GU DDx Flashcards
Adrenal Mass:
Adrenal Adenoma
- Circumscribed small (<2cm)oval homogenous low density mass
- < 10HU highly specific.
- Signal drop out on out of phase -> lipid rich.
- Lipid poor: absolute washout > 60%, relative washout > 40%.
Metastases (lung breast kidney melanoma)
Haemorrhage
Pheochromocytoma
- Well circumscribed 3-5cm mass
- MEN IIA or MEN IIB
- Neurofibromatosis
- VHL
- Carney syndrome
- Tuberous sclerosis
- Hyperintense T2, heterogenous bright C+
Adrenal myeloipoma
- T1 hyperintense
- Focal areas fat suppression
Adrenal TB
- Chronic: Addisons disease
- Small Ca++ glands
Adrenal carcinoma:
- non functional large lesions.
- May have necrosis, haemorrhage, Ca++
Adrenal collision tumour
Adrenal hyperplasia:
- Normal shape with increased thickness, or nodular.
Hypoechoic adrenal mass:
Adenoma Metastases Pheochromocytoma Adrenal haemorrhage Adrenal cortical carcinoma Adrenal pyogenic infection (unilateral) Granulomatous infection (bilateral)
Cystic adrenal Mass:
Simple cyst Abscess Organising haematoma Mimics: renal cyst, liver cyst, pancreatic cyst, splenic artery pseudoaneursym. Cystic adenoma Cystic neuroblastoma Cystic pheochromocytoma
Hyper echoic adrenal mass:
Adrenal haemorrhage Calcification: - Previous haemorrhage - Previous infection - Calcified neoplasm (neuroblastoma, myelolipoma, pheochromocytoma) - Wolman disease Myelolipoma Neuroblastoma Adrenal cortical carcinoma Pheochromocytoma.
Bilateral adrenal enlargement:
Adenoma Mets Haemorrhage / infarction Adrenal hyperplasia Pheochromocytoma Infection: TB, Histoplasmosis, granulomatous disease. Lymphoma
Medullary nephrocalcinosis:
"HAM HOP" H: hyperparathyroidism A: (renal tubular) acidosis M: medullary sponge kidney H: hypercalcaemia/hypercalciuria O: oxalosis P: papillary necrosis
Hyper PTH
- Clusters round Ca++ renal pyramids
Renal tubular acidosis (distal type)
Medullary sponge kidney
- Tiny calculi disapear with contrast
- Delayed CECT show renal pyramid blush
- unilateral less dense medullary nephrocalcinosis.
- Assocations: ehlers danlos, Carolis, Beckwith Weidemann.
Hyper calcaemia
Oxalosis:
- Dense Ca++ cortex +/- medulla.
- Normal sized kidneys
- Skeletal hyperdensity.
Papillary necrosis
Chronic Pyelonephritis:
- Punctate or focal Ca++ in cortex and medulla.
- Cortical thinning over dilated calyces.
- Kidneys small in size and function.
TB:
- Focal or diffuse amophous Ca++.
Child - frusemide treatment.
Cortical nephrocalcinosis: “COAG”
C: cortical necrosis
O: oxalosis
A: Alport syndrome
G: (chronic) glomerulonephritis
Acute cortical necrosis Hyperoxaluria Alport syndrome ARPCKD Transplant rejection Chronic GN
Echogenic kidneys:
Medical renal disease
- Diabetic nephropathy
- Glomerulosclerosis
- Actube tubular necrosis.
- HIV nephropathy: enlarged echogenic
Echogenic renal Mass:
Angiomyolipoma: shadowing echogenic mass specific.
Atypical malignant renal neoplasm.
Renal calculus
Intra renal gas
Milk of Calcium
Sloughed papillae due to papillary necrosis.
Renal Sinus Lesion DDX:
Sinus lipomastosis
Renal Sinus Cyst:
- Peripelvis: multiple confluent non communicating, surround and compress calyces.
- Parapelvic: solitary, spherical.
Renal Pelvis clot / haematoma
Vascular lesions:
- Aneurysm
- AVM
- Varices
TCC
Lymphoma
RCC
Gas around Kidney DDX:
Emphysematous pyelonephritis Renal abscess Emphysematous pyelitis Renal infarction Instrumentation
Radiolucent filling defect renal pelvis DDX:
Urolithiasis Blood clot Fungus ball TCC: - irregular filling defects, amputates calyces. Renal Papillary necrosis: - Sloughed papilla with cavitation of calyx. - CLub shaped calyces - Analgesic abuse.
Gas within Baldder DDX:
Iatrogenic
Bladder fistula
Cystits
Emphysematous cystitis
Filling defect in urinary bladder DDX:
Bladder carcinoma:
- mass protruding into lumen, enhances
- Cant completely exclude on imaging alone
Bladder calculi
Ureterocele:
- Orthoptopic, cobra head
Blood Clot
BPH
- J shaped ureters
Bladder fistula
Extra vesical pelvic mass.
Fungus ball: Candida.
Cystic Retroperitoneal Mass:
Retroperitoneal seroma Retroperitoneal Sarcoma: - mixoid liposarcoma can have water density Retroperitoneal lymphocele Urinoma Retroperitoneal Abscess Lymphangioma
Fat Containing Retroperitoneal Mass:
Liposarcoma:
- Large fat and soft tissue components
- Compresses and displaces retro-peritoneal organs.
- Invasion uncommmon
- Liposarcoma is less vascular than AML
Renal AML:
- Benign hamartoma of blood vessels, muscle, fat.
- AML will replace part of kidney / claw sign.
Adrenal myelolipoma:
- Fat and soft tissue components +/- Ca++
Teratomas: Met
AIDS: liodystrophy:
- Proliferation of retroperitoneal and mesenteric fat in response to AIDs medication.
Retroperitoneal lipoma:
- Less heterogenous than lipsarcoma.
Hyperechoic Renal Mass DDX:
Angiomyolipoma:
- Well defined hyperechoic mass that is equal to renal sinus
- May have posterior shadowing
- Small lesions echogenicity > RCC
- Large lesion: prominent vascularity
- May have central necrosis
- Requires CT.
RCC:
- 30% hyperechoic
- Necrosis or anechoic rim favours RCC
- Large RCC may have Ca++
- Mass with Ca++ and fat in adult = RCC
Wilms tumour:
- CHild
Fat in renal scar
Milk of Ca++ cyst:
- COmet tail artifact
Renal Calculi:
Renal Papillary Necrosis:
- Echogenic ring in medulla = Necrotic Papilla, surounded by rim of fluid.
Abscess with Gas.
Renal Mets
Renal TB:
- Papillary destruction with echogenic masses near calyces
- Ca++ granuloma or dense dystrophic Ca++ with shrunken kidney.
Renal oncocytoma
Renal Trauma.
Infiltrative Renal Lesion DDX:
Replaces renal parenchyma without distorting shape. Lacks sharp border of demarcation.
Pyelonephritis:
- Enlarged kidney, striated / wedge foci of reduced C+
TCC
Mets / lymphoma
- Multiple poorly defined renal masses
RCC:
- usually expansile, rarely diffusley infiltrative.
Renal medullary carcinoma:
- Young patient with sickle cell
HIV nephropathy
Renal TB.
Peri renal and subcapsular mass DDX:
Haemorrhage: - trauma, coagulopathic, tumour (AML / RCC), vasculitis. Renal Mets / lymphoma Abscess Xanthogranulomatous pyelonephritis urinoma Retroperitoneal fibrosis
Bilteral Renal Cysts:
ADPCKD:
- Progressively enlarged kidneys, loose function
- Cysts in liver, pancreas, seminal vesicles.
Acquired cystic disease uraemia:
- Dialysis -> increases risk of RCC.
VHL:
- cysts and tumours of kidney adrenal, pancreas, brain, spinal cord (haemangioblastomas)
Tuberous sclerosis:
- hamartomas brain, lung, heart, skin, kidneys
Medullary cystic Disease:
- Small kidneys with cysts in medulla, thinned cortex.
- Progressive renal faliure and anaemia in young patient.
