The Right Kidney

Duodenum. Right renal masses typically cause medial and anterior displacement of the descending duodenum, while the immediate postapical segment tends to be unaffected. This produces a characteristic appearance on frontal and lateral projections. In anteroposterior or pos-teroanterior views, the immediately proximal second portion of the duodenum descends vertically, but the

Thickening And Medial Bowing Kidney Proximal Descending Bump

Fig. 9—5. Displacement of descending duodenum by right renal cyst.

(a) Frontal and (b) right lateral views. The proximal portion descends normally (closed arrow), but there is medial and anterior displacement of the distal two-thirds (open arrows). (c) Intravenous urography demonstrates enlargement of the lower pole of the right kidney by a large cyst. (Reproduced from Meyers.2)

distal two-thirds is deflected medially (Figs. 9-5 through 9-8). In right lateral projections, correspondingly, the normal descent of the proximal segment is maintained but the distal portion is displaced anteriorly; this may result in a gentle axis inferiorly and anteriorly (Figs. 9-5b and 9-6b) or in a striking ventral bowing (Figs. 9-7 and 9-8b). Extrinsic pressure on the mucosal folds themselves may be best appreciated in only one view. This may be shown as mass flattening of the normal mucosal contour, undulations, or gross mass distortion on the lateral or posterior wall.

These changes in the descending duodenum are usu ally easily distinguishable from other extrinsic masses. Right adrenal masses may attain a size to affect the pos-tapical segment (Fig. 9-9). Enlargement of the right lobe of the liver typically produces a more uniform medial displacement (Fig. 9-10).

Small Bowel. Massive kidney enlargement displaces jejunal loops anteriorly and inferiorly. With progression, particularly if the process is bilateral as in poly cystic renal disease, the small bowel may be crowded into the midline (Fig. 9-11).

Renal Enlargement Radiography

Fig. 9—6. Displacement of descending duodenum by right renal cyst.

(a) Frontal and (b) right lateral views. The postapical portion of the duodenum descends normally (closed arrow), but there is medial and anterior deflection of the distal two-thirds (open arrow). The descending duodenum projects anterior to the duodenojejunal junction (DJ). In (a), note the renal mass also causes elevation of the hepatic flexure of the colon.

(c) Intravenous urography demonstrates a huge cyst arising from the lower pole. (Reproduced from Meyers.2)

Fig. 9—7. Displacement of descending duodenum by right renal cyst.

Bowed anterior displacement of the second portion of the duodenum.

Fig. 9—8. Displacement of descending duodenum by right renal cyst.

The proximal second portion of the duodenum descends normally. While the frontal projection (a) shows only relatively mild medial displacement of the distal two-thirds with flattening of the mucosal folds laterally (arrowheads), the lateral view (b) demonstrates striking anterior bowing and extrinsic mucosal distortion. In (a), note that the renal mass also elevates the hepatic flexure of the colon. (Reproduced from Meyers.2)

Fig. 9—8. Displacement of descending duodenum by right renal cyst.

The proximal second portion of the duodenum descends normally. While the frontal projection (a) shows only relatively mild medial displacement of the distal two-thirds with flattening of the mucosal folds laterally (arrowheads), the lateral view (b) demonstrates striking anterior bowing and extrinsic mucosal distortion. In (a), note that the renal mass also elevates the hepatic flexure of the colon. (Reproduced from Meyers.2)

Thickening And Medial Bowing Kidney

Fig. 9—10. Displacement of descending duodenum by liver enlarged with metastases.

There is mild medial displacement of the descending duodenum and compression upon the gas-filled hepatic flexure of the colon.

Fig. 9—9. Displacement of descending duodenum by right adrenal mass.

The proximal portion of the descending duodenum is displaced anteriorly by an adrenal mass. Its soft-tissue outline distinctly conforms to its effect upon the duodenum.

Picture Soft Tissure Colon

Colon. In masses originating within the upper two-thirds of the right kidney, the right colon segment most typically involved is that extending between the posterior and anterior hepatic flexures. This demonstrates displacement inferiorly, medially, and anteriorly (Figs. 9-12 through 9-14). Extrinsic pressure may be further shown by flattening and compression of the superior and posterior haustral rows at this site. Dilatation of an extra-renal pelvis in some cases of obstructive hydronephrosis may produce a more generalized mass effect extending to the anterior hepatic flexure (Fig. 9-15).

Occasionally, similar changes may be produced by a liver mass projecting downward from the visceral surface of the right lobe of the liver (Fig. 9-16).

Extension of a renal mass laterally into the flank displaces the posterior hepatic flexure inferiorly (Figs. 912 through 9-14). Further progression may result in striking displacement of the ascending colon medially and anteriorly (Figs. 9-17 and 9-18). Maintenance of the lateral haustral contours with extrinsic flattening of the posterior haustral sacculations (Fig. 9-18b) characterize the mass effects as extraperitoneal in site, rather than those from a mass within the intraperitoneal lateral paracolic gutter.3,4

A mass originating in the lower pole of the right kidney characteristically elevates the colon between the two hepatic flexures (Figs. 9-19 and 9-20). Extrinsic compression occurs on the inferior haustral rows at this site, text continues on page 504

Fig. 9—11. Displacement of small bowel by polycystic renal disease.

Massive renal enlargement bilaterally crowds jejunal loops toward the midline. (Reproduced from Meyers. )

Right Colon Mass

Fig. 9—12. Displacement of right colon by right renal cyst.

The large intestine between the posterior (PF) and anterior (AF) hepatic flexures is displaced inferiorly and medially, with extrinsic compression of its superior haustral row (arrowheads). The posterior flexure is mildly displaced downward as the mass, originating in the middle third of the kidney, extends laterally into the flank. Note that there is no displacement of the descending duodenum. (Reproduced from Meyers.2)

Fig. 9—13. Displacement of the right colon by hydronephrotic right kidney.

The segment between the two hepatic flexures is displaced inferiorly and medially. There is extrinsic flattening of its superior haustral border and marked compression of the lumen by the hugely dilated renal pelvis. (Reproduced from Meyers.2)

Fig. 9—13. Displacement of the right colon by hydronephrotic right kidney.

The segment between the two hepatic flexures is displaced inferiorly and medially. There is extrinsic flattening of its superior haustral border and marked compression of the lumen by the hugely dilated renal pelvis. (Reproduced from Meyers.2)

Right Extrarenal Pelvis

Fig. 9—14. Displacement of right colon by right renal cyst.

Oblique view shows the large intestine between the posterior (PF) and anterior (AF) hepatic flexures displaced anteriorly and medially, with extrinsic flattening of its posterior haustral row (arrows). (Reproduced from Meyers.2)

Fig. 9—15. Displacement of right colon by dilated extrarenal pelvis.

Marked pyelectasis from obstruction of the upper ureter results in mass pressure extending to the anterior hepatic flexure.

Right Extrarenal Pelvis

Fig. 9—16. Displacement of right colon by liver mass.

The segment between the two hepatic flexures is displaced inferiorly and medially by a large mass extending from the inferior surface of the liver anterior to the right kidney.

Fig. 9—18. Displacement of right colon by right renal cell carcinoma.

(a and b) The mass extends deeply in the flank and markedly displaces the ascending colon medially and anteriorly. The oblique view shows that the posterior haustral contours are flattened by the mass. (Reproduced from Meyers.2)

Extrinsic Compression The Colon

Fig. 9—19. Displacement of right colon by right renal cyst.

(a) Superior displacement of segment between the two hepatic flexures, with extrinsic compression of its inferior haustral row. The mass also affects the ascending colon. The descending duodenum is uninvolved.

(b) Excretory urogram documents a large mass in the lower renal pole with inframesocolic extension. (Reproduced from Meyers.2)

Fig. 9—19. Displacement of right colon by right renal cyst.

(a) Superior displacement of segment between the two hepatic flexures, with extrinsic compression of its inferior haustral row. The mass also affects the ascending colon. The descending duodenum is uninvolved.

(b) Excretory urogram documents a large mass in the lower renal pole with inframesocolic extension. (Reproduced from Meyers.2)

Renal Sarcoma Radiology Usg Images

Fig. 9—20. Displacement of right colon by right renal sarcoma.

There is mild extrinsic pressure on the inferior border of the segment between the two hepatic flexures by the inframesocolic mass projecting from the lower renal pole. Note that the pressure effects can be localized particularly to the posterior haustral rows (arrowheads). (Reproduced from Meyers.2)

Fig. 9—20. Displacement of right colon by right renal sarcoma.

There is mild extrinsic pressure on the inferior border of the segment between the two hepatic flexures by the inframesocolic mass projecting from the lower renal pole. Note that the pressure effects can be localized particularly to the posterior haustral rows (arrowheads). (Reproduced from Meyers.2)

and the process may affect adjacent segments of the transverse and ascending colon. Oblique projections document that the affected colon also is usually displaced anteriorly and medially. At times, very discrete pressure changes, selectively on the posterior haustra of this segment, may be recognizable, even on frontal projections (Fig. 9-20), an observation further indicating the extraperitoneal nature of the mass.4

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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