladder wall thickening
Fig 21.25b Trabecula bladder in obstructive uropathy, especially in prostatic hyperplasia
Fig 21.26a Bladder tumor – solid mass in the bladder lumen. Most of them are malignant
Fig 21.26b Bladder tumor – solid mass in the bladder lumen (longitudinal axis)
Fig 21.27a Stricture of urethra
Fig 21.27b Calcification/stone in the urethra (using high-frequency probe!)
Fig 21.28a Harmless thin-walled prostate cysts pose no problems for the patient
Fig 21.28b In transrectal examination hypoechoic, semi-liquide formation corresponding to a prostate abscess
Fig 21.29a Prostate calcifications often found after prostatitis
Fig 21.29b In BPH, dystrophic calcifications on the border between transitional zone and peripheral zone (twinkling artefact) are often found
Fig 21.30 Elastography in prostate carcinoma. Carcinomas are harder (blue), than the surrounding area
Fig 21.31 Two hyperechogenic nodules correspond to benign prostate adenomas (arrows)
Fig 21.32a Normal testicular sono-anatomy on longitudinal view, shows normal homogenous echogenicity throughout, with exception of peripherally located hyperechoic mediastinum
Fig 21.32b Normal testicular sono-anatomy on transverse view
Fig 21.33a CD show branches of centripetal arteries which supply blood to the testicular parenchyma and the capsular arteries which located on the peripherally and enter the testis and travel toward the mediastinum
Fig 21.33b CD and PWD (Pulse Wave Doppler) of normal testis
Fig. 21.34a Tunica albuginea cyst. Longitudianl view of the testis show typically peripherally located simple cyst
Fig 21.34b Moderate size simple testicular cyst. Longitudinal view show an anechoic structure with strong posterior acoustic enhancement in the testicular parenchyma
Fig 21.35a Testicular Infarction. Longitudinal view of the testis show multiple focal hypoechoic areas
Fig 21.35b Testicular Microlithiasis. Longitudinal view of the testis demonstrats scattered small bright hyperechoic points without acoustic shadowing. Two small complex cyst are also identified
Fig 21.36a CD of the left torsed testis shows no detectable blood flow on the testicular parenchyma
Fig 21.36b Longitudinal view of left torsed testis in a different patient. CD shows no detectable blood flow in the torsed testis and also shows increased flow in the wall of the scrotum
Fig 21.37a Seminoma. The testis is swollen and a lobulated, hypoechoic nodule was seen associated with microliths. Reactive hydrocele also noted
Fig 21.37b Small solid testicular lesion, Longitudinal view of the testis shows an oval hypoechoic lesion with mildly irregular border. CD shows blood flow in the periphery of the lesion
Fig 21.38a Embryonal cell carcinoma. Longitudinal view of the testis shows an oval hypoechoic lesion with a disorganized hypervascular pattern on CD, also noted that central necrosis is present
Fig 21.38b Embryonal cell carcinoma. Longitudinal view of the testis shows an oval hypoechoic lesion with a disorganized hypervascular pattern on CD, also noted that central necrosis is present
Fig 21.39a Large hydrocele with diffuse low-level echoes
Fig 21.39b Spermatocele. Longitudinal view shows a moderate size spermatocele. on the right epididymal head, however a epididymal cyst may also form in the epididymal head, with similar US features
Fig 21.40a Adenomatoid tumor of the epididymal tail. Most of this benign tumor will appear as a solid hypoechoic inhomogenous lesion
Fig 21.40b Minimal detectable blood flow may be seen on Color Flow Imaging
Fig 21.41a Varicocele. Longitudinal view at rest shows tortuous tubular structures located on the posterior aspect of the testis
Fig 21.41b During the Valsalva maneuver, minimally dilated veins posterior to the testis with augmented venous flow are seen
Fig 21.42a Acute epididymitis. A swollen epididymal head was noted
Fig 21.42b Hypervascularisation of the epididymis head is seen in CD
Fig 21.43a Left acute epididymo- orchitis. This patient has an acute left scrotal pain, longitudinal view of the left testis shows enlargement and swollen left testis with marked hyperaemia and asymmetry in perfusion
Fig 21.43b CD of the normal right testis of the same patient

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