B5.079 Urological Imaging Flashcards
most recommended radiological procedure for hematuria without vigorous exercise or known/suspected renal parenchymal disease
CT abdomen without and with contrast
appearance of RCC on imaging
large, irregularly enhancing mass
characterize RCC
3% of adult malignancies, 90-95% of primary renal tumors
arises from proximal tubule epithelium
risk factors for RCC
smoking, obesity**
industrial chemical
long term dialysis
inherited syndromes (vHL)
course of RCC
clinically occult for most of its course
only 10% of patients present with classic triad: flank pain, hematuria, flank mass
frequently invades ipsilateral renal vein and adrenal gland
why is CT the best initial imaging modality for evaluation of hematuria?
non contrast- very sensitive for detecting calculi
contrast- sensitive for detecting mass lesions within the renal parenchyma/collecting system and staging disease
imaging for acute pyelonephritis in an uncomplicated patient
NONE
imaging for acute pyelonephritis in a complicated patient
CT abdomen and pelvis with and without contrast
what makes a “complicated” patient in acute pyelonephritis
diabetes immunocompromised history of stones prior renal surgery not responding to therapy
appearance of acute pyelonephritis on CT
mildly enlarged kidney with wedge shaped diminished perfusion “striated nephrogram”
best identified on nephrogenic phase
inflammation of perinephric fat
mild circumferential bladder wall thickening
physical exam findings in acute pyelonephritis
fever
flank pain
costovertebral angle pain
nausea and vomiting
absence of flank pain
should raise suspicion of an alternative diagnosis
US findings in acute pyelonephritis
possible decreased perfusion in involved area on color Doppler imaging
