Hydronephrosis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hydronephrosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hydronephrosis]]


{{CMG}}; {{AE}}{{Vbe}}  
{{CMG}}; {{AE}}{{Vbe}}  
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==Overview==
==Overview==


Hydronephrosis must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, pyelonephritis, cystitis.
[[Hydronephrosis]] must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, [[pyelonephritis]], [[cystitis]], ovarian cyst, pelvic tumor


==Differentiating [Disease name] from other Diseases==
==Differentiating hydronephrosis from other Diseases==


Hydronephrosis must be differentiated from pelvic cyst<ref name="pmid28281789">{{cite journal |vauthors=Han D, Ma G, Wei L, Ren C, Zhou J, Shen C, He T |title=Preliminary study on the differentiation between parapelvic cyst and hydronephrosis with non-calculous using only pre-contrast dual-energy spectral CT scans |journal=Br J Radiol |volume=90 |issue=1073 |pages=20160632 |date=May 2017 |pmid=28281789 |pmc=5605099 |doi=10.1259/bjr.20160632 |url=}}</ref>, renal sinus lymphangiectasia<ref name="pmid26494296">{{cite journal |vauthors=Indiran V, Prabhu PS, Maduraimuthu P |title=Isolated Renal Sinus Lymphangiectasia-Close Mimic of Pelviureteric Junction Obstruction and Hydronephrosis |journal=Urology |volume=87 |issue= |pages=e11–2 |date=January 2016 |pmid=26494296 |doi=10.1016/j.urology.2015.10.008 |url=}}</ref>, ovarian cyst, pelvic tumor, ureteral polyp<ref name="pmid6777404">{{cite journal |vauthors=Chopra A, Teele RL |title=Hydronephrosis in children: narrowing the differential diagnosis with ultrasound |journal=J Clin Ultrasound |volume=8 |issue=6 |pages=473–8 |date=December 1980 |pmid=6777404 |doi= |url=}}</ref>
[[Hydronephrosis]] must be differentiated from pelvic cyst<ref name="pmid28281789">{{cite journal |vauthors=Han D, Ma G, Wei L, Ren C, Zhou J, Shen C, He T |title=Preliminary study on the differentiation between parapelvic cyst and hydronephrosis with non-calculous using only pre-contrast dual-energy spectral CT scans |journal=Br J Radiol |volume=90 |issue=1073 |pages=20160632 |date=May 2017 |pmid=28281789 |pmc=5605099 |doi=10.1259/bjr.20160632 |url=}}</ref>, renal sinus lymphangiectasia<ref name="pmid26494296">{{cite journal |vauthors=Indiran V, Prabhu PS, Maduraimuthu P |title=Isolated Renal Sinus Lymphangiectasia-Close Mimic of Pelviureteric Junction Obstruction and Hydronephrosis |journal=Urology |volume=87 |issue= |pages=e11–2 |date=January 2016 |pmid=26494296 |doi=10.1016/j.urology.2015.10.008 |url=}}</ref>, [[ovarian cyst]], [[pelvic tumor]], ureteral polyp<ref name="pmid6777404">{{cite journal |vauthors=Chopra A, Teele RL |title=Hydronephrosis in children: narrowing the differential diagnosis with ultrasound |journal=J Clin Ultrasound |volume=8 |issue=6 |pages=473–8 |date=December 1980 |pmid=6777404 |doi= |url=}}</ref>, pyelonephritis, cystitis.
 
 
 
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
 
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
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{| class="wikitable"
! rowspan="2" |S.No.
! rowspan="2" |Disease
! colspan="3" |Symptoms
! colspan="2" |Signs
! colspan="3" |Diagnosis
! rowspan="2" |Comments
|-
!Abdominal Pain
!Hematuria
!Headache
!Abdominal mass
!Abdominal tenderness
!Ultrasonography
!CT scan
!Histology
|-
|1.
|[[Wilms' tumor|Wilms tumor]]
|<nowiki>+</nowiki>
|<nowiki>+ </nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
*It is the best initial diagnostic study used in cases suspected with [[Wilms tumor]].
*[[Ultrasonography]] can help identify the mass as a kidney mass.
*It can distinguish [[tumor]] mass from other causes of renal swelling like [[hydronephrosis]].<ref name="pmid61529362">{{cite journal |vauthors=Hartman DS, Sanders RC |title=Wilms' tumor versus neuroblastoma: usefulness of ultrasound in differentiation |journal=J Ultrasound Med |volume=1 |issue=3 |pages=117–22 |date=April 1982 |pmid=6152936 |doi= |url=}}</ref>
*[[Doppler ultrasonography]] can help to detect invasion of [[renal vein]] and [[Inferior vena cava|IVC]] by the tumor.<ref name="pmid30036602">{{cite journal |vauthors=De Campo JF |title=Ultrasound of Wilms' tumor |journal=Pediatr Radiol |volume=16 |issue=1 |pages=21–4 |date=1986 |pmid=3003660 |doi= |url=}}</ref>
|
*Findings on [[CT scan]] which can be suggestive of  [[Wilms tumor]] include:<ref name="pmid4080660">{{cite journal |vauthors=Cahan LD |title=Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease |journal=Pediatr Neurosci |volume=12 |issue=1 |pages=58–62 |date=1985 |pmid=4080660 |doi= |url=}}</ref>
**Heterogeneous soft-tissue density masses
**These masses have frequent areas of [[calcification]] (~10%) and fat-density regions
**[[Lymph node]] metastasis
*[[CT scan]] of the renal mass can further reveal:
**Invasion of surrounding organs
**[[Thrombus]] in or occlusion of the [[renal vein]] and/or the [[inferior vena cava]]
**Abdominal lymph nodes and contralateral involvement
|
*Wilms tumor has a triphasic appearance.
*It is comprised of 3 types of cells:
**[[Stromal]]
**[[Epithelium|Epithelial]]
**[[Blastema|Blastemal]]
*All the 3 types are not required for the diagnosis of Wilms tumor.
*Primitive tubules and [[Glomerulus|glomeruli]] are often seen comprised of [[Cancer|neoplastic]] cells.
*Beckwith and Palmer reported in NWTS the different histopathologic types of Wilms tumor to categorize them based on prognosis.<ref name="pmid1978">{{cite journal |vauthors=Jolly RD, Stellwagen E, Babul J, Vodkaĭlo LV, Titov VL, Moldomusaev DM, Maianskiĭ AN |title=Mannosidosis of Angus Cattle: a prototype control program for some genetic diseases |journal=Adv Vet Sci Comp Med |volume=19 |issue=23 |pages=1–21 |date=November 1975 |pmid=1978 |doi= |url=}}</ref>
 
*Spindled cell [[stroma]] surrounding abortive tubules and [[Glomerulus|glomeruli]] is characteristic.
*The stroma may include:
**Striated [[muscle]] [[cartilage]]
**[[bone]]
**[[Adipose tissue|Fat tissue]]
**[[Fibrous connective tissue|Fibrous tissue.]]
|
|-
|2.
|[[Renal cell carcinoma]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Ultrasound]] (US) may be helpful when CT scan results are equivocal. It is noteworthy to mention that not all renal cell [[carcinomas]] are detectable on [[ultrasound]].
|Both [[CT]] and [[MRI]] may be used to detect [[neoplastic]] masses that may define renal cell carcinoma or metastasis of the primary cancer. [[CT]] scan and use of intravenous (IV) contrast is generally used for work-up and follow-up of patients with [[Renal cell carcinoma|renal cell carcinom]]<nowiki/>a.
|The histological pattern of renal cell [[carcinoma]] depends whether it is [[Papillary|papillary,]] [[chromophobe]] or [[collecting duct]] renal cell carcinoma.
|
|-
|3.
|[[Malignant rhabdoid tumor|Rhabdoid kidney disease]]
| +
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Ultrasound]] shows a complex cystic mass.
|
* [[CT]] scan may be diagnostic of malignant rhabdoid tumor. Findings on [[CT]] scan suggestive of malignant rhabdoid tumor include a large, heterogenous, centrally located mass, which is lobulated with individual lobules separated by intervening areas of decreased attenuation, relating to either previous [[hemorrhage]] or [[necrosis]]. Enhancement is similarly heterogeneous. [[Calcification]] is relatively common, observed in 20-50% of cases and is typically linear and tends to outline tumor [[lobules]].
|
* [[Malignant]] rhabdoid tumor is characterized by the round blue tumor cells of high cellularity composed of atypical cells with eccentric nuclei, small nucleoli, and abundant amounts of [[eosinophilic]] cytoplasm with frequent mitotic figures.
|
|-
|4.
|[[Polycystic kidney disease]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+ (from hypertension)</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
Ultrasound may be helpful in the diagnosis of polycystic kidney disease. Findings on an ultrasound diagnostic of polycystic kidney disease include:<ref name="pmid25786098">{{cite journal |vauthors=Chapman AB, Devuyst O, Eckardt KU, Gansevoort RT, Harris T, Horie S, Kasiske BL, Odland D, Pei Y, Perrone RD, Pirson Y, Schrier RW, Torra R, Torres VE, Watnick T, Wheeler DC |title=Autosomal-dominant polycystic kidney disease (ADPKD): executive summary from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference |journal=Kidney Int. |volume=88 |issue=1 |pages=17–27 |date=July 2015 |pmid=25786098 |pmc=4913350 |doi=10.1038/ki.2015.59 |url=}}</ref><ref name="pmid18945943">{{cite journal |vauthors=Pei Y, Obaji J, Dupuis A, Paterson AD, Magistroni R, Dicks E, Parfrey P, Cramer B, Coto E, Torra R, San Millan JL, Gibson R, Breuning M, Peters D, Ravine D |title=Unified criteria for ultrasonographic diagnosis of ADPKD |journal=J. Am. Soc. Nephrol. |volume=20 |issue=1 |pages=205–12 |date=January 2009 |pmid=18945943 |pmc=2615723 |doi=10.1681/ASN.2008050507 |url=}}</ref>
*At least three unilateral or bilateral [[cysts]] in patients 15 - 39 years old
*Atleast two [[cysts]] in each [[kidney]] in patients 40 - 59 years old
*Atleast four [[cysts]] in each [[kidney]] in patients 60 years of age or older
|
[[Renal]] CT scan may be helpful in the diagnosis of polycystic kidney disease. Findings on CT scan diagnostic of ADPKD include:
* Numerous [[renal]] [[cysts]] of varying size and shape with little intervening [[parenchyma]] with water [[attenuation]] and very thin wall.
* Reduction in [[sinus]] [[fat]] due to expansion of the [[cortex]]
* Occasional complex [[cysts]] with hyperdense appearance, with possible septations or calcifications
* Multiple [[homogeneous]] and hypoattenuating [[cystic]] lesions in the [[liver]] in patients with [[liver]] involvement
|
*On microscopic histopathological analysis, interstitial fibrosis, tubular atrophy, thickening and lamellation of tubular basement membranes, microcysts and negative immunofluorescence for complement and immunoglobulin are characteristic findings of ADPKD.<ref name="pmid12234310">{{cite journal |vauthors=Stavrou C, Koptides M, Tombazos C, Psara E, Patsias C, Zouvani I, Kyriacou K, Hildebrandt F, Christofides T, Pierides A, Deltas CC |title=Autosomal-dominant medullary cystic kidney disease type 1: clinical and molecular findings in six large Cypriot families |journal=Kidney Int. |volume=62 |issue=4 |pages=1385–94 |date=October 2002 |pmid=12234310 |doi=10.1111/j.1523-1755.2002.kid581.x |url=}}</ref><ref name="pmid24509297">{{cite journal |vauthors=Bleyer AJ, Kmoch S, Antignac C, Robins V, Kidd K, Kelsoe JR, Hladik G, Klemmer P, Knohl SJ, Scheinman SJ, Vo N, Santi A, Harris A, Canaday O, Weller N, Hulick PJ, Vogel K, Rahbari-Oskoui FF, Tuazon J, Deltas C, Somers D, Megarbane A, Kimmel PL, Sperati CJ, Orr-Urtreger A, Ben-Shachar S, Waugh DA, McGinn S, Bleyer AJ, Hodanová K, Vylet'al P, Živná M, Hart TC, Hart PS |title=Variable clinical presentation of an MUC1 mutation causing medullary cystic kidney disease type 1 |journal=Clin J Am Soc Nephrol |volume=9 |issue=3 |pages=527–35 |date=March 2014 |pmid=24509297 |pmc=3944763 |doi=10.2215/CJN.06380613 |url=}}</ref><ref name="pmid21775974">{{cite journal |vauthors=Faguer S, Decramer S, Chassaing N, Bellanné-Chantelot C, Calvas P, Beaufils S, Bessenay L, Lengelé JP, Dahan K, Ronco P, Devuyst O, Chauveau D |title=Diagnosis, management, and prognosis of HNF1B nephropathy in adulthood |journal=Kidney Int. |volume=80 |issue=7 |pages=768–76 |date=October 2011 |pmid=21775974 |doi=10.1038/ki.2011.225 |url=}}</ref><ref name="pmid20378641">{{cite journal |vauthors=Heidet L, Decramer S, Pawtowski A, Morinière V, Bandin F, Knebelmann B, Lebre AS, Faguer S, Guigonis V, Antignac C, Salomon R |title=Spectrum of HNF1B mutations in a large cohort of patients who harbor renal diseases |journal=Clin J Am Soc Nephrol |volume=5 |issue=6 |pages=1079–90 |date=June 2010 |pmid=20378641 |pmc=2879303 |doi=10.2215/CJN.06810909 |url=}}</ref>
 
|
|-
|5.
|[[Pheochromocytoma]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+ (as a part of the hypertension paroxysm)</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* CT is the preferred imaging modality for the diagnosis of pheochromocytoma.
|The following findings may be observed on [[CT scan]]:<ref name="pmid1787652">{{cite journal| author=Bravo EL| title=Pheochromocytoma: new concepts and future trends. | journal=Kidney Int | year= 1991 | volume= 40 | issue= 3 | pages= 544-56 | pmid=1787652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1787652  }}</ref>
*Most common extra-[[Adrenal gland|adrenal]] locations are superior and inferior [[abdominal]] [[Paraaortic lymph node|paraaortic]] areas, the [[urinary bladder]], [[thorax]], [[head]], [[neck]] and [[pelvis]].<ref name="pmid1729490">{{cite journal| author=Whalen RK, Althausen AF, Daniels GH| title=Extra-adrenal pheochromocytoma. | journal=J Urol | year= 1992 | volume= 147 | issue= 1 | pages= 1-10 | pmid=1729490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1729490  }}</ref>
 
*In sporadic pheochromocytoma, [[CT]] and [[MRI]] are good choices. The choice depends on availability and cost.<ref name="pmid191248172">{{cite journal| author=Baid SK, Lai EW, Wesley RA, Ling A, Timmers HJ, Adams KT et al.| title=Brief communication: radiographic contrast infusion and catecholamine release in patients with pheochromocytoma. | journal=Ann Intern Med | year= 2009 | volume= 150 | issue= 1 | pages= 27-32 | pmid=19124817 | doi= | pmc=3490128 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19124817  }}</ref>
*In patients with the [[multiple endocrine neoplasia]] type 2 ([[Multiple endocrine neoplasia type 2|MEN2]]) syndrome, [[CT]] may miss the [[tumors]].<ref name="pmid17876522">{{cite journal| author=Bravo EL| title=Pheochromocytoma: new concepts and future trends. | journal=Kidney Int | year= 1991 | volume= 40 | issue= 3 | pages= 544-56 | pmid=1787652 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1787652  }}</ref>
|
* On microscopic pathology, [[Pheochromocytoma]] typically demonstrates a nesting (Zellballen) pattern on microscopy. This pattern is composed of well-defined clusters of tumor cells containing [[eosinophilic]] cytoplasm separated by fibrovascular [[stroma]].
|
|-
|6.
|[[Burkitt's lymphoma|Burkitt lymphoma]]
|<nowiki>+/- (in non-endemic or sporadic form of the disease)</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Abdominal [[ultrasonography]] may show [[splenomegaly]] and [[ascites]].
|
* Chest, abdomen, and pelvis [[CT]] scan may be helpful in the diagnosis of [[Burkitt's lymphoma]] but it is not done routinely.<ref name="medlineplus">Burkitt lymphoma. MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/001308.htm Accessed on September 30, 2015</ref>
|
*On microscopic histopathological analysis, characteristic findings of Burkitt's lymphoma include:<ref name="pmid12610094">{{cite journal |author=Bellan C, Lazzi S, De Falco G, Nyongo A, Giordano A, Leoncini L |title=Burkitt's lymphoma: new insights into molecular pathogenesis |journal=J. Clin. Pathol. |volume=56 |issue=3 |pages=188–92 |year=2003 |month=March |pmid=12610094 |pmc=1769902 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=12610094}}</ref>
:*Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]])
:*Round nucleus
:*Small nucleoli
:*Relatively abundant cytoplasm ([[basophilic]])
:*Brisk mitotic rate and [[apoptotic]] activity
:*Cellular outline usually appears squared off
:*"Starry-sky pattern":
::*The ''stars'' in the pattern are tingible-body macrophages (macrophages containing [[apoptotic]] tumor cells.
::*The tumour cells are the ''sky''
|
|-
|7.
|[[Intussusception]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/- </nowiki>
|<nowiki>+</nowiki>
|
* [[Ultrasound]] is the [[Gold standard (test)|gold standard]] imaging modality used to diagnose intussusception<ref name="pmid17308922">{{cite journal |vauthors=Ko HS, Schenk JP, Tröger J, Rohrschneider WK |title=Current radiological management of intussusception in children |journal=Eur Radiol |volume=17 |issue=9 |pages=2411–21 |year=2007 |pmid=17308922 |doi=10.1007/s00330-007-0589-y |url=}}</ref>
**Target or doughnut sign<ref name="pmid8470658">{{cite journal |vauthors=Boyle MJ, Arkell LJ, Williams JT |title=Ultrasonic diagnosis of adult intussusception |journal=Am. J. Gastroenterol. |volume=88 |issue=4 |pages=617–8 |year=1993 |pmid=8470658 |doi= |url=}}</ref>
***Edematous intussuscipien forms an external ring around the centrally located intussusceptum
***Target sign is usually seen in right lower quadrant
**Layers of intussusception forms pseudo-kidney appearance on the transverse view
|
* [[Computed tomography|CT scan]] may be helpful in the [[diagnosis]] of intussusception. [[Computed tomography|CT scan]] maybe used when other image modalities like [[x-ray]] and [[ultrasound]] have not given positive results but suspicion of intussusception is high.
|
* Intussusception occurs if there is an imbalance between the longitudinal and radial [[smooth muscle]] forces of [[intestine]] that maintain its normal structure. This imbalance leads to a segment of [[intestine]] to invaginate into another segment and cause entero-enteral intussusception. [[Etiology]] of intussusception is either idiopathic or [[Pathology|pathologic]] (lead point). 
|
|-
|8.
|[[Hydronephrosis]]
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+ (CVA tenderness in case of pyelonephritis)</nowiki>
|
* [[Ultrasound]] allows for visualization of the [[ureters]] and [[kidneys]] and can be used to assess the presence of [[hydronephrosis]] and/or [[hydroureter]]. 
|
* In the case of [[renal colic]] (one sided loin pain usually accompanied by a trace of blood in the urine) the initial investigation is usually an intravenous urogram. This has the advantage of showing whether there is any obstruction of flow of urine causing [[hydronephrosis]] as well as demonstrating the function of the other kidney. Many [[Stones- kidney|stones]] are not visible on [[X ray|plain x ray]] or IVU but 99% of [[Stones- kidney|stones]] are visible on [[CT]] and therefore CT is becoming a common choice of initial investigation.
|
* The kidney undergoes extensive dilation with atrophy and thinning of the renal cortex.
|
|-
|9.
|[[Dysplasia|Dysplastic kidney]]
|N/A
|N/A
|N/A
|N/A
|N/A
|
MCDK is usually diagnosed by [[ultrasound]] examination before birth.
* Mass of non-communicating cysts of variable size.
* Unlike severe [[hydronephrosis]], in which the largest cystic structure (the renal pelvis) lies in a central location and is surrounded by dilated calices, in multicystic dysplastic kidney the cyst distribution shows no recognizable pattern.
* [[Dysplasia|Dysplastic]], echogenic [[parenchyma]] may be visible between the cysts, but no normal renal parenchyma is seen.
|
* MCKD can be discovered accidentally on [[CT]] scan.
* [[CT scan]] shows myltiple cysts with absence of renal parenchyma.
|
* MCKD is the result of abnormal differentiation of the renal parenchyma.
|
|-
|10.
|[[Neuroblastoma|Pediatric Neuroblastoma]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
* On ultrasound, neuroblastoma is characterized by a heterogeneous [[echogenicity]] due to the [[vascular]], [[necrotic]], and calcified content of the mass.<ref name="radio">Neuroblastoma. Radiopaedia (2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 8 2015</ref>
|
*CT scan is the investigation of choice for the diagnosis of neuroblastoma.<ref name="pmid21736987">{{cite journal| author=Colon NC, Chung DH| title=Neuroblastoma. | journal=Adv Pediatr | year= 2011 | volume= 58 | issue= 1 | pages= 297-311 | pmid=21736987 | doi=10.1016/j.yapd.2011.03.011 | pmc=PMC3668791 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21736987  }}</ref>
*On CT scan, neuroblastoma is characterized by:<ref name="radio2">Neuroblastoma. Radiopaedia (2015) http://radiopaedia.org/articles/neuroblastoma Accessed on October, 8 2015</ref>
:*Heterogeneous mass
:*[[Calcification]]
:*[[Necrosis]]
:*Compression of the surrounding vessels
:*Invasion of the [[psoas]] [[muscle]] or [[kidney]]s
:*Swollen [[lymph node]]s
|
*On microscopic histopathological analysis the presence of round blue cells separated by thin [[fibrous]] septa are characteristic findings of neuroblastoma.
*Other findings of neuroblastoma on [[light microscopy]] may include:<ref name="patho">Neuroblastoma. Libre Pathology(2015) http://librepathology.org/wiki/index.php/Adrenal_gland#Neuroblastoma Accessed on October, 5 2015</ref>
:*Homer-Wright rosettes (rosettes with a small  meshwork of fibers at the center)
:*Neuropil-like [[stroma]] (paucicellular stroma with a cotton candy-like appearance)
*On [[electron microscopy]] neuroblastoma is characterized by:
:*Dendritic processes with longitudinally oriented [[microtubule]]s
:*Membrane bound electron-dense [[granule]]s that contain [[catecholamine]]s
:*Presence of [[desmosomes]]
:*Absence of [[glycogen]]
|
|-
|11.
|[[Rhabdomyosarcoma|Pediatric Rhabdomyosarcoma]]
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|
|On [[CT scan]], rhabdomyosarocma is characterized by:
* Soft tissue density
* Some enhancement with [[contrast]]
* Adjacent bony destruction (over 20% of cases)
|
* Rhadbomyosarcoma has an appearance similar to the other round blue cell tumors such as [[Ewing sarcoma]] and [[Osteoblastoma|small cell osteoblastoma]].
|
|-
|12.
|[[Mesoblastic nephroma]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
*[[Ultrasound]] may be helpful in the diagnosis of mesoblastic nephroma.
*Mesoblastic nephroma may presents as a well-defined [[mass]] with low-level homogeneous echoes.<ref name="radio3">Mesoblastic nephroma.Dr Ayush Goel and Dr Yuranga Weerakkody et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/mesoblastic-nephroma</ref>
*The presence of concentric echogenic and hypoechoic rings can be a helpful diagnostic feature of [[mesoblastic nephroma]].
|
* [[CT scan]] may be helpful in the diagnosis of mesoblastic nephroma.
* Findings on CT scan suggestive of mesoblastic nephroma include:
:* Solid hypoattenuating renal lesion
:* Variable contrast enhancement
:* No [[calcification]]
|
Classic mesoblastic nephroma
* [[Spindle cells]] in [[fascicles]]
* Infiltrative border
Cellular mesoblastic nephroma
* Plump cells with vesicular nuclei
* Well-defined border
* Mitotically active
Mixed mesoblastic nephroma
* Both classic pattern and cellular pattern areas are present
|Most common renal tumor that occurs in 1st month of life
|}


==References==
==References==
{{Reflist|2}}
<references />
 
[[Category:Kidney diseases]]
[[Category:Nephrology]]
[[Category:Pediatrics]]
[[Category:Disease]]
[[Category:Syndromes]]
[[Category:Needs content]]
{{WH}}
{{WS}}

Latest revision as of 21:08, 14 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Overview

Hydronephrosis must be differentiated from parapelvic cyst, renal sinus lymphangiectasia, pyelonephritis, cystitis, ovarian cyst, pelvic tumor

Differentiating hydronephrosis from other Diseases

Hydronephrosis must be differentiated from pelvic cyst[1], renal sinus lymphangiectasia[2], ovarian cyst, pelvic tumor, ureteral polyp[3], pyelonephritis, cystitis.

References

  1. ↑ Han D, Ma G, Wei L, Ren C, Zhou J, Shen C, He T (May 2017). "Preliminary study on the differentiation between parapelvic cyst and hydronephrosis with non-calculous using only pre-contrast dual-energy spectral CT scans". Br J Radiol. 90 (1073): 20160632. doi:10.1259/bjr.20160632. PMC 5605099. PMID 28281789.
  2. ↑ Indiran V, Prabhu PS, Maduraimuthu P (January 2016). "Isolated Renal Sinus Lymphangiectasia-Close Mimic of Pelviureteric Junction Obstruction and Hydronephrosis". Urology. 87: e11–2. doi:10.1016/j.urology.2015.10.008. PMID 26494296.
  3. ↑ Chopra A, Teele RL (December 1980). "Hydronephrosis in children: narrowing the differential diagnosis with ultrasound". J Clin Ultrasound. 8 (6): 473–8. PMID 6777404.
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