GU Flashcards
Retroperitoneum
Ant. Pararenal space - asc + desc colon, pancreas, 2nd and 3rd duod
Perirenal space- Kidneys, prox ureter, adrenals
Post. Pararenal space - only contains fat but can be involved with inflammation
Liposarcoma
Most common 1° retroperitoneal malignant tumour
Most commonly fat containing ( least aggressive)
More aggressive subtypes have minimal fat
Retroperitoneal fibrosis
Fibrosis deposition In the retroperitoneum leading to ureteric obstruction.
No displacement of aorta away from spine
Retroperiotneal haematoma
2° to ruptured AAA, trauma, renal AML or haemorrhagic cyst
Adrenal adenomas
Can cause cushings or conns syndrome.
Adrenal adenoma
Microscopic fat
Rapid wash-out characteristics on contrast enhanced CT
<10HU on non con is definite adenoma
>10 HU contrast given to assess characteristics
Adenoma has absolute washout >60% and relative washout >40%
Collsion tumour
Co-existence of two tumours within adrenal mass such as metastasis within adrenal adenoma or myelolipoma.
Absolute washout
Enhanced attenuation - delayed attenuation
/
Enhanced attenuation - unenhanced attenuation
Relative washout
Enhanced attenuation - delayed attenuation
/
Enhanced attenuation
Chemical shift imaging
Adenomas suppress on OOP images whilst metastases do not
Adrenal myelolipoma
Adrenal mass with macroscopic fat
Usually incidental and can be large (>4cm)
Pheochromocytoma
Neuroendocrine tumour of adrenals
Can be large and heterogenous due to central necrosis.
Avid enhancement on CT and ++T2 signal on MRI.
IO-123 and In-111 can be used to detect it.
Assoc. MEN 2, VHL,NF1,Carney’s triad .
If bladder is involved can cause post-micturition syncope .
Adrenal Mets
Lung and Melanoma are most common primaries.
Adrenal calcifications
Can be 2° to :
Previous haemorrhage
Granulomatosis with polyangitis
TB
Histoplasmosis
HIV nephropathy
Can cause bilateral enlarged and echogenic Kidneys
Unilateral delayed nephrogram (slow parenchymal uptake of contrast ) causes
Acute ureteral obstruction
Renal artery stenosis
Renal vein thrombosis
Acute pyelonephritis
Unilateral prolonged (hyperdense) nephrogram:
Acute ureteral obstruction
Renal artery stenosis
Renal vein thrombosis
Bilateral persistent nephrogram
Systemic hypotension
Acute tubular necrosis
Contrast or urate nephropathy
Myeloma (proteinuria)
Bilateral obstruction
Striated nephrogram causes
Acute obstruction
Pyelonephritis
Infarct
Acute tubular necrosis
Contusion
Hypotension
ARPKD
hypotension
Medullary nephrocalcinosis
Calcification of renal medullary pyramids secondary to hypercalcaemia or hypercalciuria
Preserved renal function
Causes :
Hyperparathyroidism
Sarcoid
Renal tubular acidosis
Medullary sponge kidney
Papillary necrosis
Cortical nephrocalcinosis
Dystrophic peripheral calcification of renal cortex with sparing of pyramids
Due to :
Cortical necrosis
Chronic glomerulonephritis
Transplant rejection
Alport syndrome (deaf too )
ARPKD.
Cortical necrosis
2° to hemolytic uraemic syndrome and thrombotic microangiopathy
Reduced renal cortex enhancement with preservation of medullary enhancement.
Papillary necrosis
Common causes:
NSAIDS, SCD,diabetes, renal vein thrombosis
US: focal echogenic papilla
CT: pooling of contrast in papillary regions adjacent to calyces. Can have filing defects in calyces, renal pelvis or ureter due to sloughed papilla
Ball on tee sign : contrast filling central papilla
Lobster claw: contrast filling periphery of papilla
Signet ring sign : contrast surrounding sloughed papilla
Renal artery pseudoaneurysm or AV fistula characteristics
Hyperattenuating focus with density similar to aorta
Decreases in attenuation on delayed phase
Active bleed will increase in attenuation or size with delayed phase imaging
Page kidney
Cause of 2° hypertension due to extrinsic compression of kidney by haematoma after trauma . Takes several months to develop.
Which stones are not radioopaque on CT
Indinavir stones
Matrix stones (mucin)
Uric acid
Xanthine
Pure struvite
Soft tissue rim sign
Small amount of soft tissue surrounding calcification in ureter thought to represent oedematous ureteral wall. (Not seen with phleboliths )
Obstruction without hydronephrosis
Very acute obstruction
Severe dehydration
Obstruction with ruptured fornix
Recently passed stone
Hydronephrosis without obstruction
Focal pyelonephritis
Can mimic renal mass
Hypoechoic mass or masses that disrupts corticomedullary junction.
Lacks distinct wall.
Can have associated mild hydronephrosis.
Emphysematous pyelonephritis
Renal parenchyma replaced by gas
Usually 2° to E Coli
Needs broad spectrum abx and likely nephrectomy.
Renal TB
Focal cavitary lesion with calcification
Also scarring , papillary necrosis and infundibular strictures
End-stage : Putty kidney (atrophic and calcified) or autonephrectomy.
XGP pyelonephritis
Chronic infection 2° to Staghorn calc
Renal parenchyma replaced with fibrofatty inflammatory tissue
(Localised form is called tumefactive XGP and can mimic renal mass )
Bear paw sign of fibrofatty masses.
Complications- perinephric abscess and fistula formation
HIV Nephropathy
Focal segmental glomerulosclerosis
**Echogenic and Enlarged ** Kidneys
Renal failure
ADPKD
Bilateral enlarged Kidneys with multiple large cysts
70% have multiple hepatic cysts
15% have saccular cerebral aneurysms
ARPKD
Bilateral enlarged kidney with tiny renal cysts.
Hepatic fibrosis usually develops
Presents in utero as enlarged echogenic Kidneys
Acquired cystic kidney disease
Pts on long term dialysis
Small renal cysts in atrophic Kidneys
Increased risk of renal cell ca
Lithium nephropathy
Can present as nephrogenic diabetes insipidus or chronic renal insufficiency
Scattered microcysts in bilateral normal sized Kidneys
Solid renal masses
> 3cm , 75% are malignant
Assess renal veins for tumour thrombus and extension
RCC
Rf:
Smoking
VHL
Tuberous sclerosis
on US is isoechoic to renal cortex
Tumor thrombus has colour doppler with arterial wave form
Clear cell RCC
Most common type
Enhances most on CT and MR
T2 hyperintense
Papillary RCC
Hypovascular subtype
Only mildly enhances
T2 hypointense with mild enhancement
Renal medullary ca
Aggressive
Ill defined , infiltrative , hypovascular central mass with necrosis being common .
Affects males with sickle cell trait
Renal lymphoma
Multiple hypoechoic renal masses
Little enhancement
Treated ca cervix
T2 Hypointense
Myometrium ca
Normal uterus high t2 endometrium , dark junctionanl zone , isointense myometrium. Avidly enhances
Tumour enhances less than myometrium
Dwi in endometrial ca
Dwi is good sequence for drop Mets. Restricts
Pre eclampsia and cortical blindness
PRES
Ovarian thecoma
Unilateral solid ovarian mass
Increased endometrial thickness
Multicystic
Ovarian hyperstimulatioj syndrome
Small pleural Effusion
Fever
Nausea
Ascites
Bilateral small ovarian cystic lesions
Intraductal lesion
Most common is papilloma
Brca2
Annual mri up to 40 and then mri +mammo after that
Tp53 and ataxia telagiectasia breast
Mri only
Abnormal tfts and increased uptake
GRAVES
Prostate
Dwi for peripheral
High T2 for transitional
Gartner cyst
Anterior upper vagina
Bartholin cyst
Posterior / near anus
Skene gland
Anterior to vagina , below perineal membrane
Solid lesion post vasectomy
Sperm granuloma
Testes cancer
Para-aortic is local/ regional spread
Goblet sign in ureter
TCC and endometriosis
Renal pelvis mass
TCC
Cadasil
Temporal lobe and external capsule high T2
Lewy body
Spares cingulate gyrus
