GU Flashcards
name 2 nuclear tests performed for f/u reflux:
RCN
DMSA
What is the Weigert–Meyer rule re duplex PC system
there is an increased risk of obstruction (in the upper pole moiety) and reflux (in the lower pole moiety)
Where does the upper pole insert?
the upper pole ureter inserts ectopically (inferomedially) into the bladder and is prone to obstruction,
Where does the lower pole insert?
The lower pole ureter inserts orthotopically (normally) but is prone to reflux.
Ddx of Drooping lily sign on VCUG
- Renal ptosis, which would be expected to show a normal number of calyces.
- obstructed upper pole of the drooping lily has fewer calyces.
Seen in some patients with a duplicated collecting system. It refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed (and unopacified) upper pole moiety.
The similarity to a lily is further strengthened by the small number of calyces the lower pole moiety has
Tx for PUJ obstruction
Pyeloplasty
How to differentiate bwn PUJ obstruction and prominent extra renal pelvis
Whitaker test - Urodynamic study with integrate pyelogram
Abrupt calibre change bwn dilated posterior urethra and normal calibre anterior urethra on VCUG
Posterior urethral valves
MRI shows hydro in the kidney and a key hole in the bladder
Posterior urethral valves
Most Common cause of hydronephrosis in fetus is PUJ Obstruction
BUZZWORD: Perirenal fluid collection
Posterior urethral valves
Non specific, can b seen in obstructive picture.
main differential for posterior urethral valve
prune belly syndrome, which would show dilation of the ENTIRE ureter rather than only the prostatic portion
Prune belly triad:
- Crappy abdominal musculature. 2. Hydroureteronephrosis 3. Cryptorchidism- bladder distention interferes with descent of testes
What is the diagnosis?
focal dilation of the distal ureter within the bladder wall, where the ureter infolds between the mucosal and muscular layers of the bladder wall.
Ureterocele
Cobra head sign: contrast surrounded by a lucent rim protruding from the contrast filled bladder
Ureterocoele
The ureterocoele is associated with….
Duplicated system- specially the upper pole
MCDK
- No functioning renal tissue
- Contralateral renal tract abnormalities 50% of the time
TS (4)
- Renal cysts
- Renal angiomyolipomas.
- Cardiac rhabdomyoma.
- CNS cortical hamartomas, subependymal nodules, and subependymal giant cell astrocytoma.
VHL (5)
- Renal cysts
- Renal cell carcinoma (RCC): Up to 30% of VHL patients die from RCC.
- Adrenal pheochromocytoma.
- Pancreatic cysts, islet cell tumors, and serous cystadenomas.
- Brain and spinal cord hemangioblastomas.
BUZZWORD: Protrudes into renal pelvis
Multilocular cystic nephroma
What is the diagnosis?
Bilateral enlarged and diffusely echogenic kidneys with loss of CM differentiation- No urine in the bladder in utero
ARPKD
Liver findings in ARPKD
Abnormal bile ducts and fibrosis.
RF for Wilm’s tumour (4)
- Beckwith–Wiedemann syndrome (hemihypertrophy, macroglossia, omphalocele, neonatal hypoglycemia (due to insulin overproduction by pancreatic β-cells), and increased risk of childhood malignancies, including Wilms tumor and hepatoblastoma).
- WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and mental retardation).
- Horseshoe kidney: Approximately 2x incidence of Wilms tumor.
- Trisomy 18.
What is the diagnosis?
heterogeneous, solid renal mass. The claw sign indicates renal parenchyma origin. Tumor venous extension is seen in 5–10%.
Calcifications may be present.
Wilm’s tumour
Ddx multilocular cystic nephroma.
cystic Wilm’s tumour
Bilateral Wilm’s tumour
They had nephroblastomatosus in 99%
Hypodense rind , homogenous mass, with no necrosis
Nephroblastomatosis
Beckwith Weidemann
Wilms
Omphalocele
Hepatoblastoma
What is the diagnosis?
Wilms
Omphalocele
Hepatoblastoma
Beckwith Weidemann
Primary malignancies with potential metastases to kidneys(3)
- Neuroblastoma
- Leukaemia
- Lymphoma
Similar to Wilm’s tumour in younger children < 1 year old
Mesoblastic nephroma
Multiple AMLs are associated with….
TS
What is the lesion?
suprarenal mass, with calcifications seen in ~50%.
adrenal neuroblastoma
Neuroblastoma vs Wilm’s tumour
Neuroblastoma tends to encase vessels, while Wilms tumor is known to displace vessels.
MRI findings of neuroblastoma
On MRI, neuroblastoma often:
- invades into neural foramina and the spinal canal.
- Diffusion is often restricted, reflecting hypercellularity.
NM test for adrenal neuroblastoma
I-123 MIBG scintigraphy
same test used for phaeo, carcinoid
A classic presentation of metastatic neuroblastoma
intracranial, subdural mass originating from the marrow
Neuroblastoma vs ganglioneuroma
- In contrast to neuroblastoma, ganglioneuroma affects slightly older children (most common age of a ganglioneuroma patient is 6 years old)
- only 50% of ganglioneuromas are positive on I-123 MIBG scintigraphy.
- MRI classically shows restricted diffusion of a neuroblastoma, but not in ganglioneuroma.
What is the lesion?
ultrasound: a hypoechoic, avascular, suprarenal mass. Hemorrhage may appear similar to neuroblastoma on initial ultrasound, but a follow-up scan would demonstrate involution.
Adrenal haemorrhage
Name 2 conditions associated with adrenal cortical carcinoma
- Beckwith–Wiedemann and
- Li–Fraumeni syndromes
Risk of which type of cancer with urachus remnant?
Adenocarcinoma
What is the lesion?
Imaging features a characteristic lobulated, bunch of grapes appearance.
Rhabdomyosarcoma
What is the lesion?
…….. is usually apparent on prenatal imaging. When detected after birth the characteristic clinical appearance is a skin-covered mass extending from the midline buttocks. It has a heterogeneous imaging appearance with cystic, solid, and fatty components.
Sacrococcygeal teratoma
Horseshoe kidneys increase the risk of which malignancies?
- TCC
- Wilm’s
- Renal carcinoid
Renal artery thrombosis
secondary to ….
What does is cause?
secondary to umbilical artery catheter.
Does not cause enlargement but causes severe HTN.
renal masses in neonates
- Nephroblastomatosis
- Mesoblastic nephroma- hamartoma (polyhydramnios)§
patients is too young to have wilms tumour, what is the diagnosis?
Mesoblastic nephroma
bilateral wilms
Nephroblastomatosis
I say Beckwith Weidemann, you say….
- Wilms
- Omphalocele
- Hepatoblastoma
paratesticular mass with lung and bone metastases
rhabdomyosarcoma
AFP is usually elevated in this testicular tumour
Yolk sac tumour (non seminoma)
