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Uroradiology > Congenital abnormalities > Flashcards

Congenital abnormalities Flashcards

1
Q

How does malrotation present on ct and urography?

A

Anteriorly facing renal pelvis on CT Urography will show the calyces to be medial to the pelvis

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2
Q

What is the cause of renal ectopy?

A

Due to lack of kidney acquiring blood supply during its cranial migration or spinal abnormality preventing migration

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3
Q

What is the most common form of renal ectopy?

A

Pelvic kidney - located anterior to sacrum

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4
Q

What test is run before any sort of surgical procedure on an ectopic kidney?

A

CTA to determine blood supply

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5
Q

Which side is the intrathoracic kidney often found? M or F?

A

Male Left sided usually

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6
Q

In true renal agenesis, what is found on cystoscopy?

A

Abscence of the trigone and ureteral orifice in the bladder

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7
Q

What is the % of adrenal absence with renal agenesis?

A

8-10%

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8
Q

What are some associations with renal agenesis in the male? female?

A

Male - ipsilateral seminal vesicle cysts, absence of ipsilateral vas deferens, testicular hypoplasia/agenesis, hypospadias Female - uni/bicornuate uterus, absent/hypoplastic uterus, aplasia of vagina

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9
Q

What is rokitansky-kuster-hauser syndrome?

A

Mullerian ductal anomalies Type a - absent uterus and upper vagina, normal ovaries Tybe b - ovarian/renal abnormalities

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10
Q

What are the facial features of bilateral renal agenesis?

A

Low set ears and prominent palpebral fold

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11
Q

How do you differentiate acquired from congenital renal hypoplasia?

A

Acquired will have normal number of calyces congenital will have less calyces

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12
Q

Where is the supernumerary kidney usually located?

A

caudal may be connected to ipsilateral kidney with separate collecting system

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13
Q

What are the 4 types of crossed renal ectopy? Which is most common?

A

Crossed fused ectopy - both kidneys on one side of midline with normal ureteral insertion, most common (90%) Crossed non fused ectopy Solitary crossed Bilaterally crossed - kidneys in normal positions but ureters cross and enter bladder on opposite side

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14
Q

Which is more common ectopy - L-R or R-L?

A

L->R is 3x more common

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15
Q

What is thought to cause crossed renal ectopy?

A

Abnormally positioned umbilical artery which forces caudal migration to flow to the other hemiabdomen

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16
Q

What is the most common renal anomaly? M or F?

A

Horseshoe kidney M 2x more common

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17
Q

What is thought to cause horseshoe kidney

A

Abberant umbilical artery obstructs normal cephalic migration

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18
Q

What is the common associated renal problem with horseshoe kidney?

A

UPJ obstruction

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19
Q

What are the three imaging features of horseshoe kidney aside from the connection

A

Lower poles are more medial than upper poles, causing a renal tilt Kidneys are more caudad Malrotation with anterior facing pelves

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20
Q

What is a pancake kidney?

A

Fusion of the upper and lower poles results in a flat pancake like renal mass with 2 distinct ureters and anterior collecting systems

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21
Q

How many calyces are usually in a kidney? What is the association with a unipapillary kidney

A

10-14 ipsilateral renal hypoplasia and contralateral abnormalities in contrast, polycalycosis is usually isolated finding

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22
Q

How do you differentiate megacalycosis vs hydro?

A

Megacalycosis will have normal renal pelvis and ureter kidney is also usually normal in size

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23
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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24
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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25
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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26
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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27
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

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28
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

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29
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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30
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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31
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter

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32
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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33
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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34
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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35
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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36
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

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37
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

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38
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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39
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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40
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter

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41
Q

What are the 3 main abnormalities involved with complete duplication?

A

Maldeveloped valve in lower pole ureter Ectopic ureteral insertion of upper pole ureter outside bladder Ectopic ureterocele of upper pole ureter

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42
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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43
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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44
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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45
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

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46
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

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47
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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48
Q

Where do ectopic ureteroceles end?

A

50% in bladder, 50% prostatic urethra

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49
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

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50
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

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51
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

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52
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

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53
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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54
Q

What is prune belly/eagle barret syndrome? which sex? association?

A

Triad of absent abdominal musculature, undescended testicles, urinary tract abnormalities males only twins

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55
Q

What are the urinary tract abnormalities with prune belly syndrome?

A

Can see renal dysplasia or hypoplasia or normal kidneys Tortuous and dilated ureters Enlarged bladder with/without patent urachus (tract to the umbilicus) Dilated and rapidly tapering prostatic urethra

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56
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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57
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

How well did you know this?
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4
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58
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

How well did you know this?
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59
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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60
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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61
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

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62
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

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63
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

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64
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

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65
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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66
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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67
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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68
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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69
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

How well did you know this?
1
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2
3
4
5
Perfectly
70
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

How well did you know this?
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71
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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72
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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73
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

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74
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

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75
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

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76
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

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77
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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78
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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79
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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80
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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81
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

How well did you know this?
1
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2
3
4
5
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82
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

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83
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

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84
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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85
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

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86
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

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87
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

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88
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

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89
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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90
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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91
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

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92
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

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93
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

How well did you know this?
1
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2
3
4
5
Perfectly
95
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

How well did you know this?
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2
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4
5
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96
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

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97
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

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98
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

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99
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

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100
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

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101
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

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102
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

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103
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

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104
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

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105
Q

where is an abortive calyx usually found

A

upper pole infundibulum

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106
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

How well did you know this?
1
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2
3
4
5
Perfectly
107
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

110
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

111
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

112
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

113
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

114
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

115
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

116
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

117
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

118
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

119
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

120
Q

where is an abortive calyx usually found

A

upper pole infundibulum

121
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

122
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

123
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

124
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

125
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

126
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

127
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

128
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

129
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

130
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

131
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

132
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

133
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

134
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

135
Q

where is an abortive calyx usually found

A

upper pole infundibulum

136
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

137
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

138
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

139
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

140
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

141
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

142
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

143
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

144
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

145
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

146
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

147
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

148
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

149
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

150
Q

where is an abortive calyx usually found

A

upper pole infundibulum

151
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

152
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

153
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

154
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

155
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

156
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

157
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

158
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

159
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

160
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

161
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

162
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

163
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

164
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

165
Q

where is an abortive calyx usually found

A

upper pole infundibulum

166
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

167
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

168
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

169
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

170
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

171
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

172
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

173
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

174
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

175
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

176
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

177
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

178
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

179
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

180
Q

where is an abortive calyx usually found

A

upper pole infundibulum

181
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

182
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

183
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

184
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

185
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

186
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

187
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

188
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

189
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

190
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

191
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

192
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

193
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

194
Q

What is the Meyer-Weigert law?

A

States that the ureter from the upper moiety will enter inferomedially (ectopic) States that upper moiety is predisposed to obstruction

195
Q

Which ureter in a duplicated collected system is prone to obstruction? which one refluxes?

A

Obstruction - upper Reflux - lower

196
Q

Blunt ended calyx that is broader than it is tall suggests what

A

abortive calyx

197
Q

where is an abortive calyx usually found

A

upper pole infundibulum

198
Q

DDx for a smooth marginated and fixed filling defect in the collecting system

A

Stone Aberrant/ectopic papilla (smooth margins and fixed position are characteristic)

199
Q

What is the most common cause of abdominal mass in a neonate?

A

Congenital UPJ obstruction

200
Q

What is the pathology behind UPJ obstruction and congenital megaureter?

A

Deficiency and derangement of ureteric smooth muscle fibers with associated fibrosis - results in abnormal peristalsis

201
Q

What is beer drinkers hydronephrosis?

A

Mild UPJ obstruction, the diuresis caused by the alcohol causes hydro

202
Q

How to differentiate extrarenal pelvis from UPJ obstruction?

A

Extra renal pelvis will have normal calcyeal size

203
Q

When thinking of UPJ obstruction, what other abnormality must be considered?

A

Aberrant vessel with mass effect

204
Q

What is congenital megaureter?

A

Functional obstruction of DISTAL ureter, not anatomic

205
Q

How does a circumcaval ureter form?

A

Forms when the infrarenal IVC arises from the subcardinal vein and not the supracardinal vein

206
Q

Which side is a circumcaval ureter found?

A

Always right sided since IVC forms from right sided veins

207
Q

What is the reverse J sign?

A

The medial course of a circumcaval right ureter has a reverse J shape

208
Q

What is the most common anomaly involving the urinary tract?

A

Partially duplicated collecting system

209
Q

What is a ureteral diverticulum?

A

When a branch of a partially duplicated collecting system fails to reach the metanephric blastema (kidney) and results in a blind ending ureteral stump

210
Q

What is the embryologic difference between partial and complete duplicated collecting systems?

A

Partial is a single ureteral bud from the mesonephric duct that branches before it gets to the metanephric blastema Complete has two separate ureteral buds from the mesonephric duct

211
Q

What is the Meyer-Weigert law?

A

States that the ureter from the upper moiety will enter inferomedially (ectopic) States that upper moiety is predisposed to obstruction

212
Q

Which ureter in a duplicated collected system is prone to obstruction? which one refluxes?

A

Obstruction - upper Reflux - lower

213
Q

What is the faceless kidney?

A

Complete duplicated pelves will have absence of collecting system elements or renal sinus fat in between

214
Q

What are the 3 main abnormalities involved with complete duplication?

A

Maldeveloped valve in lower pole ureter Ectopic ureteral insertion of upper pole ureter outside bladder Ectopic ureterocele of upper pole ureter

215
Q

How does ectopic insertion of the ureter present in males?

A

Chronic or recurrent epididymitis

216
Q

What is the drooping lilly sign?

A

In a duplicated collecting system with obstruction of the upper pole moiety, the lower pole moiety will be displaced inferomedially with a smaller than usual number of calyces

217
Q

How does an obstructed upper pole moiety present on US?

A

Echo free cystic lesion in medial upper pole with dilated ureter coursing to bladder

218
Q

Where is the most common site for ectopic ureter insertion in duplicated collecting systems?

A

Male - prostatic urethra Female - vestibule

219
Q

What is the association with ectopic ureterocele?

A

Ipsilateral complete duplication

220
Q

Which ureter has the ectopic ureterocele?

A

Upper pole moiety

221
Q

Where do ectopic ureteroceles end?

A

50% in bladder, 50% prostatic urethra

222
Q

What is an orthotopic ureterocele?

A

Dilation of a normally coursing ureter at the trigone orifice

223
Q

What percentage of ectopic ureters are associated with duplicated collecting systems? M or F?

A

80% 6x more common in females

224
Q

T or F: the more distal the ectopic insertion of the ureter, the more dysplastic the ipsilateral kidney

A

True

225
Q

In a nonduplicated ectopic ureter, what happens to the ipsilateral trigone?

A

Absent

226
Q

What causes clubbed calyces and overlying parenchymal scarring?

A

Reflux nephropathy

227
Q

What is prune belly/eagle barret syndrome? which sex?

A

Triad of absent abdominal musculature, undescended testicles, urinary tract abnormalities males only

228
Q

What are the urinary tract abnormalities with prune belly syndrome?

A

Can see renal dysplasia or hypoplasia or normal kidneys Tortuous and dilated ureters Enlarged bladder with/without patent urachus Dilated and rapidly tapering prostatic urethra

229
Q

What is the most common congenital bladder lesion? What is it? What are the associations?

A

Bladder exstrophy - deficiency in development of lower abdominal bladder muscles, bladder is open and mucosa is continuous with skin. Epispadias Skeletal - pubic symphysis widening GI - hernias

230
Q

What is a hurley stick sign?

A

Widening of the distal ureters with exstrophy

231
Q

What is the spectrum of bladder duplication?

A

Complete - Each bladder has normal musculature and mucosa. Can have separate urethral orifice that drains into single urethra or have separate urethra and penises Partial - incomplete septal division

232
Q

Where is a bladder diverticulum usually located?

A

Superolateral to the ureteral orifice

233
Q

What is the pathology associated with a bladder diverticulum?

A

Reflux due to distortion of the valve mechanism

234
Q

What are bladder ears?

A

Inferolateral protrusions of the bladder in young kids due to incomplete bladder filling

235
Q

What is the allantois?

A

Attachment of the bladder dome to the umbilicus.

236
Q

What is the urachus?

A

As the bladder lowers into the pelvis from the abdomen during embryogenesis, the bladder dome narrows and forms the urachus which elongates with bladder descent/

237
Q

What is the spectrum of urachal remnants? M or F?

A

M 3x Patent urachus Umbilical sinus - failure of closure at the umbilical attachement Urachocele - Failure of closure at the bladder dome Urachal cyst - failure of closure in any other site

238
Q

What are the remnants of mullerian duct atrophy?

A

Prostatic utricle and appendix testes

239
Q

Nonatrophy of the mullerian duct results in what?

A

cystic dilations along the route of the vas deferens

240
Q

Where do mullerian duct cysts occur?

A

Midline just superior to the prostate Midline - Mullerian

241
Q

What is the association with seminal vesicle cysts?

A

Ipsilateral absence of the kidney and ureter

242
Q

What are the three types of posterior urethral valves?

A

1 - leaflets from distal verumontanum to urethral wall 2 - proximal leaflets 3 - iris diaphragm across distal prostatic urethra

243
Q

Who gets posterior urethral valves?

A

Young males

244
Q

What is the urethral crest?

A

Continuation of the inferior aspect of the verumontanum which is a mucosal fold that divides into two to four fins (plica colliculi)

245
Q

test of choice for posterior urethra valves?

A

voiding cystourethrogram

246
Q

What is a fibroepithelial polyp in the urethra?

A

A stalked polyp that arises from the prostate and connects to the verumontanum, and extends in the prostatic urethra or into the bladder When voiding, the polyp will extend distally into the bulbar urethra

247
Q

What is atresia ani-urethralis

A

Associated with anal atresia, a fistulous tract can from between the bowel and posterior urethra. Tehre will be difficulty catheterizing the bladder.

248
Q

What condition is associated with bowel calculi?

A

Anal atresia - the passage of urine from a fistulous tract between the posterior urethra and the bowel precipitates crystal formation with bowel mucous

249
Q

What is the easiest way to differentiate meatal stenosis vs posterior urethral valves?

A

Meatal stenosis will have much more distal obstruction of catheter insertion

250
Q

What is a lacuna magna?

A

Wide necked diverticulum in the dorsal urethra associated with meatal stenosis

251
Q

Where is the defect in hypospadias?

A

Ventral surface

252
Q

Which is more common, hypo or epi spadias?

A

Hypospadias are more common

253
Q

Who gets congenital urethral diverticulum? Where?

A

Males only - females get acquired version ventral surface of anterior urethra

254
Q

How do duplicated urethras lie in the male vs female? which is functional?

A

Males - one on top of another, ventral is more functional Female - side by side

255
Q

What are the indications of removal of an anomalous urethra?

A

Urinary incontinence and urethritis

256
Q

What is the function of cowpers glands?

A

Secrete mucin to help lubricate semen and prevent coagulation of sperm

257
Q

What is the presentation of cowpers retention cysts?

A

Swell, causing ductal obstruction and mass effect on the bulbar urethra Will be seen as an indentation on the floor of the mid or proximal bulbar urethra

258
Q

Major risk factor for cryptorchidism?

A

Prematurity

259
Q

What are the three most common complications of cryptorchidism?

A

Malignant degeneration, sterility, torsion

260
Q

Does location of the undescended teste have an affect on the risk of malignancy?

A

Yes - the more proximal to the abdomen, the higher the risk

261
Q

What are the three main catergories of female genital tract anomaly?

A

Agenesis, duplication, anomalies related to DES

262
Q

What is a class 1 female genital anomaly?

A

Mullerian agenesis or hypoplasia varies - hypoplasia of vagina, cervix, uterus, fallopian tubes

263
Q

What is mayer-rokitansky-kuster-hauser syndrome?

A

Absence, of uterus, cervix, and vagina - can also see renal and ovarian abnormalities

264
Q

What is a class 2 female genital anomaly?

A

Failure of formation of one mullerian duct Unicornuate uterus

265
Q

What is class 3 female genital anomaly?

A

Uterine didelphys - two cervices, each with there own cornu and tube May have own vagina or there may be a vaginal septum Note on HSG, both endocervical canal must be opacified to show the anomaly

266
Q

What is the association with uterine didelphys?

A

Renal agenesis

267
Q

What is a class 4 female genital anomaly?

A

Bicornuate uterus one cervix with two upper uterine segments and two fundi, each with its own cornu

268
Q

What is a class 5 female genital anomaly?

A

Septate uterus External surface appears normal, but there is a septum that separates the fundus

269
Q

What is a class 6 female genital anomaly?

A

Arcuate uterus Slight bulging of fundal surface of endometrial cavity into endometrial space

270
Q

What are class 7 female genital anomalies?

A

Associated with DES morphologic changes, adenosis, ridges/hoods/stenosis of the cervix

271
Q

What is the appearance of a DES uterus? What is the risk?

A

T shaped uterus Clear cell carcinoma

272
Q

what are the uterine anomalies?

A

Uroradiology (11 decks)

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