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AJT CORE > CORE - Urinary > Flashcards

CORE - Urinary Flashcards

1
Q

Nephrographic phase

A

100 seconds

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2
Q

Excretory phase

A

15 minutes

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3
Q

“Too small to characterize”

A

less than twice the slice thickness

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4
Q

Definition of enhancement on CT

A

> 20 HU

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5
Q

Definition of enhancement on MRI

A

> 20% increase in signal intensity

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6
Q

Soft tissue rim sign

A

small rim of soft tissue (ureter) surrounding an obstructing stone, distinguishing it from a phelobolith

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7
Q

Corduroy appearance of the ureter

A

leukoplakia (squamous metaplasia); premalignant

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8
Q

Enlarged echogenic kidneys

A

ARPKD in peds, HIV nephropathy in adults

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9
Q

Young adult with hypertension and renal mass

A

juxtaglomerular cell tumor; secrete renin => hypertension + hypokalemia

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10
Q

Calcifications in RCC correlates with a better or worse prognosis?

A

better prognosis

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11
Q

Hyperechoic renal mass with posterior acoustic shadowing

A

AML; RCCs rarely demonstrate posterior acoustic shadowing

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12
Q

Hyperacute rejection

A

ABO incompatibility

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13
Q

Acute rejection timing

A

<3 months

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14
Q

Chronic rejection timing

A

> 3 months

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15
Q

Multifocal ureteral stenoses

A

ureteral TB

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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)

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17
Q

Blood at the meatus, painful urination, or inability to void after trauma

A

perform RUG before cystogram

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18
Q

Prostatic utricle

A

mullerian duct derivative, blind ending male homologue to the uterus and vagina; located at verumontanum

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19
Q

Inflammed glands of Littre (RUG)

A

urethritis

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20
Q

Most common site of urethral injury

A

disruption at the urogenital diaphragm and rupture of bulbomembranous urethra

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21
Q

Pyelonephritis on US and CT

A

decreased perfusion => decreased Doppler flow and hypoenhancing

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22
Q

Another term for renal pyramids

A

renal medulla (or medullary pyramids)

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23
Q

What are the renal papilla?

A

tips of the medullary pyramids

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24
Q

Echogenicity of cortex vs. pyramids (adult)

A

normal pyramids are hypoechoic relative to cortex

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25
Q

Echogenicity of cortex vs. pyramids (neonate)

A

hyperechoic pyramids; due to Tamm-Horsfall proteinuria

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26
Q

Dromedary hump

A

normal variant; focal bulge on left kidney related to adjacent spleen

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27
Q

Unilateral renal agenesis associations

A

unicornuate uterus (females); absent vas deferens/epididymis, seminal vesicle cysts (males)

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28
Q

Mayer-Rokitansky-Kuster-Hauser syndrome

A

congenital absence of uterus and upper vagina +/- fallopian tube/ovarian abnormalities; assoc. with renal anomlies

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29
Q

Most common renal fusion anomaly

A

horseshoe kidney

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30
Q

Complications of horseshoe kidney

A

increases risk of traumatic injury, stasis (infection, stones, TCC), Wilms, UPJ obstruction

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31
Q

Horseshoe kidney associations

A

Turner’s, Wilm’s

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32
Q

Complications of crossfused renal ectopia

A

stones, infection, hydronephrosis

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33
Q

Characteristics of RCC mets in liver and brain

A

hypervascular; enhancing in liver, hemorrhagic in brain

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34
Q

Risk factors for RCC

A

tobacco, VHL, dialysis-associated kidney disease, family history, tuberous sclerosis (younger age)

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35
Q

Renal mass with macroscopic fat and no calcifications

A

AML

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36
Q

Renal mass with macroscopic fat and calcifications

A

RCC (very rare); AMLs do not contain calcification

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37
Q

Renal mass with signal loss on out-of-phase

A

RCC (clear cell); AMLs do NOT contain microscopic fat

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38
Q

Renal mass with etching artifact on out-of-phase

A

represents macroscopic fat (that may not be resolvable on other sequences); suggests AML

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39
Q

T2 dark renal mass DDx

A

papillary RCC, lipid-poor AML, hemorrhagic cyst

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40
Q

Multiple renal masses DDx

A

RCCs (VHL), RCCs + oncocytomas (Birt-Hogg-Dube), AMLs (tuberous sclerosis)

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41
Q

Most sensitive phase of contrast for RCC

A

nephrographic (80-100 seconds)

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42
Q

RCC subtype assoc. with VHL

A

clear cell

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43
Q

RCC subtype assoc. with sickle cell trait

A

medullary

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44
Q

Hereditary RCC subtype

A

papillary (may also be related to chronic dialysis)

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45
Q

RCC subtype assoc. with Birt-Hogg-Dube

A

chromophobe (best prognosis of all subtypes)

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46
Q

Multiple bilateral renal cysts with increased risk of RCC

A

dialysis-associated cystic kidney disease

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47
Q

Renal mass(es) with preservation of reniform shape

A

lymphoma (often bilateral)

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48
Q

AML size assoc. with increased risk of hemorrhage

A

> 4 cm

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49
Q

2nd most common benign renal tumor

A

oncocytoma

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50
Q

Enhancing renal mass with central “scar” on CT/MR

A

suggestive of oncocytoma

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51
Q

Oncocytoma vs. RCC on PET

A

oncocytoma is PET hot, RCC is PET cold

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52
Q

Treatment of oncocytoma

A

typically resected; if obvious features of oncocytoma, may elect to watch

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53
Q

Bosniak 1

A

simple cyst, no septa or enhancement; no follow-up

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54
Q

Bosniak 2

A

hairline septations, fine calcificationl; also homogeneously hyperdense cysts <3 cm; no follow-up

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55
Q

Bosniak 2F

A

several septations, thick calcification; also homogeneously hyperdense cysts >3 cm; imaging follow-up

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56
Q

Bosniak 3

A

nodular spetal thickening, enhancing septa/wall; surgical

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57
Q

Bosniak 4

A

enhancing nodule; surgical

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58
Q

ADPKD associations

A

liver cysts, Berry aneurysms, seminal vesicle cysts, biliary hamartomas; end result is renal failure

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59
Q

Seminal vesicle cyst DDx

A

ipsilateral renal agenesis, ADPKD

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60
Q

ARPKD associations

A

congenital hepatic fibrosis, Caroli disease

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61
Q

Lithium nephropathy

A

small to normal-sized kidneys with numerous tiny cysts; may cause diabetes insipidus and renal insufficiency

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62
Q

MCDK on renal scintigraphy

A

no excretory function

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63
Q

Cyst originating from renal parenchyma, may compress collecting system

A

parapelvic

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64
Q

Cyst originating from renal sinus, mimics hydronephrosis

A

peripelvic (lymphatic origin); small and multiple

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65
Q

Striated nephrogram DDx

A

pyelonephritis, acute urinary obstruction, renal vein thrombosis, contusion, post-radiation, ATN (bilateral)

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66
Q

Renal abscess size needing drainage

A

> 3 cm

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67
Q

Emphysematous pyelonephritis vs. pyelitis

A

gas in the renal parenchyma vs. gas in the collecting system; both are seen in diabetics

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68
Q

Causes of pyonephrosis

A

stones, tumor, sloughed papilla (due to pyelonephritis)

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69
Q

Fluid-fluid level in renal collecting system (US)

A

pyonephrosis; Tx emergent PCN

70
Q

Bear paw appearance of kidney on CT

A

xanthogranulomatous pyelonephritis; staghorn calculus, recurrent infection, fibrofatty parenchymal replacement

71
Q

Papillary necrosis DDx

A

POSTCARD - Pyelonephritis, Obstruction, Sickle cell, TB, Cirrhosis, Analgesics (NSAIDs), Renal vein thrombosis, Diabetes

72
Q

Ball-on-tee sign

A

papillary necrosis

73
Q

Lobster claw sign

A

papillary necrosis

74
Q

Signet ring sign (renal)

A

papillary necrosis

75
Q

Most common cause of papillary necrosis

A

diabetes

76
Q

Small, calcified kidney

A

“putty kidney” (sequela of TB)

77
Q

Kerr kink sign

A

sharp kink at the UPJ; due to scarring from renal TB

78
Q

Scattered punctate renal cortical calcifications

A

disseminated PCP (similar findings in spleen and liver involvement)

79
Q

T/F - contrast allergy is a risk factor for contrast-induced nephropathy

A

FALSE

80
Q

Risk factors for contrast-induced nephropathy

A

renal insufficiency, diabetes, CHF, dehydration, myeloma

81
Q

Prevention of contrast-induced nephropathy in renal insufficiency

A

IVF 6-12 hours before and 4-12 hours after (NOT oral)

82
Q

Renal stone associated with UTI

A

struvite

83
Q

Renal stone(s) not seen on x-ray

A

uric acid, indinavir, cystine, xanthine

84
Q

Renal stone(s) not seen on CT

A

indinavir

85
Q

Most common renal stone

A

calcium oxalate

86
Q

Treatment for uric acid stones

A

medically, with sodium bicarbonate or potassium citrate (increase pH)

87
Q

Renal cortical necrosis

A

hypoenhancing renal cortex +/- very thin enhancing rim; affects entire kidney

88
Q

Causes of renal cortical necrosis

A

severe hemodynamic shock, hemolytic uremic syndrome, renal transplantation

89
Q

Cortical nephrocalcinosis DDx

A

renal cortical necrosis, chronic transplant rejection, Alport syndrome, hyperoxaluria, chronic glomerulonephritis

90
Q

Medullary nephrocalcinosis DDx

A

medullary sponge kidney, hyperparathyroidism (hypercalcemia), sarcoidosis (hypercalcemia), type 1 RTA, furosemide (child)

91
Q

Medullary sponge kidney associations

A

Caroli disease, Ehlers-Danlos, Beckwith-Wiedemann

92
Q

Page kidney

A

subcapsular hematoma => secondary hypertension (takes several months to develop)

93
Q

Unilateral delayed nephrogram

A

acute ureteral obstruction, renal vein thrombosis, renal artery stenosis

94
Q

Bilateral delayed nephrograms

A

systemic hypotension, ATN, contrast-induced nephropathy, bilateral obstruction, myeloma kidneys

95
Q

Cortical rim sign

A

subacute renal infarct; hypoenhancing area of infarction with thin enhancing rim

96
Q

Causes of renal vein thrombosis

A

dehydration, nephrotic syndrome, sickle cell

97
Q

Renal trauma with suspicion of collecting system injury - NEXT STEP

A

delayed phase to assess for urine leak

98
Q

Normal renal artery waveform

A

low resistance, brisk upstroke, forward flow throughout diastole; for native and transplant kidneys

99
Q

Post-renal transplant collections

A

hematoma (immediate), urinoma (1-2 weeks), abscess (3-4 weeks), lymphocele (>4 weeks)

100
Q

Most common post-transplant fluid collection to cause hydronephrosis

A

lymphocele

101
Q

Ipsilateral lower extremity edema in a post-renal transplant patient

A

lymphocele; causes femoral vein compression

102
Q

Findings in acute renal transplant rejection

A

swollen kidney, echogenic pyramids, elevated RIs, urothelial thickening

103
Q

ATN vs. acute rejection (post-transplant)

A

both occur within first week; on MAG3 study, ATN demonstrates normal perfusion, while acute rejection demonstrates delayed perfusion; both show delayed excretion

104
Q

Reversal of diastolic flow in transplant main renal artery

A

renal vein thrombosis; occurs <1 week following transplant; renal vein would show no flow

105
Q

Most common vascular complication of renal transplantation

A

renal artery stenosis; occurs at the anastomosis

106
Q

Findings in transplant renal artery stenosis

A

PSV >200-300 cm/s or PSV ratio >2; high resistance waveform with elevated PSV pre-stenosis; parvus et tardus post-stenosis

107
Q

Findings in renal transplant AVF

A

tissue vibration artifact, elevated PSV (in artery), pulsatile venous waveform

108
Q

Post-renal biopsy complications

A

AVF, pseudoaneurysm

109
Q

Cyclophosphamide association

A

increased risk of TCC

110
Q

Causes of primary megaureter

A

idiopathic, distal adynamic segment, reflux at UVJ

111
Q

Causes of pseudoureterocele

A

impacted stone, recently passed stone, bladder malignancy

112
Q

Ureterocele vs. pseudoureteocele

A

pseudoureterocele has loss or thickening of the normal thin lucent halo surrounding a ureterocele

113
Q

Ureteral wall calcifications

A

schistosomiasis, TB

114
Q

Ureteritis cystica

A

numerous tiny subepithelial cysts, due to chronic inflammation (diabetics with recurrent UTIs)

115
Q

Multiple small ureteral outpouchings

A

ureteral diverticulosis; often bilateral, due to chronic inflammation

116
Q

Premalignant -plakia

A

leukoplakia (risk of SCC); both are due to chronic irritation and occur in bladder > ureter

117
Q

-plakia seen in immunocompromised patients

A

malakoplakia (not premalignant)

118
Q

Ormond disease

A

idiopathic retroperitoneal fibrosis

119
Q

Medial deviation of ureters

A

retroperitoneal fibrosis, psoas hypertrophy, retrocaval ureter (right side), pelvic lipomatosis

120
Q

Lateral deviation of ureters

A

retroperitoneal lymphadenopathy, aortic anuerysm

121
Q

Nuclear medicine findings of retroperitoneal fibrosis

A

gallium avid, PET hot

122
Q

Risk factors for TCC

A

smoking, cyclophosphamide, horseshoe kidney, nephrolithiasis, HNPCC

123
Q

Location of TCC

A

bladder > collecting system > lower ureter > upper ureter

124
Q

Balkan nephropathy

A

increased risk of upper tract TCC; assoc with aristolochic acid ingestion in plant seeds

125
Q

Smooth long segment ureteral filling defect

A

ureteral fibroepithelial polyp; most common benign tumor of ureter

126
Q

Treatment of multilocular cystic nephroma

A

resection (cannot be distinguished from cystic RCC or cystic Wilms)

127
Q

Eagle-Barrett syndrome

A

a.k.a. prune belly syndrome; abdominal muscle deficiency, hydroureteronephrosis, cryptorchidism

128
Q

Bladder diverticulum associations

A

chronic outlet obstruction, Ehlers-Danlos

129
Q

Hutch diverticulum

A

congenital, occurs near UVJ; associated with VUR

130
Q

Anterior-superior bladder diverticulum

A

likely a urachal diverticulum

131
Q

Lateral protrusion of the bladder into the inguinal canal

A

bladder ears; transient

132
Q

Confluence of rectum, vagina, and urethra into a single common channel

A

cloacal malformation; females only, assoc. with imperforate anus

133
Q

Schistosomiasis

A

calcified bladder and/or ureters; increased risk of SCC

134
Q

Leiomyoma (bladder)

A

most common at the trigone; most common mesenchymal bladder tumor

135
Q

Most common early complication of urinary diversion (<30 days)

A

adynamic ileus > urine leak

136
Q

Emphysematous cystitis association

A

diabetes

137
Q

Causes of bladder fistula

A

diverticulitis, Crohn’s, rectal cancer; men > women (no lady parts to interfere)

138
Q

Pine cone bladder

A

neurogenic bladder (stasis => stones/infection/cancer)

139
Q

Bladder outlet obstruction sequelae

A

diverticulae; stasis => stones/infection/cancer

140
Q

Pear-shaped bladder

A

pelvic hematoma, pelvic lipomatosis, lymphocele(s), psoas hypertrophy

141
Q

Suspected bladder rupture - NEXT STEP

A

CT cystogram (contrast infused into bladder via foley)

142
Q

Most common type of bladder rupture

A

extraperitoneal; Tx is foley placement (vs. intraperitoneal rupture, which is surgical)

143
Q

Molar tooth sign

A

extravasated contrast in the space of Retzius (extraperitoneal rupture)

144
Q

Extraperitoneal bladder rupture association

A

pelvic fracture (almost 100% of the time)

145
Q

Urethral injury type - stretching/elongation without extravasation

A

type 1

146
Q

Urethral injury type - extravasation above the urogenital diaphragm only

A

type 2

147
Q

Urethral injury type - extravasation below the urogenital diaphragm

A

type 3; may extend to the pelvis or perineum; bladder neck is intact

148
Q

Urethral injury type - extraperitoneal extravasation

A

type 4; bladder neck is disrupted

149
Q

Urethral injury type - periurethral extravasation

A

type 4a; bladder base is disrupted

150
Q

Urethral injury type - extravasation extending into the anterior urethra

A

type 5

151
Q

Short segment stricture of bulbous urethra

A

straddle injury

152
Q

Long segment stricture of bulbous urethra with irregularity

A

gonococcal

153
Q

Location of iatrogenic urethral injury

A

at the penile-bulbous (or penile-scrotal) junction

154
Q

Multiple small filling defects on retrograde urethrogram

A

condyloma acuminata; RUG not recommended if suspected due to seeding

155
Q

Urethrorectal fistula associations

A

post-brachytherapy, post-radiation

156
Q

Urethral diverticulum (male)

A

due to long-term foley placement

157
Q

Most common malignancy of urethra (male)

A

SCC (distal) > TCC (proximal); cancer in a urethral diverticulum is likely adenocarcinoma

158
Q

Urethral diverticulum (female)

A

assoc. with repeated UTIs and urinary incontinence; increased risk of adenocarcinoma

159
Q

Stuff located at the verumontanum

A

paired ejaculatory ducts, prostatic utricle, PUVs (if present)

160
Q

Urethral stuff located at the urogenital diaphragm (male)

A

membranous urethra, external urethral sphincter, Cowper’s glands (drain into bulbous segment)

161
Q

Glands of Littre

A

small mucous glands in the penile urethra; opacification on RUG suggests urethritis

162
Q

Skene glands

A

secrete mucus into female urethra; equivalent of male prostate

163
Q

Best study to visualize anterior urethra

A

retrograde urethrogram (RUG)

164
Q

Best study to visualize posterior urethra

A

voiding cystourethrogram (VCUG)

165
Q

Medullary sponge kidney

A

tubular ectasia + medullary calcification

166
Q

Dual energy ratios for uric acid, calcium oxalate, and cystine stones

A

uric acid = 1.1, calcium oxalate = 1.25, cystine = 1.25; ratio of low energy HU to high energy HU

167
Q

> 50% renal artery stenosis (ultrasound)

A

acceleration time >70 msec (tardus) or acceleration index <3.0 m/s

168
Q

Resistive index (RI) formula

A

(PSV - EDV) / PSV

169
Q

Elevated RI in native kidney (>0.7)

A

acute obstruction; or difference >0.1 between kidneys

170
Q

Intrarenal arteries (from big to small)

A

segmental&raquo_space; interlobar&raquo_space; arcuate

AJT CORE (12 decks)

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