Kidney: Ultrasound Anatomy and Scanning Methods
Normal kidney longitudinal diameter is between 10.9 and 12 cm (median 10 cm), and transverse extent is on average 5–6 cm, despite individual differences related to age and size.
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Kidney: Ultrasound Anatomy and Scanning Methods Giulio Argalia, Serena Campa, Fatjon Cela, Nicola Carboni, Fabio Salvatori, and Gian Marco Giuseppetti
1.1
Sonographic Scanning Technique
US examination of the native kidney is performed with multifrequency convex probe with transmission frequency between 2 and 5 MHz according to the patient’s body structure, using longitudinal, coronal, transversal, oblique scans and an anterior or abdominal, posterior or dorsal, and lateral or lumbar approach. In anterior abdominal approach, in lateral or supine decubitus, the kidney is imaged with longitudinal or oblique subcostal scans, during inspiratory apnea. This approach avoids obstruction due to gas bowel, using the liver as an acoustic window. In anterior longitudinal scans, the kidney assumes an ellipsoidal shape and parenchymal ring appears uninterrupted. The ultrasound bipolar diameter does not exactly coincide with the anatomical larger diameter, because of the organ spatial arrangement. For this reason, the bipolar kidney diameter, determined in the longitudinal scan, tends to be overestimated or underestimated depending on the case. Subcostal scans represent the hilum with anterior and
G. Argalia (*) • S. Campa • F. Cela • N. Carboni F. Salvatori • G.M. Giuseppetti University Politecnica delle Marche, Az. Ospedali Riuniti, Ancona, Italy e-mail: [email protected]
p osterior lip, the renal vessels, and just below the pelvis. On the left, gas in the stomach and splenic flexure often represents an insurmountable impediment to view the kidney in anterior scans. However, upward subcostal scan in deep inspiration is required for the definition of topographic relations of a possible left adrenal mass. The dorsal approach, with the patient in the prone position, finds its main indication in performing ultrasound-guided minimally invasive procedures such as renal biopsy and percutaneous pyelostomy. It’s also useful for viewing the lower pole and the middle part of the kidney in the presence of intense bloating and colic stasis. The lumbar approach through middle and posterior axillary line, with the patient in supine or lateral position, allows a good assessment of the left and right kidney, in coronal and transversal scans. Coronal scan is the most suitable to measure correctly the repeatable bipolar diameter and cortical thickness. Parenchymal thickness must be determined close to chalices of the lower or upper lobe. In the coronal scan, the probe is located in posterior-anterior and cranio-caudal direction with the purpose of following ideally anatomical arrangement of the kidney in the lumbar loggia. Remember that the largest axis of the kidney is oblique from top to bottom in the frontal plane, because of the forward rotation of the renal sinus, and is anterior posterior oblique in the sagittal plane because of lumbar lordosis.
© Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_1
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