CORE - Urinary Flashcards
1
Q
Nephrographic phase
A
100 seconds
2
Q
Excretory phase
A
15 minutes
3
Q
“Too small to characterize”
A
less than twice the slice thickness
4
Q
Definition of enhancement on CT
A
> 20 HU
5
Q
Definition of enhancement on MRI
A
> 20% increase in signal intensity
6
Q
Soft tissue rim sign
A
small rim of soft tissue (ureter) surrounding an obstructing stone, distinguishing it from a phelobolith
7
Q
Corduroy appearance of the ureter
A
leukoplakia (squamous metaplasia); premalignant
8
Q
Enlarged echogenic kidneys
A
ARPKD in peds, HIV nephropathy in adults
9
Q
Young adult with hypertension and renal mass
A
juxtaglomerular cell tumor; secrete renin => hypertension + hypokalemia
10
Q
Calcifications in RCC correlates with a better or worse prognosis?
A
better prognosis
11
Q
Hyperechoic renal mass with posterior acoustic shadowing
A
AML; RCCs rarely demonstrate posterior acoustic shadowing
12
Q
Hyperacute rejection
A
ABO incompatibility
13
Q
Acute rejection timing
A
<3 months
14
Q
Chronic rejection timing
A
> 3 months
15
Q
Multifocal ureteral stenoses
A
ureteral TB
16
Q
Total volume for CT cystogram
A
350 cc or as much as tolerated, instilled by gravity (bag 40 cm above bladder); dilute water soluble contrast (50 cc contrast + 500 cc warm saline)
17
Q
Blood at the meatus, painful urination, or inability to void after trauma
A
perform RUG before cystogram
18
Q
Prostatic utricle
A
mullerian duct derivative, blind ending male homologue to the uterus and vagina; located at verumontanum
19
Q
Inflammed glands of Littre (RUG)
A
urethritis
20
Q
Most common site of urethral injury
A
disruption at the urogenital diaphragm and rupture of bulbomembranous urethra
21
Q
Pyelonephritis on US and CT
A
decreased perfusion => decreased Doppler flow and hypoenhancing
22
Q
Another term for renal pyramids
A
renal medulla (or medullary pyramids)
23
Q
What are the renal papilla?
A
tips of the medullary pyramids
24
Q
Echogenicity of cortex vs. pyramids (adult)
A
normal pyramids are hypoechoic relative to cortex
25
Echogenicity of cortex vs. pyramids (neonate)
hyperechoic pyramids; due to Tamm-Horsfall proteinuria
26
Dromedary hump
normal variant; focal bulge on left kidney related to adjacent spleen
27
Unilateral renal agenesis associations
unicornuate uterus (females); absent vas deferens/epididymis, seminal vesicle cysts (males)
28
Mayer-Rokitansky-Kuster-Hauser syndrome
congenital absence of uterus and upper vagina +/- fallopian tube/ovarian abnormalities; assoc. with renal anomlies
29
Most common renal fusion anomaly
horseshoe kidney
30
Complications of horseshoe kidney
increases risk of traumatic injury, stasis (infection, stones, TCC), Wilms, UPJ obstruction
31
Horseshoe kidney associations
Turner's, Wilm's
32
Complications of crossfused renal ectopia
stones, infection, hydronephrosis
33
Characteristics of RCC mets in liver and brain
hypervascular; enhancing in liver, hemorrhagic in brain
34
Risk factors for RCC
tobacco, VHL, dialysis-associated kidney disease, family history, tuberous sclerosis (younger age)
35
Renal mass with macroscopic fat and no calcifications
AML
36
Renal mass with macroscopic fat and calcifications
RCC (very rare); AMLs do not contain calcification
37
Renal mass with signal loss on out-of-phase
RCC (clear cell); AMLs do NOT contain microscopic fat
38
Renal mass with etching artifact on out-of-phase
represents macroscopic fat (that may not be resolvable on other sequences); suggests AML
39
T2 dark renal mass DDx
papillary RCC, lipid-poor AML, hemorrhagic cyst
40
Multiple renal masses DDx
RCCs (VHL), RCCs + oncocytomas (Birt-Hogg-Dube), AMLs (tuberous sclerosis)
41
Most sensitive phase of contrast for RCC
nephrographic (80-100 seconds)
42
RCC subtype assoc. with VHL
clear cell
43
RCC subtype assoc. with sickle cell trait
medullary
44
Hereditary RCC subtype
papillary (may also be related to chronic dialysis)
45
RCC subtype assoc. with Birt-Hogg-Dube
chromophobe (best prognosis of all subtypes)
46
Multiple bilateral renal cysts with increased risk of RCC
dialysis-associated cystic kidney disease
47
Renal mass(es) with preservation of reniform shape
lymphoma (often bilateral)
48
AML size assoc. with increased risk of hemorrhage
>4 cm
49
2nd most common benign renal tumor
oncocytoma
50
Enhancing renal mass with central "scar" on CT/MR
suggestive of oncocytoma
51
Oncocytoma vs. RCC on PET
oncocytoma is PET hot, RCC is PET cold
52
Treatment of oncocytoma
typically resected; if obvious features of oncocytoma, may elect to watch
53
Bosniak 1
simple cyst, no septa or enhancement; no follow-up
54
Bosniak 2
hairline septations, fine calcificationl; also homogeneously hyperdense cysts <3 cm; no follow-up
55
Bosniak 2F
several septations, thick calcification; also homogeneously hyperdense cysts >3 cm; imaging follow-up
56
Bosniak 3
nodular spetal thickening, enhancing septa/wall; surgical
57
Bosniak 4
enhancing nodule; surgical
58
ADPKD associations
liver cysts, Berry aneurysms, seminal vesicle cysts, biliary hamartomas; end result is renal failure
59
Seminal vesicle cyst DDx
ipsilateral renal agenesis, ADPKD
60
ARPKD associations
congenital hepatic fibrosis, Caroli disease
61
Lithium nephropathy
small to normal-sized kidneys with numerous tiny cysts; may cause diabetes insipidus and renal insufficiency
62
MCDK on renal scintigraphy
no excretory function
63
Cyst originating from renal parenchyma, may compress collecting system
parapelvic
64
Cyst originating from renal sinus, mimics hydronephrosis
peripelvic (lymphatic origin); small and multiple
65
Striated nephrogram DDx
pyelonephritis, acute urinary obstruction, renal vein thrombosis, contusion, post-radiation, ATN (bilateral)
66
Renal abscess size needing drainage
>3 cm
67
Emphysematous pyelonephritis vs. pyelitis
gas in the renal parenchyma vs. gas in the collecting system; both are seen in diabetics
68
Causes of pyonephrosis
stones, tumor, sloughed papilla (due to pyelonephritis)
69
Fluid-fluid level in renal collecting system (US)
pyonephrosis; Tx emergent PCN
70
Bear paw appearance of kidney on CT
xanthogranulomatous pyelonephritis; staghorn calculus, recurrent infection, fibrofatty parenchymal replacement
71
Papillary necrosis DDx
POSTCARD - Pyelonephritis, Obstruction, Sickle cell, TB, Cirrhosis, Analgesics (NSAIDs), Renal vein thrombosis, Diabetes
72
Ball-on-tee sign
papillary necrosis
73
Lobster claw sign
papillary necrosis
74
Signet ring sign (renal)
papillary necrosis
75
Most common cause of papillary necrosis
diabetes
76
Small, calcified kidney
"putty kidney" (sequela of TB)
77
Kerr kink sign
sharp kink at the UPJ; due to scarring from renal TB
78
Scattered punctate renal cortical calcifications
disseminated PCP (similar findings in spleen and liver involvement)
79
T/F - contrast allergy is a risk factor for contrast-induced nephropathy
FALSE
80
Risk factors for contrast-induced nephropathy
renal insufficiency, diabetes, CHF, dehydration, myeloma
81
Prevention of contrast-induced nephropathy in renal insufficiency
IVF 6-12 hours before and 4-12 hours after (NOT oral)
82
Renal stone associated with UTI
struvite
83
Renal stone(s) not seen on x-ray
uric acid, indinavir, cystine, xanthine
84
Renal stone(s) not seen on CT
indinavir
85
Most common renal stone
calcium oxalate
86
Treatment for uric acid stones
medically, with sodium bicarbonate or potassium citrate (increase pH)
87
Renal cortical necrosis
hypoenhancing renal cortex +/- very thin enhancing rim; affects entire kidney
88
Causes of renal cortical necrosis
severe hemodynamic shock, hemolytic uremic syndrome, renal transplantation
89
Cortical nephrocalcinosis DDx
renal cortical necrosis, chronic transplant rejection, Alport syndrome, hyperoxaluria, chronic glomerulonephritis
90
Medullary nephrocalcinosis DDx
medullary sponge kidney, hyperparathyroidism (hypercalcemia), sarcoidosis (hypercalcemia), type 1 RTA, furosemide (child)
91
Medullary sponge kidney associations
Caroli disease, Ehlers-Danlos, Beckwith-Wiedemann
92
Page kidney
subcapsular hematoma => secondary hypertension (takes several months to develop)
93
Unilateral delayed nephrogram
acute ureteral obstruction, renal vein thrombosis, renal artery stenosis
94
Bilateral delayed nephrograms
systemic hypotension, ATN, contrast-induced nephropathy, bilateral obstruction, myeloma kidneys
95
Cortical rim sign
subacute renal infarct; hypoenhancing area of infarction with thin enhancing rim
96
Causes of renal vein thrombosis
dehydration, nephrotic syndrome, sickle cell
97
Renal trauma with suspicion of collecting system injury - NEXT STEP
delayed phase to assess for urine leak
98
Normal renal artery waveform
low resistance, brisk upstroke, forward flow throughout diastole; for native and transplant kidneys
99
Post-renal transplant collections
hematoma (immediate), urinoma (1-2 weeks), abscess (3-4 weeks), lymphocele (>4 weeks)
100
Most common post-transplant fluid collection to cause hydronephrosis
lymphocele
101
Ipsilateral lower extremity edema in a post-renal transplant patient
lymphocele; causes femoral vein compression
102
Findings in acute renal transplant rejection
swollen kidney, echogenic pyramids, elevated RIs, urothelial thickening
103
ATN vs. acute rejection (post-transplant)
both occur within first week; on MAG3 study, ATN demonstrates normal perfusion, while acute rejection demonstrates delayed perfusion; both show delayed excretion
104
Reversal of diastolic flow in transplant main renal artery
renal vein thrombosis; occurs <1 week following transplant; renal vein would show no flow
105
Most common vascular complication of renal transplantation
renal artery stenosis; occurs at the anastomosis
106
Findings in transplant renal artery stenosis
PSV >200-300 cm/s or PSV ratio >2; high resistance waveform with elevated PSV pre-stenosis; parvus et tardus post-stenosis
107
Findings in renal transplant AVF
tissue vibration artifact, elevated PSV (in artery), pulsatile venous waveform
108
Post-renal biopsy complications
AVF, pseudoaneurysm
109
Cyclophosphamide association
increased risk of TCC
110
Causes of primary megaureter
idiopathic, distal adynamic segment, reflux at UVJ
111
Causes of pseudoureterocele
impacted stone, recently passed stone, bladder malignancy
112
Ureterocele vs. pseudoureteocele
pseudoureterocele has loss or thickening of the normal thin lucent halo surrounding a ureterocele
113
Ureteral wall calcifications
schistosomiasis, TB
114
Ureteritis cystica
numerous tiny subepithelial cysts, due to chronic inflammation (diabetics with recurrent UTIs)
115
Multiple small ureteral outpouchings
ureteral diverticulosis; often bilateral, due to chronic inflammation
116
Premalignant -plakia
leukoplakia (risk of SCC); both are due to chronic irritation and occur in bladder > ureter
117
-plakia seen in immunocompromised patients
malakoplakia (not premalignant)
118
Ormond disease
idiopathic retroperitoneal fibrosis
119
Medial deviation of ureters
retroperitoneal fibrosis, psoas hypertrophy, retrocaval ureter (right side), pelvic lipomatosis
120
Lateral deviation of ureters
retroperitoneal lymphadenopathy, aortic anuerysm
121
Nuclear medicine findings of retroperitoneal fibrosis
gallium avid, PET hot
122
Risk factors for TCC
smoking, cyclophosphamide, horseshoe kidney, nephrolithiasis, HNPCC
123
Location of TCC
bladder > collecting system > lower ureter > upper ureter
124
Balkan nephropathy
increased risk of upper tract TCC; assoc with aristolochic acid ingestion in plant seeds
125
Smooth long segment ureteral filling defect
ureteral fibroepithelial polyp; most common benign tumor of ureter
126
Treatment of multilocular cystic nephroma
resection (cannot be distinguished from cystic RCC or cystic Wilms)
127
Eagle-Barrett syndrome
a.k.a. prune belly syndrome; abdominal muscle deficiency, hydroureteronephrosis, cryptorchidism
128
Bladder diverticulum associations
chronic outlet obstruction, Ehlers-Danlos
129
Hutch diverticulum
congenital, occurs near UVJ; associated with VUR
130
Anterior-superior bladder diverticulum
likely a urachal diverticulum
131
Lateral protrusion of the bladder into the inguinal canal
bladder ears; transient
132
Confluence of rectum, vagina, and urethra into a single common channel
cloacal malformation; females only, assoc. with imperforate anus
133
Schistosomiasis
calcified bladder and/or ureters; increased risk of SCC
134
Leiomyoma (bladder)
most common at the trigone; most common mesenchymal bladder tumor
135
Most common early complication of urinary diversion (<30 days)
adynamic ileus > urine leak
136
Emphysematous cystitis association
diabetes
137
Causes of bladder fistula
diverticulitis, Crohn's, rectal cancer; men > women (no lady parts to interfere)
138
Pine cone bladder
neurogenic bladder (stasis => stones/infection/cancer)
139
Bladder outlet obstruction sequelae
diverticulae; stasis => stones/infection/cancer
140
Pear-shaped bladder
pelvic hematoma, pelvic lipomatosis, lymphocele(s), psoas hypertrophy
141
Suspected bladder rupture - NEXT STEP
CT cystogram (contrast infused into bladder via foley)
142
Most common type of bladder rupture
extraperitoneal; Tx is foley placement (vs. intraperitoneal rupture, which is surgical)
143
Molar tooth sign
extravasated contrast in the space of Retzius (extraperitoneal rupture)
144
Extraperitoneal bladder rupture association
pelvic fracture (almost 100% of the time)
145
Urethral injury type - stretching/elongation without extravasation
type 1
146
Urethral injury type - extravasation above the urogenital diaphragm only
type 2
147
Urethral injury type - extravasation below the urogenital diaphragm
type 3; may extend to the pelvis or perineum; bladder neck is intact
148
Urethral injury type - extraperitoneal extravasation
type 4; bladder neck is disrupted
149
Urethral injury type - periurethral extravasation
type 4a; bladder base is disrupted
150
Urethral injury type - extravasation extending into the anterior urethra
type 5
151
Short segment stricture of bulbous urethra
straddle injury
152
Long segment stricture of bulbous urethra with irregularity
gonococcal
153
Location of iatrogenic urethral injury
at the penile-bulbous (or penile-scrotal) junction
154
Multiple small filling defects on retrograde urethrogram
condyloma acuminata; RUG not recommended if suspected due to seeding
155
Urethrorectal fistula associations
post-brachytherapy, post-radiation
156
Urethral diverticulum (male)
due to long-term foley placement
157
Most common malignancy of urethra (male)
SCC (distal) > TCC (proximal); cancer in a urethral diverticulum is likely adenocarcinoma
158
Urethral diverticulum (female)
assoc. with repeated UTIs and urinary incontinence; increased risk of adenocarcinoma
159
Stuff located at the verumontanum
paired ejaculatory ducts, prostatic utricle, PUVs (if present)
160
Urethral stuff located at the urogenital diaphragm (male)
membranous urethra, external urethral sphincter, Cowper's glands (drain into bulbous segment)
161
Glands of Littre
small mucous glands in the penile urethra; opacification on RUG suggests urethritis
162
Skene glands
secrete mucus into female urethra; equivalent of male prostate
163
Best study to visualize anterior urethra
retrograde urethrogram (RUG)
164
Best study to visualize posterior urethra
voiding cystourethrogram (VCUG)
165
Medullary sponge kidney
tubular ectasia + medullary calcification
166
Dual energy ratios for uric acid, calcium oxalate, and cystine stones
uric acid = 1.1, calcium oxalate = 1.25, cystine = 1.25; ratio of low energy HU to high energy HU
167
>50% renal artery stenosis (ultrasound)
acceleration time >70 msec (tardus) or acceleration index <3.0 m/s
168
Resistive index (RI) formula
(PSV - EDV) / PSV
169
Elevated RI in native kidney (>0.7)
acute obstruction; or difference >0.1 between kidneys
170
Intrarenal arteries (from big to small)
segmental >> interlobar >> arcuate
