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HeadNeckSpineCards > GU > Flashcards

GU Flashcards

1
Q

Mural bladder wall calcification?

A

Bladder stone.. TCC.. Cystitis.. Foreign body encrustation.. Amyloidosis.

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2
Q

Extrinsic displacement of bladder?

A

Pelvic hematoma and urinoma. Pelvic mass. Bladder diverticulum. Lymphadenopathy. Pelvic lipomatosis. Iliopsoas hypertrophy.

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3
Q

Intraperitoneal bladder rupture, CT characteristics?

A

Lateral pelivic recess (lateral paravesical recesses superior to bladder). Midline pouch of Douglas (posterior to bladder and anterior to rectosigmoid)

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4
Q

Extraperitoneal bladder rupture, CT characteristics?

A

Perivesical space (extends anterior and superior to bladder to level of umbilicus). Retrorectal or presacral space.

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5
Q

Ileal loop complications?

A

Early (obstruction or extravasation at ureteroileal anastomosis). Late (chronic pyelonephritis, nephrolithiasis, obstruction).

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6
Q

Filling defects in urethra?

A

Calculus. Polyp. Carcinoma. Condylomata acuminata. Polypoid urethritis. Malacoplakia. Urethritis cystica. Metastases. Amyloidosis.

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7
Q

Paraurethral outpouchings or tracts?

A

(Pseudo)diverticulum. Fistula. Cowper’s duct or gland. Glands of Littre. Mullerian remnants (utricle or Mullerian cyst).

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8
Q

Ovarian neoplasms, types and frequency?

A

Epithelial 65%. Germ cell 25%. Sex cord-stroma 5%. Secondary or metastatic 5%. Gonadoblastoma rare.

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9
Q

Epithelial ovarian tumors?

A

Serous. Mucinous. Endometrioid. Clear-cell. Brenn (rare).

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10
Q

Serous or Papillary epithelial ovarian tumors?

A

75% benign (large unilocular cyst). Malignant (solid masses, nodular walls, contrast enhancement).

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11
Q

Mucinous epithelial ovarian tumors?

A

95% benign (large multilocular cystic mass). Pseudomyxoma peritonei.

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12
Q

Ovarian dermoid cyst (mature cystic teratoma)

A

Primordial germ cell. Common in girls less than 15 yo. 15% bilateral. Torsion, trauma, infection, rupture. Sebaceous plug or tooth.

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13
Q

Metastases to ovary

A

Krukenberg tumors: Signet ring cells, mucinous ADCA from stomach or colon. Breast cancer. Lymphoma

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14
Q

Nonseminomatous germ cell tumors?

A

Embryonal cancer. Yolk sac cancer. Choriocarcinoma. Teratoma.

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15
Q

Bilateral, Entire ureteral dilatation without ureteral obstruction?

A

Bladder outlet obstruction. Prune-belly. Diabetes insipidus. Polydypsia. Primary megaureter.

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16
Q

Unilateral, entire ureteral dilatation without ureteral obstruction?

A

Vesicoureteral reflex (grades II-IV). Ectopic ureter inserting below bladder. Bacterial infection.

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17
Q

Ureteral dilatation of distal segment only without ureteral obstruction?

A

Primary megaureter. Vesicoureteral reflux (grade I).

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18
Q

Ureteral dilatation of proximal segment only without ureteral obstruction?

A

Retrocaval or retroiliac ureter. Enlarged urterus. Postpartum ectasia.

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19
Q

Malignant causes of ureteral narrowing?

A

Urothelial neoplasm. Local extension of extrinsic tumor. Distant metastasis. Lymphoma.

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20
Q

Infectious causes of ureteral narrowing?

A

TB. Schistosomiasis.

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21
Q

Inflammatory bowel disease causes of ureteral narrowing?

A

Regional enteritis. Diverticulitis. Appendicitis.

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22
Q

Gynecologic causes of ureteral narrowing?

A

Endometriosis.

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23
Q

Traumatic causes of ureteral narrowing?

A

Stone passage. Iatrogenic. Mechanical stone extraction. Ureterolithotomy. Radiation therapy.

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24
Q

TCC features?

A

2/3 papillary. 85% of urothelial neoplasms. 20% multifocal. Associations: aniline dyes, tobacco, analgesics, Balkan nephropathy.

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25
Q

Uncommon associations with retroperitoneal fibrosis?

A

Aortic aneurysm. Aortic graft. Retroperitoneal hemorrhage. Urinoma. Abscess. Metastases. Drugs. Bowel Disease.

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26
Q

CT signs of ureteral stone?

A

Homogeneous density in ureter lumen. Unilateral hydronephrosis. Hydroureter. Perirenal stranding. Nephromegaly. Loss of white renal pyramids. Kidney stones.

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27
Q

Intraluminal ureteral filling defects

A

Calculi. Blood clots. Sloughed papilla. Fungus ball. Mucopus. Air bubbles.

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28
Q

Mucosal ureteral filling defects?

A

Neoplasm. Edema. Leukoplakia.

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29
Q

Mural ureteral filling defect?

A

Ureteritis cystica. Hemorrhage. Malacoplakia. Endometreiosis. Schistosomiasis.

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30
Q

Common causes of focal filling defects of the bladder wall?

A

Neoplasm. Stone. Blood clot. Enlarged prostate.

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31
Q

Malignant bladder neoplasms?

A

TCC. SCC. Adenocarcinoma.

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32
Q

Benign bladder neoplasms?

A

Leiomyoma. Fibroepithelial polyp. Hemangioma. Pheochromocytoma. Adenoma.

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33
Q

Outpouchings of bladder wall?

A

Diverticulum and saccule (<5 mm). Cystocele. Herniation of bladder. Urachal diverticulum.

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34
Q

Bladder diverticula features?

A

Result from bladder neck or urethral obstruction. Congenital (Hutch diverticulum). Can cause ureteral obstruction or reflux. Urinary stasis may lead to stones or cystitis. 2% have carcinomas.

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35
Q

Features of xanthogranulomatous pyelonephritis?

A

Female predominance. History of UTIs. Nephrolithiasis. Renal enlargement. Renal hypofunction. Fractured calculus. Renal cysts. Extrarenal extension common.

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36
Q

Features of renal infarcts?

A

Wedge-shaped. Cortical rim sign. Usually multifocal. Progressive atrophy over time.

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37
Q

CT findings of pyelonephritis?

A

Renal enlargement. Multifocal wedge-shaped hetergeneous areas. Parenchymal striations.

38
Q

Differential of small scarred kidneys?

A

Unilateral: Reflux nephropathy. Previous renal surgery. Bilateral: Normal calyces (renal infarcts). Abnormal calyces (bilateral reflux nephropathy or analgesic nephropathy).

39
Q

In reflux nephropathy scarring first develops?

A

At renal poles.

40
Q

Differential of unilateral small smooth kidney?

A

Normal calyces: Renal artery stenosis. Chronic renal vein thrombosis. Renal hypoplasia. Subcapsular hematoma. Radiation therapy. Abnormal calyces: Postobstructive atrophy.

41
Q

Urographic signs of renal artery stenosis

A

Small smooth kidney. Delayed nephrogram. Delayed pyelogram. Hyperdense pyelogram. Ureteral notching.

42
Q

Causes of unilateral reniform enlargement?

A

Ureteral obstruction. Duplication anomalies and hypertophy. Parenchymal infiltration (pyelonephritis, XGP, contusion, infiltrating neoplasm). Edema (acute renal vein occlusion, acute arterial occlusion/arteritis).

43
Q

Causes of striated nephrogram?

A

Common: Acute ureteral obstruction. Pyelonephritis. Uncommon: ARPKD. Acute renal vein thrombosis. Renal contusion. Rare: Radiation nephritis.

44
Q

Common and uncommon causes of bilateral renal enlargement with masses?

A

Common: ADPCKD. Uncommon: Acquired renal cystic disease. Simple cysts. Lymphoma. Metastases. Wilm’s tumor.

45
Q

Causes of medullary nephrocalcinosis?

A

Common: Medullary sponge kidney. Hypercalcemia. RTA. Uncommon: Papillary necrosis. TB. Hyperoxaluria. Chronic furosemide use.

46
Q

Causes of cortical nephrocalcinosis?

A

Common: Chronic glumerulonephritis. Acute cortical necrosis. Uncommon: Hyperoxaluria. Rare: Alport’s syndrome. Chronic transplant rejection.

47
Q

General causes of renal failure?

A

Prerenal: Underperfusion. Renal: Diffuse parenchymal disease. Postrenal: Bladder outlet obstruction, Bilateral ureteral obstruction.

48
Q

Enlarged hyperechoic kidneys?

A

HIV nephropathy.

49
Q

2 types of renal sinus fat proliferation?

A

Renal sinus lipomatosis: increased fat with little mass effect. Replacement lipomatosis: renal atrophy, massive fat.

50
Q

Renal sinus cysts?

A

Peripelvic: multiple, small, insinuating. Parapelvic: typical simple renal cyst. Uriniferous: urine extravasation.

51
Q

Renal sinus neoplasms

A

Renal: RCC, AML, MLCN. Sinus: AML, teratoma, Lipoma/sarcoma, fibroma/sarcoma, neuroma/sarcoma, leiomyoma/sarcoma, malignant histiocytoma.

52
Q

Normal ureter course measurements and landmarks?

A

less than 1 cm lateral to transverse process.. Not medial to vertebral pedicle. Ureters separated by > 5 cm.

53
Q

Right adrenal gland is located posterior to the

A

Inferior vena cava (IVC) at the level where the IVC enters the liver.

54
Q

Radiographic abnormalities of Horseshoe kidney?

A

Renal nonrotation. Lower pole fusion. Low retroperitoneal position. Renal vascular anomalies

55
Q

Other urinary tract abnormalities associated with horseshoe kidney?

A

UPJ obstruction. Duplication anomalies. Stone formation. Pyeloureteritis cystica. Infection-based stone formation.

56
Q

Crossed fused ectopia?

A

One kidney crosses midline and fuses with the other. Ureters insert in the bladder in their normal position (crossed kidney’s ureter crosses midline).

57
Q

Radiographic findings of pelvoinfundibular MDK (Multicystic dysplastic kidney)?

A

Randomly distributed cysts. Noncommunicating cysts. Absent renal function. Atretic ureter.

58
Q

Radiographic findings of hydronephrotic MDK (multicystic dysplastic kidney)?

A

Dominant cyst in region of renal pelvis. Radially arrayed cysts may communicate. Minimal renal function possible. Ureter occluded at UPJ (ureteropelvic junction).

59
Q

Abnormalities with ARPKD (autosomal recessive polycystic kidney disease)?

A

Oligohydramnios. Nephromegaly. Hyperechoic kidneys. Renal failure inversely proportional to hepatic failure.

60
Q

MSK (Medullary sponge kidney associations?

A

Renal tubular ectasia. Nephrolithiasis. Medullary nephrocalcinosis. Caroli’s disease. Ehler’s-Danlos syndrome.

61
Q

Multilocular cystic nephroma associations?

A

Benign cystic neoplasm. Young boys (1st decade). Adult women (3rd and 4th decades). Herniation of parenchymal mass into renal pelvis

62
Q

Bosniak CT classification of cystic renal masses?

A

Class I: simple cysts, nonoperative. Class II: septated, minimal calcium, nonenhancing high-density cyst, infected cyst, nonoperative. Class III: multiloculated, hemorrhagic, dense calcium, non-enhancing solid component, renal-sparing surgery. Class IV: marginal irregularity, enhancing solid component, radical nephrectomy.

63
Q

RCC: IVU features?

A

Expansile mass. calyceal displacement, compression. Ureteral notching. Diminished function, if renal vein occluded.

64
Q

RCC: CT, MR features?

A

Approximately spherical shape. Fails criteria for simple cyst. Lacks internal fat (AML). Enhances.

65
Q

Other abnormalities that present with renal agenesis?

A

Absent ipsilateral ureter. Absent ipsilateral hemitrigone. Absent ipsilateral vas deferens. Ipsilateral seminal vesicle cyst. Unicornuate uterus. Abnormal bowel gas pattern.

66
Q

Nonrotated verus malrotated kidney?

A

Nonrotated: anterior positioned UPJ (Ureteropelvic junction). Malrotated (over-rotated): posterior positioned UPJ.

67
Q

Calyceal diverticulum, details?

A

Intraparenchymal cavity lined with transitional epithelium that communicates with collecting system. Type 1 communicates with minor calyx. Type 2 communicates with infundibulum. Type 3 communicates with renal pelvis.

68
Q

Mesoblastic nephroma, details?

A

Benign neoplasm. Hamartoma of the kidney. Diagnosed in children under 2. Mimic malignant neoplasms (Wilm’s).

69
Q

Nephroblastomatosis associations?

A

Increased risk of Wilm’s tumor (multiple and bilateral). Young patients with renal enlargement and multiple subcapsular masses.. Primitive renal tissue that persists beyond 36 wks gestation.

70
Q

Organs within anterior pararenal space of retroperitoneum?

A

Pancreas. Retroperitoneal colon (right and left). Duodenum.

71
Q

Organs within posterior pararenal space of retroperitoneum?

A

None.

72
Q

Organs within perirenal space of retroperitoneum?

A

Kidney. Adrenal gland. Collecting system. Renal and perirenal vasculature. Renal and perirenal lymphatics.

73
Q

Solitary expansile renal masses?

A

Common: Cyst, RCC. Uncommon: AML, abscess, mets. Rare: Oncocytoma, MLCN, Localized renal cystic dz, Focal xanthogranumomatous pyelonephritis.

74
Q

Other areas of interest in abdominal imaging in RCC?

A

Contralateral kidney. Renal vein. Vena cava. Regional lymph nodes. Ipsilateral adrenal gland. Adjacent organs. Liver. Skeleton.

75
Q

Features of oncocytoma?

A

Males 6th or 7th decade. Solid expansile mass. Iso-heteroechoic at US. Homogeneous enhancement CT. Pseudocapsule. Central scar in larger lesions. Spoke wheel angiographic pattern.

76
Q

Features of multilocular cystic nephroma?

A

50% males less than 3 yo. 50% females > 40 yo. Expansile, multiloculated cystic renal mass. Herniation into collecting system. Enhancing septa at CT. Absent hemorrhage. Hypo-or avascular at angiography.

77
Q

Features of renal abscess?

A

Evidence of infection. Hypoechoic with less through transmission than cyst. Thick wall, rim enhancement CT. Perinephrich inflammatory changes. Neovascularity in wall on angiogram.

78
Q

Features of xanthogranulomatous pyelonephritis?

A

Middle-aged females with UTIs. Focal hypofunctioning renal mass. Infection-based stones.

79
Q

Features of renal lymphoma?

A

Usually with systemic lymphoma. Usually bilateral. Multifocal, diffuse, or focal. Hypoechoic without through-transmission. Often with massive lymphadenopathy.

80
Q

Features of angiomyolipoma?

A

80% in adults (females). 4th-5th decade. 20% in tuberous sclerosis. Well-defined hyperechoic mass. Fat, even small amounts, diagnostic with CT. Neovascularity with aneurysm on angiography. Unlikely to bleed if less than 4 cm.

81
Q

von Hippel-Lindau disease?

A

40% RCC. 75% simple renal cysts. Hemangioblastomas CNS. Retinal angiomas. Pancreatic cysts. Pancreatic neoplasms. 50-80% Pheochromocytomas (multiple, bilateral, extraadrenal).

82
Q

Tuberous sclerosis features?

A

Renal cystic disease. 80% AMLs. Cerebral hamartomas. Cardiac rhabdomyomas(sarcomas). Skeletel osteomas. Pulmonary lymphangioleiomyomatosis.

83
Q

Infiltrative renal neoplasms?

A

TCC. SCC. Infiltrative RCC. Renal medullary carcinoma. Renal lymphoma.

84
Q

Distinctions of GU SCC versus TCC?

A

SCC more aggressive. Fast-growing. 50% SCC have coexistent renal calculus.

85
Q

Renal medullary carcinoma

A

Patients less than 40 yo. Sickle cell trait > disease. Poor prognosis, < 4 months.

86
Q

Weigert-Meyer rule?

A

Duplication anomaly. Upper moiety ureter inserts inferior and medial to normal (lower moiety) bladder insertion.

87
Q

Medial deviation of upper ureter?

A

Lower-pole renal mass. Lateral retroperitoneal mass. Psoas hypertrophy. Retroperitoneal fibrosis. Retrocaval ureter.

88
Q

Medial deviation of lower ureter?

A

Lymphadenopathy. Pelvic lipomatosis. Iliopsoas hypertrophy. Pelvis mass/fluid collection. Iliac vessel ectasia. Abdominopelvic resection. Cystocele.

89
Q

Lateral deviation of upper ureter?

A

Malrotated or horseshoe kidney. Lymphadenopathy. Psoas hypertrophy. AAA. Retroperitoneal mass/fluid. Ureter mobilization surgery.

90
Q

Lower ureter lateral deviation?

A

Central pelvic mass/fluid collection. Sciatic ureteral hernia.

91
Q

Retrocaval ureter: urography findings?

A

Right ureter. Abrupt medial deviation. Course medial to pedicle. Fish-hook shape. Hydronephrosis.

92
Q

Pelvic lipomatosis features?

A

Young African male. Bilateral hydronephrosis. EXtrinsic bladder compression. tear-drop bladder .

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