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Radiology > GU and breast > Flashcards

GU and breast Flashcards

1
Q

Actinomycosis (pelvic)

A

Opportunistic infection resulting mucosal breach following IUCD, trauma or recent surgery.

Imaging features:

  • Fat stranding
  • Intraperitoneal free fluid
  • Tubo-ovarian abscess
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2
Q

Adenomyosis

A

MRI:

  • Increased thickness (>12mm) of junctional zone with high T2 foci.
  • Enlargement or globular shape of uterus.

US:

  • Heterogenously increased echotexture with JZ and myometrila cysts

HSG:

  • Outpouchings of contrast in to wall
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3
Q

Adult polycystic kidney disease

A
  • 30-50 yo
  • AD
  • No increased risk of malignancy
  • Assoc. w/ Hepatic cysts, intracranial berry aneurysms, pancreatic and splenic cysts.
  • IVP - Swiss chees appearance
  • Cysts have variable MR characteristics.
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4
Q

Asherman’s disease

A

Intra-uterine adhesions formed as a result of previous trauma, D&C and infection. Can affect fertility.

HSG - irregular linear filling defects.

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5
Q

Birt-Hogg-Dube

A

Lung:

  • Multiple cysts and spontaneous pneumothorax

Skin:

  • angiofibromas,
  • perifollicular fibromas
  • acrochordons
  • fibrofolliculomas

Renal:

  • Chromophobe RCC
  • Oncocytoma
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6
Q

Bladder rupture classification

A
  1. Bladder contusion
  2. Intraperitoneal rupture
  3. Interstitial bladder injury
  4. a) Simple extraperitoneal rupture b) Complex EPR
  5. Combined bladder injury
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7
Q

Bosniak

A

I:

  • low attenuation, hairline wall with nor septations or calcifications.

II:

  • Paper-thin septations
  • May contain thin or short segement thick calcification in the wall or septa.
  • Hyperattenuating cysts

IIF:

  • Multiple hairline septa that do not enhance
  • Can contain thick irregular calcification
  • hyperattenuating cysts that are larger than 3cm
  • CT or MR follow-up at 6 montsh and then yearly for 5 years.

III

  • Multiloculated cyctic nephroma
  • Complex septated cysts with heavy calcification
  • Radiologicially indisiguishable from cystic RCC therefore surgerically removed.

IV:

  • Large ehnacing soft tissue component with irregular margins and enhancement.
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8
Q

Breast implants.

A

Foramation of a fibrous capsule occurs. ruptures can be intracapular or extracupsular.

Intracapsular:

  • Linguini sign on MR

Extracapsular & Intracapsular:

  • Snow storm node
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9
Q

Breast papilloma

A

Most common cause of bloody nipple discharge

Early menopausal women

Solitary dilated duct in the subareolar region

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10
Q

Brenner Tumour

A

AKA transitional cell tumour

Rare and usually benign

Solid fibrous tumour assoc. w/ ipsilateral cystadenoma or cytic teratoma

Low T2 and T1

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11
Q

Clear cell carcinoma

A

Over 45

Mailgnant transformation of endometriomas

BIG >6cm

Enhancing mural nodules

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12
Q

Contraindications to HSG

A

Active uterine bleeding/menses

Active infection

Pregnancy

Uterine surgery on the past 3 days

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13
Q

Contraindications to UAE

A
  • Pelvic infection
  • History of pelvic radiation
  • Connective tissue disease
  • Asymptomatic fibroids
  • Pregnancy
  • Pedunculated fibroids
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14
Q

Corpus Luteum Cyst (CLC)

A

Residual follicle following ovulation.

CLC results from failed resorption of bleeding in to the cyst.

If fertilised the CLC becomes CLC of pregancy and can continue to grow til 8-10 weeks - shoudl resolve by 16 weeks.

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15
Q

DCIS

A

Early form of breast Ca

Hitology: camedo type is more aggressive than non-comedo.

Pagets disease = high-grade DCIS

US: microlobulated mildly hypoechoic mass with ductal extension and normal acoustic transmisson.

Mammo: Fine linear branching or fine pleomorphic calc.

MRI: non-mass-like enhancement

Galactography: multiple intraductal masses.

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16
Q

Diethylstibestrol (DES) expesure

A

T-shaped uterus

Uterine hypoplasia

Increased risk of clear cell cancer of the vagina

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17
Q

Dygerminoma

A

30 yo

Similar to seminoma of the testes and pineal germinomas

Radiosensitive and good survival outcome.

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18
Q

Ectopic ureter

A

Female with UTI, hydromephrosis and incontinence.

Majority of ectopic ureters emby into the post sphincteric urethra > vagina > tubes > perineum.

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19
Q

Endometrioma

A

Rounded homogenous mass with low level echoes and increased through transmission.

T1 bright - will not fat sat - T2 dark - ‘shading sign’

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20
Q

Endometroid ovarian cancer

A

Second most common ovarian cancer

Assoc w/ concomitant endometrial cancer (25%)

Malignant transformation of endometriomas

15% bilateral

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21
Q

Fibroadenoma

A

Well defined lobulated mass.

Popcorn calcification

US - well defined and hypoechoic

MRI - T1 hypo - T2 hyper - enhances

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22
Q

Fibrothecoma

A

PM women

Ovarian stomal tumour

Assoc w/ endometrial hyperplasia and Meigs syndrome if larger than 5cm

Assoc w/ fibromatosis - causing omental fibrosis and sclerosis peritonitis (Dark T1 and T2 ‘ black garland sign’)

Iso T1 and Low T2

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23
Q

Germ cell tumour

A

Teratoma = Any tissue (dermoid plug or Rokintansky nodule can be premalignant)

Dermoid = Hair, teeth, sebaceous gland

Epidermoid = Only epidermis and secretes watery fluid.

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24
Q

Granulosa cell tumour

A

Oestrogen active tumour

assoc. w/endrometrial hyperplasia/polyp/carcinoma

Adult form more common - Px w irregular bleeding

Juvenile form (rare) - Px w pseudoprecocious puberty

MR: Solid-cystic with haemorrhagic components

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25
Q

Indications for breast MRI

A
  1. High risk screening
  2. Preoperative assessment
  3. Evaluation of recurrence or residual tumour post surgery
  4. Response to therapy
  5. Evaluation of post-op scar vs recurrence
  6. Implant integrity.
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26
Q

Invasive Ductal Ca

A

Most common breast Ca

Hard, non-mobile, painless lump.

Inx - irregular high density mass with spiculate/indistinct margines and pleomorphic calc. Mass with echogenic halo on US

Subtypes:

  • NOS - most common (65%)
  • Tubular
  • Mucinous - Uncommon round/lobulated and circumscribed mass with good outcomes.
  • Medullary
  • Papillary
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27
Q

Invasive Lobular Carcinoma

A
  • Second most common breast Ca after IDC-NOS (5-10%)
  • Presents later than IDC in and Older population.
  • Uncommon to met to axilla - prefers stuff like peritoneal surfaces
  • Mammo:
    • architectural distortion withouth a central mass “dark star”
    • “shrinking breast” - non compressible breast
  • US - Shadowing without a mass
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28
Q

Krukenberg’s

A

Ovarian mets from stomach or colon Ca. Typically bilateral complex masses.

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29
Q

Leukoplakia

A

Haematuria, white plaques - premalignant for SCC

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30
Q

Malakoplakia

A

Rare inflammatory comdition affecting the bladder

Yellow-Brown subeithelial plaques

Cobblestone appearance on IVP.

Occur in immunocomprimised, DM etc. NOT premalignant.

31
Q

Malignant types of calcification in breast.

A
  • Amorphous
  • Coarse, heterogenous and irregular
  • Fine pleomorphic
  • Fine linear/branching (ductal)
32
Q

Mallerian duct cyst vs. Prostatic utricle cyst

A

Mullerian duct cyst

Prostatic utricle cyst

Age

20-40

0-20

Shape

Teardrop

Pear

Extends above prostate

Yes

No

Communicates with prostatic urethra

No

Yes

33
Q

Mayer-Rokitanksy-Kuster-Hauser syndrome

A
  • Dysgenesis of the mullerian ducts
  • Vaginal or uterine agenesis
  • Normal sex characteristics and karyoptype
  • Renal abnormalities
  • Normal ovaries in typical type. Ov and FT can be abnormal in atypical type.
34
Q

Medullary Breast Carcinoma

A
  • Sub-type of IDC
  • 40-50yo
  • 25% have BRCA1
  • Very large at time of discovery.
  • Round circumscribed mass w/ no calc - just soft tissue mass on mamm
  • US - Posterior acoustic enhancement
35
Q

Meigs Syndrome

A

Classically ovarian fiboma related ascites and pleural effusion. But can be seen with other ovarian tumours.

36
Q

MEN I

A
  • Pituitary adenoma
  • Parathyroid adenoma
  • Pancreatic islet cell tumour
37
Q

MEN 2b

A
  • Marfanoid habitus with course facial features
  • Medullary thyroid carcinoma
  • Pheochromocytoma
  • Oral ganglioneuroma
38
Q

MEN IIa

A
  • Medullary thyroid carcinoma
  • Pheochromocytoma
  • Parathyroid adenoma
39
Q

Mets to breast (in order)

A
  1. melanoma
  2. sarcoma
  3. lymphoma
  4. lung ca
  5. gastric
40
Q

Myelolipoma

A

Rare benign tumour composed of adipose and haematopoietic tissue.

Inx:

  • Obvioud fat mass
  • May enhance
  • 20% have calcification
41
Q

Ovarian cancer

A

Premenopausal ovarian volume >18cm^3 and PM >8cm^3. Large cyst (>5cm)

Doppler RI <0.4 with pleak velocity >25cm/s

Mucinous or cyst adenocarcinoma (most common)

Complex cystic mass.

  • Stage 1 Limited to ovary
  • Stage 2 Both ovaries +/- Ascites
  • Stage 3 Intraperitoneal mets
  • Stage 4 Extra peritioneal mets

Endrometroid carcinoma

Germ cell tumour

  • Dysgerminoma
  • Embyonal cell
  • Choriocarcinoma
  • Teratoma
  • Yolk sac tumour

Sex chord-stromal tumour

  • Granulosa cell
  • Sertoli-Leydig tumour
  • Thecoma and fibroma

Mets

  • Uterine
  • Stomach/colon
  • Lymphoma
42
Q

Dermoid (ovarian)

A

20-30yo

‘tip of the iceberg sign’ - absorption of most of the US beam at the top of the lesion.

cystic mass with a hyperechoic soild mural nodule. (Rokitansky nodule)

MRI: T1 bright - Will fatsat out - T2 bright

1% malignant - become squamous cell Ca. (RF = BIG and >50yo)

43
Q

Ovarian vein syndrome

A

Ureteral notching as result of thrombus in the gonadal veins.

Usually assoc w/ pregnancy.

Right gonadal vein - crosses ureter - IVC

Left gonadal vein - crosses ureter - left renal vein

44
Q

Papillary breast carcinoma.

A
  • Rare subtype of IDC
  • Complex cystic solid mass
  • Elderly
45
Q

Papillary necrosis

A

Ischaemic damage to the medulla and does not tend to involve the cortex.

Appearance:

  • clubbed calyces
  • Calcification
  • sloughing of necrotic papilla.
  • altered renal contour
  • lobster claw and signet ring sign

Causes:

  • analgesia
  • diabetes
  • pyelonephritis
  • renal vein thrombosis
  • sickle cell.
46
Q

Paraovarian cysts

A

Embryological remnant of the broad ligament.

Can have cyclical changes, tort or rupture.

Can only be diagnosed if ipsilateral ovary is shown to be separate.

47
Q

PCOS

A

Px: Stein-Leventhal syndrome - Oligomenorrhea, hirsutism & obesity. Increase LH, LH/FSH ratio and androgens.

Imaging:

  • Bilaterally enlarged kidneys (similar size)
  • >12 follicles not bigger than 1cm
  • Peripheral location of cysts with central hyperechoic fibrous tissue
48
Q

PET in the menstural cycle

A

1st week to avoid false positive.

Should not be positive post menaupause.

49
Q

Peyronie Disease

A

Calcified plaques in both corpora cavernosa

Ix:

US

  • calcified peripheral plaques
  • thickened septum between corpora cavenosa

MR - above pluse DWI to demonstrate inflammation (place saline bags over dick to prevent susceptibility artefact)

50
Q

Pheochromocytoma

A

Paraganglioma arising from the adrenal medulla.

Functional tumours secrete catecholamines (adrenaline/noradrenaline/dopamine)

10% extradrenal (most commonly at organ of zuckerland near the aortic bifurcation)

10% bilateral

10% are malignant.

Assoc w/ MEN 2, NF1 and VHL.

Inx:

  • MR: T2 lightbulb
  • MIBG scintigraphy
  • Octeotride scintigraphy
51
Q

Phyllodes Tumour

A
  • Rare encapsulated fibroepithelial tumour. Resembles fibroadenoma.
  • Rapidly growing
  • 40-50yo
  • Can met to pleura.
52
Q

Radial scar

A

High-risk lesion and needs to come out - Assoc. w/ DCIS, IDC and tubular carcinoma

Not an actual scar - just fibrous tissue around ducts which gives the impression of architectural distortion.

53
Q

Renal SCC

A
  • 5% of renal pelvis tumours
  • Assoc w/ Leukoplakia, chronic irritation from schistosomiasis or nephrolithiasis
54
Q

Renal-retinal dyplasia

A

Recessive disease of mudullary custic disease and retinitis pigmentosa.

55
Q

Reninoma

A

Small hypvascular mass

Px: HTN, Hypernatraemia and hypokalaemia.

56
Q

Risk factors for breat cancer

A
  1. Age
  2. Fhx
  3. Early menarche
  4. Late meopause
  5. Late first pregnancy
  6. Nulliparity
57
Q

Salpingitis Isthmica Nodosa (SIN)

A

Diverticula-like invaginations into the myosalpinx.

Associated with previous PID

Increased risk of ectopic pregnancy.

58
Q

Schistosomiasis

A

S. Japonicum eggs in the urinary tract cause sever granulomatous reaction.

Inflammatory polyposis (bilharziomas)

Extensive Calcification ___ Can lead to SCC

59
Q

Serous Ovarian / cystadenocarcinoma

A

Most common ovaria malignancy (75% benign or borderline - 25% malignant)

Women of child bearing age.

Unilocular cystic with septations. Pappilary projections

60
Q

Sertoli-Leydig

A

<30 yo

Androgen secreting tumours associated with virilisation

Unilateral - 15% malignant

61
Q

Stages of RCC

A
62
Q

TB GU

A

Renal>Ureteral>Bladder>Seminal vesicles.

Commonly unilateral.

  • Variable paranchymal calcification.
  • Pappillary necrosis
  • Tyberuloma
  • Parenchymal scarring.
  • Infundibular stenosis leading to amplutated calyx
  • Corckscrew ureter
  • Renal pelvis stenosis
  • Narrow, rigid and aperistaltic segments of the ureter.
63
Q

Testicular tumours

A

Germinoma (95%)

  • seminoma (40%) - radio sensitive with a good prognosis - age 40-60 assoc. w/ crypotorchidism
  • embyonal carcinoma (10%) - aggressive seminoma with bad prognosis
  • choriocarcinoma (1%) - very aggressive
  • teratoma (10%) - 10-20yo with good prognosis
  • mixed

Sex-cord stromal tumours

  • Leydig cell - endochronogically active and benign

Mets

  • prostate
  • kidney
  • lymphoma
  • leukaemia

Epidermoid - benign with classical onion skin on US

64
Q

Theca Lutein Cysts

A

Develop in conditions with elevated b-HCG.

  • Molar pregnancy
  • Choriocarcinoma
  • Rh incompatibility
  • Twins
  • Ovarian hyperstimulation syndrome

MRI:

  • Can be MASSIVE (20cm)
  • Usually bilateral and multi-locular
  • Solid components show intense enhancement
  • Intermediate T2; High DWI.
65
Q

Transplant kidney

A

Functional assessment = Resistive index should be <0.7 (Psys - Pdia/Psys)

ATN: most common reversible renal failure - 24 hours post transplant. Seen as a persistent dense nephrogram on CT. -Normal flow but reduced extretion.

Rejection:

  • RI >0.7
  • Increased renal size
  • Thickened hypo-echoic cortex
  • Large pyramids
  • Loss of CMJ
66
Q

Traumatic kidney injury grades

A
67
Q

Tubular Breast Carcinoma

A
  • Subt-type of IDC
  • Rare and slow growing
  • Small/slow growing
  • Assoc. w/ radial scar
  • Contralateral breact Ca 10-15%
  • Mammographically indistinguishable from other cancers with spiculated margins
68
Q

Unterine MR signal intensities

A
  • Endometrium, high SI
  • Junctional zone (inner layer of compact myometrium), low SI
  • Myometrium, intermediate SI
  • Cervical stroma, low SI
  • Serosal covering, low SI
69
Q

Urachal adenocarcinoma

A

Antero-superior dome of the bladder in the midline

70% calcify

90% are adenocarcinoma

70
Q

Uraemic cystic disease

A

End stage renal disease and dialysis patients.

Increased incidence of RCC and haemorrhagic cysts

71
Q

Waterhouse-Friderichsen syndrome

A

Adrenal haemorrhage secondary sepsis (DIC)

72
Q

Yolk sac tumour

A

<20 yo

Raised AFP

Rare and highly malignant

73
Q

Struma Ovarii

A

Subtype of ovarain teratoma

Multilocular cystic mass - T2 dark ‘cystic’ areas due to colloid - intense enhancement.

Actually contain thyroid tissue and can present as a thyroid storm.

Radiology (6 decks)

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