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Chapman Aids to differentials flashcards > Adrenals, urinary tract, testes and prostate > Flashcards

Adrenals, urinary tract, testes and prostate Flashcards

1
Q

adrenal mass sizing for benignvs malignant

A

3cm

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2
Q

if adrneal lesion is <10HU

A

lipid rich - adenoma

benign

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3
Q

washout values for adrneal lesions

A

Relative wahsout over 40% - lipid poor adenomas

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4
Q

Types of functioning adrenal tumours

A

Conns

Phaeo

Cushings

Adrenal carcinoma

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5
Q

Functioning adenomas are likely to be lipid poor or pipid rich?

A

lipid rich

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6
Q

size of phaeo normally

A

large

> 5cm

enhance, necrotic

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7
Q

Cushings adenoma size

A

normally bigger than 2cm.

most of Cushings syndrome is from pituitary adenoma or ectopic source with hyperplasia of adrenal resulting

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8
Q

signs of cushings adenoma

A

atrophy of the other adrenal gland

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9
Q

features of adrenal carcinoma

A

rare and large

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10
Q

neuroblastoma does what to vessles

A

surrounds and displaces without causing narrowing

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11
Q

non functioning adenomas

size and enhancement

A

homogenous enhancement, <2cm

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12
Q

adrenal haemorrhage cahrachteristics

A

high attenuation on non contrasdt

in severe truama

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13
Q

adrenal cysts appearance

A

round, well define ect

if multilocualted think - lymphangioma and hydatid cyst

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14
Q

features of adrenal granulomatous disease

A

Bilateral

think TB, histoplasmosis

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15
Q

Bilateral adrenal masses

A

mets

phaweo

adenomas
\hyperplasia (CAH in kids)

haemorrhage

Granulomatous disease - central nec

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16
Q

adrenal calc

A

previous haemorrhage

cystic disease

chronic TB/histoplasmosis

part of tumour

addisons (likely infective rather than autoimmune)

Wolman disease

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17
Q

what is wolman disease

A

rare auto rec lysosoaml acid lipase deficine t

enalrged adrenals
fatty liver and spleen

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18
Q

Congenital renal anomalies

broadly, different types

A

position

form

number

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19
Q

renal anomalies of position

A

ectopic - pelvic

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20
Q

anomalies of form

kidney

A

Horseshoe

Crossed reanl ectopia (l–>R)

Pancake

Renal hypoplasia

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21
Q

Horseshoe AX

A

many

but remeber Turners

more likely to get Wilms, TCC, RCC

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22
Q

renal

anomalies of numer

A

Unilateral agenesis - VACTERAL, mullerian ducts, Zinner syndrome

Potter syndrome - bilat absent

Supernumerary kidney - rare, left side

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23
Q

what is Zinner syndrome

A

men

renal agenesis, ipsilateral seminal vesicle cyst, ejaculatory duct obstruction

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24
Q

Bulgin of renal outline. - different types

A

cyst / multiple cysts
Tumour
Dromedary hump
Septum of bertin
Hilar lip
Pseudotumour in reflux
Duplex kidney
dilatation of a single calyx

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25
Q

Pseudotumour in reflux nephropathy - why

A

hypertrophy of the unscarred renal parenchyma

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26
Q

appearance of an enlarged septum of Bertin

A

betwene upper and interpolar region

Pseudomass with calyceal splaying and associated short calyx duplication

Normal echogenicity or increase.
CT similar to normal cortex

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27
Q

Appearance of a duplex

A

hydronephrotic upper moiety.

delayed films have contrast in the upper moiety.

lower moiety - drooping lilly appearance

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28
Q

unilateral scarred kidney

shapes

A

Fetal lobulation

duplex

spleen impression

reflux nephropathy

lobar infarction

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29
Q

unilateral scarred kidney

causes

A

reflux nephropathy

Tuberculous autonephrectomy - calc!

lobar infarction

renal dysplasia - lots of cysts

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30
Q

unilateral small smooth kidney

general list of causes

A

post obstructive, ischaemia and post inflammatory

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31
Q

unilateral small smooth kidney

Pre-renal vascular vasues

A

Ischaemia from RAS

Radiation nephritis

Renal infarction

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32
Q

unilateral small smooth kidney

Renal causes

A

Congenital hypoplasia

Multicystic dysplastic kidney

Papullary necrosis

Post inflammatory

Following partial nephrectomy

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33
Q

unilateral smooth small kidney

post renal causes

A

collecting system issues

post obstructive atrophy

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34
Q

Bilateral small smooth kidneys

causes by

Pre renal
Reanl

Post reanl

A

Arterial hypotension
Generalaized arteriosclerosis

chronic glomerulonephritis
Hereditory nephropathies

Chronic papillary necrosis

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35
Q

unilateral LARGE smooth kidney

most common causes are

A

duplex kidney
compensatory hypertrophy
obstruction

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36
Q

unilateral LARGE smooth kidney

pre renal causes

A

Acute renal vein thormbosis

Acute arterial infarction

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37
Q

unilateral LARGE smooth kidney

reanl casues

A

Duplex

Hypertrophy compensatory

Fused ectopia

Diffuse infiltrative tumour

Malakoplakia

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38
Q

what is malakoplakia ?

A

rare chronic granulomatous inflammatory disease

soft yellow plaques

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39
Q

bilateral large smooth kidneys

A

Developmental
- Bilateral duplex kidneys
- ARPKD

Inflammationv
- acute glomerulonephritis
- ATN
- Acute cortical necrosis
- Acute interstitial nephritis
- Polyarteritis nodosa

Deposition of abnormal proteins
- Amyloid
- MM

Neoplastic infiltration
- leukaemia and lymphoma

Miscellaneous
- Bilateral hydronephrosis
- Acute renal papillary necrosis
- Acute uric acid nephropathy
- early diabetic nephropathy
- sickle cell
- HIV assocaited nephropathy
- Acromegaly

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40
Q

Causes of dystrophic calcification due to localized disease

A

Infections
- chronic pyelo
- TB
- Xanthogranulomatous pyelo
- Hydatid

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41
Q

what are the HU of renal calculi that could then be seen on abdo radiograph

A

> 500HU

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42
Q

renal calculi mimics in the kidney

A

vascular (surrounded by renal sinus fat)

Randalls plaques

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43
Q

causes of medullary nephrocalcinosis

A

Nedullary sponge kidney
HyperPTH
Renal tubulour acidosis
Renal papillary acidosis
Renal papillary necrosis

Causes of hypercalcaemia or hypercalciuria

Pre term neonates

Hyperoxaluria

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44
Q

causes of cortical nephrocalcinosis

A

Acute cortical necrosis

chronic glomerulonpehritis

chronic infection

chronic renal tranplant rejection

hyperoxaluria

alport syndrome

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45
Q

renal cystic disease

renal dysplasia

A

MCDK

Localised cystic renal disease

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46
Q

renal cystic disease

Polycystic kideny disease

A

ARPKD

ADPKD

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47
Q

reanl cystic disaese

cystic tumours

A

mutlilocular cystic nephroma (Mj lesion)

Multilocular cystic RCC

Mixed epithelial and stromal tumour

Angiomyolipoma with epithelial cysts

Primary reanl sarcoma

Cystic wilms tumour

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48
Q

cortical cysts

A

simple

syndromic
- VHL, follow cysts up
- TS

End stage CKD

lithium

glomerulocystic kidney disease

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49
Q

Medullary cysts

A

Calyceal diverticulum

Medullary sponge kidney

Papillary necrosis

Medullary cystic disease complex

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50
Q

list bozniak classification

A

1 - water, no enhancement, no wall, no septa, no solid component
no fu

2 - thin septations, fine calcification only.
2F - thickened septa, or thick calc. (US/ CT)

3 - measurable enhacnement

51
Q

fat containing renal mass

A

AML
RCC
Liposarcoma
lipoma
Oncocytoma
Xanthogranulomatous pyeo
Wilms
Teratoma
Renal sinus lipomatosis

52
Q

solid renal lesions

A

RCC - multiple of bilateral in 3-5%.

oncocytoma

fat poor aml

haemangioma

leiomyoma

Juxtaglomerular cell tumour

Metanephric adenoma

Medullary fibroma

Papillary adenoma

Sarcomas

Pseudotumours

53
Q

Infiltrative renal lesions

A

TCC

SCC

infiltrative RCC

Lymphoma

Metastases

Leukaemia

Malakoplakia

Sarcomas

54
Q

Non neoplastic renal lesions

A

Peripelvic cyst

Parapelvic cyst

sinus lipomatosis

vascular

inflammatory

haematoma

urinoma

rare infiltrative disorder

55
Q

neoplastic and proliferative disorders of the perinephric space

soft tissue rind

A

Lymphoma
Erdheim chester disease
Amyloidosis
retroperitoneal fibrosis
Metastases
Extramedullary haematopoiesis
Rosai-Dorfman disease
Nephroblastomatosis

56
Q

neoplastic and proliferative disorders of the perinephric space

focal solid lesions

A

Renal lesions extending outward

mets

perinephri haematoma

ndoular fat necrosis in pancreaitis

primary sarcoma

57
Q

neoplastic and proliferative disorders of the perinephric space

fatty lesions

A

Exophytic angiomyolipoma

liposarcoma

perinephric lipomatosis

extraadrenal myelolipoma

58
Q

neoplastic and proliferative disorders of the perinephric space

cystic lesions

A

exophytic renal cyst

urinoma

lymphangiomatosis

59
Q

nephrographic patterns

A

corticomedullary phase - 25-80s

nephrographic phase - 90-120s

excretory phase - 3mins+

60
Q

Nephrographic patterns

Absent nephrogram

A

Global
- renal artery occlusion

Segmental
- focal infarction (embolic or vasculitic)

capuslar enhancement indicates infarction

61
Q

unilateral delayed nephrogram

A

Obstructive uropathy
reduced arterial inflow

reduced venous outflow

pyelonephritis

62
Q

bilateral persistent nephrogram

A

reduced arterial inflow

abnormal renal tubules

bilateral obstructive uropathy

Reduced venous outflow

63
Q

Unilateral striated nephrogram

A

Acute ureteruc obstruction
acute pyelonephritis
renal vein thrombosis
traumatic reanl contusion

64
Q

Bilateral striated nephrogram

A

acute pyelo
abnormal renal tubules
hypotension
medullary sponge kidney
autosomal recessvie PCKD

65
Q

Spotted nephrogram

A

Vascultiis

multiple emboli

pyelonephritis

66
Q

reverse rim nephrogram

A

only medulla and renal capsule enhancing

  • acute crotical necrosis
67
Q

MRI

diffuse low signal in the renal cortex

A

Paroxysmal nocturnal haemoglobinuria
Mechanical haemolysis
Severe sickle cell disease
Renal cortical necrosis

68
Q

Types of renal papillary necrosis

A

Swollen

Partial

Total

Necrosis in situ

69
Q

renal causes of hypertension

A

Renal artery stenosis
Chronic bilateral parenchymal disease

chronic reflux nephropathy

tumours producing renin

chronic renal infection

renal vein thrombosis

radiotherapy

70
Q

features of RAS on US

A

peak systolic velocity over 200cm/s
60% stenosis

turbulent flow

71
Q

Causes of Renal Artery Stenosis

A

Atherosclerosis
- prox 2cm

Fibromuscular dysplasia
- women, string of beads. often bilateral.

Renal artery dissection
- extension from aorta dissection

Arteritis
- PAN. GPA
- Takyasu - can cause stenosis
- Takayso

Neurofibtomatosis - rarely

Midaortic syndrome

72
Q

Non opacification of a calyx on CT or excret urography

A

Technical

Tumour (RCC/ WIlms)
Obstructed (Calc/Tumour/TB)
Duplex kidney
infection
partial nephrectomy

73
Q

filling defect in the renal collecting system or ureter

Extrinisic with a smooth margin

A

renal sinus masses

Vascular impression

Renal sinus lipomatosis

74
Q

filling defect in the renal collecting system or ureter

arising from the wall - with smooth margins

A

Early urothelial cancer

papilloma

Pyeloureteritis cystica

metastases

suburothelial haemorrhage

endometriosis

pseudodiverticulosis

steven-johnson syndrome

75
Q

filling defect in the renal collecting system or ureter

arising from thw wall with an IRREGULAR margin

A

urothelial carcinoma

SCC

RCC

Squamous metaplsia

TB

Malakoplakia

Amyloidosis

Sarcoidosis

76
Q

filling defect in the renal collecting system or ureter

WITHIN THE LUMEN

A

Calc

Blood clot

Air bubble

Sloughed papilla

Benign fibroepithelial polyp

Fungus ball

77
Q

Spontaneous urinary contrast extravasation

A

pyelosinus backflow

pyelotubular backflow

pyelointerstital backflow

Pyelolymphatic backflow

Pyelovenous backflow

78
Q

collecting system dilatation

Dilated calyx ith a narrow infundibulum

A

Stricture

Xanthogranulomatous pyelonephritis

Infiltrative proxesses of the renal sinus

Extrinisc compressino by an artery

Calcyceal diverticulum

79
Q

collecting system dilatation

Dilated calyx with a WIDE infundibulum

A

Chronic reflux

papillory necrosis - clubbed

congenital megacalyces

80
Q

collecting system dilatation

Dilated calyx with a NORMAL infundibulum

A

normal variant

81
Q

collecting system dilatation

Dilated calyx and renal pelvis with a normal ureter

A

Congenital PUJ obstruction

Acquired PUJ obstruction - all causes

Pelvicalcyceal cysts - hard to diff from hydronephrosis on US. Extretory phase CT diagnostic.

82
Q

Dilated ureter

causes from WITIHIN the wall

A

Stricture / Oedema

Primary tumour (TCC/Papilloma)

Mets

Post surgery

TB striucture - multifocal

Schisto - distal +calc++

Ureterocoele

radiation ureteritis

malakoplakia

amyloidosis

vasculitis

Primaryobstructive megureter

congenital midureteric stricture

83
Q

Dilated ureter

outside the wall

A

retroperitoneal fibrosis

malignancies

Strictures from inflammation

endometriosis

extrinsic compression from benign pelvic masses

retrocaval ureter

84
Q

dilated ureter

Causes not from obstruction or reflux

A

Pregnancy

Residual post relief

Polyuria

Urinary tract infection

Primary nonobstructive megaureter

85
Q

deviation of the ureters

medial

A

Fibrosis

normal variant due to large iliopsoas muscle

Retrocaval ureter (right only)

Pelvic lipomatosis (men) - pear shaped bladder

sidewall mass

86
Q

deviation of the ureters

lateral

A

Hypertrophy of psoas muscles (upper ureter laterally)

retroperitoneal mass

pelvic mass

aneurysmal aortic dilatation

postoperative

prune - belly syndrome

87
Q

retroperitoneal mass

solid

A

Lymphoma

Mets to lymph nodes (kidneys, testes, cervix, porstate)

Infection (TB or MAC)

Sarcoid

Castleman disease

Rosai Dorfman disease

Vascular

Erdheim chester

Extramedullary haematopoiesis

Amylodosis

Old renal transplant

Sarcomas

neurogenic tumours

88
Q

retroperitoneal masses

cystic

A

Lymphangioma

Cystadenoma

Epidermoid cyst

Mullerian Cyst

Cystic mesothelioma

Cystic teratoma

Lymphangiomyelolioma

Bronchogenic cyst

Dilated cisterna chyli

Cystic change in a solid neoplasm

Hydatid cyst

Nonneoplastic - pseudo cyst, urinoma, lymphocele, haemtoma, abscess

89
Q

retroperitoneal masses

fat containing

A

Liposarcoma

Angiomyolipoma Retroperitoneal fat necrosis

perinephric lipomatosis

lipoma

teratoma

Hibernoma (prominent feeding vessel) - high PET uptake

Extrameduallary haematopoiesis

Others

90
Q

Retroperitoneal fibrosis

A

idiopathic (70%) ?IgG4

2ary
- Retroperitoneal malignancy
- retroperitoneal haemorrhage
- inflammatory conditions
- connective tissue diseases
- drugs (dopamine agonists, hydralazine, b blockers)
- radiotherapy

91
Q

Bladder

filling defect or mass

IN THE LUMEN

A

Clac

foreign body

blood clot

Ureterocoele

fungus ball

92
Q

Filling defect or mass

ARISING FROM THE WALL

MALIGNANT

A

Malignant neoplasms
- Urothelial cacrinoma (Polypoid or papillary projecting into the lumen)
- SCC
- Adeno, persistent urachus.
- mets
- sarcoma (rare, by rhabdomyosarcoma in kids)
-Neuroendocrine - carcinoid/small cell
-melanoma

93
Q

Filling defect or mass

ARISING FROM THE WALL

BENIGN neoplasms

A

Papilloma

Leimyoma

Neurofibroma

Paraganglioma

Haemangioma

Solitary fibrous tumour

94
Q

Filling defect or mass

ARISING FROM THE WALL

Inflammatory conditions

A

Nephrogenic adenoma

cystitis cystica

malakioplakia

infalmamtory peseudotumour

esoinophilic cystitis

95
Q

Filling defect or mass

ARISING FROM THE WALLTRINSIC

A

Prostate enlargement

Pelvic masses

enlarged uterus

Inflamation adjacent to the bladder wall

iliac artery aneurysm

Colonic distension

urachal cyst or mass

endometriosis

96
Q

diffuse bladder wall thickening

Inflammatory

A

cystitis

TB

Schisto

Malakoplakia

97
Q

diffuse bladder wall thickening

muscle hypertrophy

A

Chronic bladde routlet obstruction

neurogenic bladder - Upper motor neurone damage only

98
Q

diffuse bladder wall thickening

Neoplastic

A

Signet ring andeocarcinoma

mets

lymphoma

plexiform neurofibroma

99
Q

Bladder calcification

in the lumen

A

calc

foregin body

tumour - TCC, SCC, paraganglioma,

Alkaline encrusted cystitis

100
Q

Bladder calcifcaiton

in the wall

A

Schisto

TB

Chronic radiation

tumour - mucinous adneocarcinoma

amyloidosis

101
Q

Bladder fistula

causes

Congential

inflammatory

Neoiplastic

Trauma

A

Congential
- bladder exstrophy
-imperforate anus
- patent urachus

inflammatory
- diverticular disease
- crohns
- appendix abscess
- TB

Neoplastic
- carcinoma of the colon, bladder, reproductive organs
- radiotherapy

Trauma
- accidental
- iatrogenic

102
Q

gas in the bladder wall

A

Emphysematous cystitis
- diabetics, e coli

103
Q

Urachal lesions

Congential

infection

Malignancy

A

Congenital
- patent urachus, leaking of urine
- urachal cyst , focal patency fluid filled cyst
- urachal sinus
- vesicourachal diverticulum

infection
- S aureus, E. Coli.

Malignancy
- Adeno, mostly mucinous

104
Q

Calcification of the male genital tract

Seminal Vesicles and vas deferens

A

DM

Chronic infection

Seminal Vesicle duct calculi

105
Q

Prostate

Calcifications

A

benign
can be due to chronic prostatitis

cancer - if in the peripheral zone

seed brachytherapy

106
Q

scrotum

calcifications

A

testicular microlithiasis

scrotal pearl

Prior trauma

Clacification in a mass lesion

Sperm granuloma

End stage renal failure

107
Q

Penis

Calcifications

A

Peyronis disease

End stage renal failure

108
Q

Prostatic lesions

Solid

A

Benign prostatic hyperplasia

Prostatic adenocarcinoma

Benign mimics of prostate cancer

Secondary malignancy

Rare prosate neoplasms

109
Q

MRI charachteristics of

Prostatic adeno

A

T2 low, DWI restriction and early enhancement with washout

110
Q

how to distinguish prostate adeno from recent biopsy

A

T1 from haemorrhage - will diasppear after 6 weeks.

both will be t2 low

111
Q

prosatic lesions

Cystic

by location

A

MIDLINE
- Utricle cyst
- mullerian duct cyst
- ejaculatory duct cyst
-cowpers duct cyst

LATERAL
- cystic degeneration of BPH
- retention cyst
- Abscess
- Cavitary prostatitis
- Cystic tumours
- Hydatid - rare

112
Q

Seminal vesicle abnormalities

A

Congenital

Tumour invasion

Iatrogenic changes

infection

amyloidosis

primary seminal vesicle tumours

hydatid

113
Q

ultrasound of intratesticular abnormalities

neoplastic

A

painless

Germ cell tumours
- Seminoma - homogenous hypoechoic
- nonseminomatous - aggresive , cystic
- epidermoid cyst - onion skin

sex cord stromal tumours - Leydig or sertoli

Lymphoma

Mets

Cystadenoma of rete testis

114
Q

sertoli tumours have ax with

A

Carney complex

peuts Jaggers

115
Q

Non neoplastic cysts

intratesticular

A

Tubular ectasia of the rete testis

simple cyst

intratesticular varicocele (mimic)

116
Q

intratesticular abnormalities

vascular

A

torsion

segmental infarction
- infeciton, trauma, vascultiis, sickle cell,

117
Q

intratesticular abnormalities

infective

A

Epidydymoorchitis

Abscess

Granulomatous infection

118
Q

Testicular sarcoid

A

Multiple bilatearl small hypoechoic mases

119
Q

Testicular liomatosis

A

multiple bialteral HYPERECHOIC lesions

COWDENS

120
Q

Ultrasound of extratesticular abnormalities

in the epidydimys

A

Epidydimitis

Spermatocele

Epididymal cyst

Postvasectomy ectasia

Sarcoidosis

Neoplasms - multiple

121
Q

testicular abnormaliteis

spermatic cord

A

varicocele

Inguinoscrotal hernia

lipoma

hydrocele of the spermatic cord

sperm granuloma

spermatic cord haematoma

leiomyoma

sarcoma

122
Q

extratesticular abnormalities

paratesticular

A

Hydrocele

Pyocele/haemtocoele

Tunica albuginea

Scrotal pearl

Fibrous pseudotumour

Malignancies of the periteonal origin

123
Q

Male urethral stricture

A

trauma

infeciton - long, gonoccal urethritis

urethralccancer - scc commonly

secondary urethral malignancy

balantitis xeroticanobliterans

congenital stricture

benign urethral lesions

124
Q
A

Chapman Aids to differentials flashcards (5 decks)

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