GU/renal/breast Flashcards
1
Q
Kidneys:
* What type of organ?
* What do you see on IVU?
* What is the modality of choice in most GU imaging?
A
-Kidneys are retroperitoneal
-Normal IVU (intravenous urogram) on KUB excretory phase and horseshoe kidney on CT
CT with contrast is the diagnostic modality of choice in most GU imaging.
2
Q
what structures are 1,2,3,4,5
A
1: Right kidney ; 2: Left kidney ; 3: Ascending colon ; 4: Descending colon ; 5 : Abdominal Aorta.
3
Q
explain this
A
normal renal-Highlighted renal cortex
4
Q
What are the different renal diseases?
A
Renal cysts
Nephroureterolithiasis
Polycystic renal disease
Pyelonephritis
Renal masses
5
Q
What is the study of choice of renal disease?
A
CT abdomen and Pelvis with and without IV contrast (few exceptions) is the study of choice
6
Q
Renal Parenchymal Disease:
* What does it involve?
* Could start with what imaging? BUT what is the study of choice?
A
-Involves Cortex and Medulla
-AKA medical renal disease involving glomeruli, interstitium, tubules, and small blood vessels of the kidneys.
-Could always startwith US but CT with and without contrast is the study of choice
-Image depicts ARF
7
Q
what is this?
A
Renal Parenchymal Disease
* Bolus-enhanced CT at the portal vein phase reveals almost no early renal parenchymal enhancement; normally there would be dense cortical enhancement.
* Really gray=chronic issues aka fibrosis, vascular, renal failure
8
Q
What is this?
A
renal cyst
9
Q
what is this?
A
renal cyst
10
Q
how are renal cyst classified on the Bosniak scales?
A
simple: benign, round, thin-walled, homogenous, fluid-filled cyst w/o septation or calcification
complex: any cyst that is not simple
complicated: cysts that have ruptured, bled, or become infected. simple and complex can be complicated
11
Q
Polycystic kidney disease may have a similar appearance to what? What do you need to do?
A
May have similar appearance to
malignancy
* Need to do biopsy
12
Q
what is this
A
polycystic kidney disease
13
Q
what is the gold standard imaging for polycystic kidney disease?
A
CT abd/pel with and without contrast
14
Q
what can be see on CT with polycystic kidney disease? (5)
A
bilateral enlarged kidneys, numerous cysts of varying sizes, thin or distored renal parenchyma, corticomedullary differentiation lost, cyst may enhance with contrast if complicated
15
Q
What is this?
What does it appear similar to?
A
-Pyelonephritis
-Appears similar to renal cell carcinoma or renal lymphoma-> systemic issues like weight loss
16
Q
what is acute pyelonephritis (APN)?
A
bacterial infection of the renal parenchyma, can lead to renal edema, abscesses and necrosis
17
Q
what are Classic CT Findings of Acute Pyelonephritis (APN)?
A
Patchy or Striated Hypoattenuation (Corticomedullary phase) → Wedge-shaped or linear regions of decreased enhancement due to ischemia & edema.
Kidney Enlargement → Swelling with loss of corticomedullary differentiation.
Perinephric Fat Stranding → Hazy/streaky increased attenuation around the kidney (inflammatory spread).
Renal Fascia Thickening → Gerota’s fascia thickened due to fluid accumulation.
Delayed Excretion (Excretory phase) → Poor contrast excretion, worse with obstruction (e.g., stone, stricture).
18
Q
what is the gold standard for renal disease?
A
CT abdomen/pelvis with IV contrast (pyelonephritis, obstructive uropathy)
19
Q
what is this?
what is the gold standard diagnostic imaging?
what is the imaging for staging?
A
Right: Arteriography in a patient with renal cell carcinoma. Vasculature to kidney and tumor.-> left side, notes how vascular it is
-GOLD= CT
-MRI for staging
20
Q
what is this?
what is the gold standard for renal trauma?
A
CT scan of a fractured left kidney. no laceration, but reveals blood in the perirenal space, surrounding the kidney.
-CT Abdomen/Pelvis with IV Contrast (Multiphasic Study)
21
Q
what are the phases for renal trauma ct abd/pel with iv contrast multiphasic study (4)
A
-Non-Contrast Phase
-Corticomedullary Phase (Arterial Phase, ~30-40 sec post-contrast)
-Nephrographic Phase (Venous Phase, ~80-100 sec post-contrast)
-Excretory Phase (Delayed Phase, ~5-10 min post-contrast)
22
Q
what is this
A
laceration of the kidney
23
Q
what is this?
A
laceration of the kidney
24
Q
Nephroureterolithiasis
* What is the choice of study for kidney stones?
* What is the rule of thumb for stone that will pass?
* 10% of uretherolithiasis will cause no what?
*when should you consider contrast
* When should you consider US?
A
gold=ct abd/pel without contrast
25
what is this
Nephroureterolithiasis
26
What does the curved and straight arrow show?
what is the gold standard?
-Enlargement of the right adrenal gland (straight arrow) due to the presence of an adrenocortical tumor, an aldosteronoma. The curved arrow points to the only left adrenal gland, which is normal in size.
-CtT abdomen with IV contrast (adrenal protocol), ct or mri can be suitable
27
Adrenal Gland Imaging:
* What do you need to consider and check if adrenal lesions are present and unexplained HTN ?
-Consider pheochromocytoma if adrenal lesions and unexplained HTN – check vanillylmandelic
acid levels (radiotracer injection and delayed imaging)
28
Hematuria:
* What does the patient need?
* What are the pre-renal, renal and post renal cause?
* What do you need to consider and why?
-Patients with gross or microscopic hematuria need thorough workup.
-Identify typical pre-renal, renal and post-renal causes
– Pre-renal: Vascular trauma, septicemia, purpura hemorrhagica, hemophilia (vagina smells putried homie hoe)
– Renal: renal infarct/embolism, Acute GN, RCC, ATN, and pyelonephritis (RARA P)
– Post-renal: fistula, cystitis, urolithiasis, and malignancy (F CUM)
-Always consider smoking history because it will increase bladder cancer
inside () for me to remember lol
29
What are the different GU studies? (5)
Intravenous pyelogram (IVP)
Retrograde urethrogram (RUG)
Retrograde cystogram
Voiding cystourethrogram (VCUG)
CT urography
30
what type of imaging is this?
what is this?
Intravenous pyelogram-> x-ray timed intervals with contrast injected in veins to see the kidneys and bladder
* Normal IVP, but possible phlebolith, appendicolith
* On right, mass or hypertrophy of prostate can elevate the floor of bladder.
31
what type of imaging is this?
IVP
32
what is a CT Urogram?
what is it a gold standard for evaluating?
-A CT Urogram (CTU) is a high-resolution CT scan of the urinary tract performed with IV contrast to evaluate the kidneys, ureters, and bladder.
-THIS IS THE gold standard for evaluating hematuria, urinary tract malignancies, and urothelial abnormalities.
33
what are the three phases for CTU?
-Non-contrast phase – Detects kidney stones or calcifications.
-Nephrographic phase (Post-contrast, ~100 seconds) – Evaluates renal parenchyma for masses, infections, or trauma.
-Excretory phase (Delayed, ~5-10 minutes) – Visualizes contrast in the renal collecting system, ureters, and bladder, making it the best test for urothelial tumors or obstruction
34
CT urography:
* Can be ordered when?
* What will the ct have?
-Can be ordered before any other tests to globally screen patient for renal and nonrenal abnormalities and explain symptoms (hematuria etc.)
-CT will have higher resolution and identify problems not found on Urography
35
what is a retrograde urethrogram (RUG)?
how does it work?
-fluroscopic x-ray to evaluate the urethra
-It involves injecting contrast dye retrograde (against normal urine flow) into the urethra through the meatus while capturing real time X-ray images
36
what is the gold standard for diagnosing urethral injuries, strictures, and fistulas?
RUG
37
what evaluates the anterior urethra?
RUG
38
What is this?
Bladder imaging-retrograde urethrogram showing prostatic hypertrophy
* note the constriction of urethra
39
what is this?
Retrograde urethrogram in a case of urethral trauma demonstrates near-complete disruption of the proximal bulbous urethra (white arrow)
40
what is a retrograde cystogram?
what does it evaluate?
what is the gold standard for dx?
-a fluoroscopic X-ray study of the bladder that involves instilling contrast directly into the bladder via a catheter
-evaluate for bladder rupture, leaks, or structural abnormalities.
-It is the gold standard for diagnosing bladder rupture, ct cystography can be used with full bladder
41
what is being shown here?
Retrograde cystogram showing multiple radiolucencies within the bladder, outlined by contrast material. These represent a nodular carcinoma in a pediatric patient.
42
what is voiding cystourethrogram (vcug)?
how does it work?
when are fluoroscopy pictures taken?
- fluoroscopic X-ray study that evaluates the bladder and urethra during filling and voiding.
- Patient is catheterized to instill bladder with contrast and later told to urinate to evaluate function while under fluoroscopy.
-during bladder filling and emptying to assess for abnormalities, reflux, or obstruction
43
what is the gold standard for diagnosing vesicoureteral reflux (vur) in children?
VCUG
44
what is vcug used to evalute?
lower urinary tract dysfunction, recurrent UTIs, and urethral anomalies
45
what evaluates the posterior urethra?
vcug
46
what does this show?
vcug
47
what is shown in the image?
Cystocele
* Bladder herniation/diverticulum
* Voiding CystoUrethrogram (VCUG) shows with straining, the patient voids while revealing the bladder floor relaxes allowing the bladder base (*) to extend 2 cm below the pubic symphysis (dotted line). This is a cystocele anatomically resulting in stress urinary incontenince.
Cystocele=risk factor for UTI
48
what is shown on this image?
vcug+rug of one of the patients, showing a bulbar stricture.
49
Which study involves injection of contrast locally (not intravenously) to evaluate for urologic abnormalities in a male patient?
1. Pelvic Ultrasound
2. Voiding Cystourethrogram
3. CT abdomen and pelvis with contrast
4. Intravenous Pyelogram
2. Voiding Cystourethrogram
50
Female pelvis radiology:
* What is the primary imaging method for the female pelvis?
* Transabdominal pelvic ultrasound is performed using what?
* Transvaginal pelvic ultrasound uses what?
51
What type of US is used when the patients bladder is full and used as an acoustic window?
What US helps see if a pt is having an ectopic pregnancy?
Transabdominal
Tranvag-> bladder should be empty
52
why is transvaginal ultrasound (tvus) the gold standard? (4)
-High-resolution imaging → Best for ovarian cysts, masses, fibroids, ectopic pregnancy
-Dynamic evaluation → Real-time Doppler for torsion/malignancy
-No radiation → Preferred for reproductive-age & pregnancy cases
-Cost-effective & widely available → First-line for gynecologic complaints
53
when should tvus not be used?
Child patient
Pregnancy concerns → Ruptured membrane, placenta previa
Vaginal obstruction
Recent vaginal surgery
Lack of consent
Imperforate hymen
Vaginitis → Discomfort risk
Vaginal atrophy
54
What type of US are these two?
55
what is a transabdominal ultrasound used to diagnose?
used to diagnose ovarian torsion, a gynecological emergency that requires early treatment to prevent loss of the ovary
56
US:
* What is hypoechoic? What are examples?
* What is hyperechoic? what are examples?
57
what imaging shows flow to ovary?
duplex US, included for torsion r/o
58
what do each of these US show?
Endometrioma (bottom) vs functional cyst (top). Note no blood flow within endometrioma, therefore it is not a solid mass.
59
what does this image show?
torsion of the left ovary
60
what is endometriosis and 3 types?
Chronic gynecologic condition with functional endometrial tissue outside the uterus
Three types:
Superficial (peritoneal) disease
Ovarian disease (endometriomas)
Deep endometriosis
61
what is the first line imaging modality for endometriosis?
what is the gold standard for deep infiltrating endometriosis?
what does endometriosis show as on imaging?
-Transvaginal ultrasound (TVUS) is the first-line imaging modality but has limitations in detecting peritoneal implants.
-MRI is gold standard if tvus is inconclusive
-Well-defined, thick-walled cysts with homogeneous low-level internal echoes ("ground-glass" appearance) due to old blood)
62
Female Pelvis:
* What are different conditions what can be diagnosed with US?
* Overian masses may be what?
A wide variety of benign pelvic conditions can be diagnosed with ultrasound including ovarian cysts, pelvic inflammatory disease, endometriosis, and benign tumors of the uterus (leiomyomas), and ovaries (cystadenomas, cystic teratomas)
Ovarian masses may be cystic, solid, or complex.
63
What imaging is this? What does it show?
Transabdominal ultrasound showing a benign left ovarian cyst.
64
what should be ordered if patient has inconclusive findings on transvaginal or trans abdominal ultrasound, or if you are concerned about further intra-abdominal pathology?
A CT abdoman pelvis with contrast can be ordered.
65
What does this US show?
What imaging will show flow to the ovary? What do we need to look at blood flow?
CT of large ovarian cyst
Only Duplex US will show flow to the ovary
Include it for torsion r/o (with any cyst greater than 5cm)
If greater than 7cm, you need a -MRI because of malignancy
66
What do these images show?
67
What does this show?
what is used to diagnose the presence and monitor growth?
what imaging can be used for surgical prep and better define lesions?
How are small ones and large ones handled?
68
What imaging is helpful in the staging of pelvic malignancies in female?
What should be preferred if US is not definitive?
-CT and MRI can also produce excellent images of the female pelvis, and are helpful in the staging of pelvic malignancies
-MRI should be preferred if US is not definitive
69
what does this show?
Normal CT pelvis. Arrow indicates vaginal vault
70
Hysterosalpingogram (HSG):
* what is a hysterosalpingogram?
*how is this imaging done?
* What will normal exam show?
*what is this an excellent tool for?
Image is normal-> after one year of trying for baby, do this because chalymia infection can cause scarring of FT
71
What does this show?
What it be seen in?
72
what is sonohysterography and what does it evaluate?
how does it work and what other imaging is used with it?
73
what does this show?
Hydrosalpinx- amount of fluid in FT-> can be dt STD (clam or gon mc)
74
Obstetrical Imaging:
* What is used during pregnancy and why?
* With ultrasound’s real-time motion images, you can observe what?
-Ultrasound during pregnancy can accurately date the pregnancy, detect multiple pregnancies, monitor fetal growth, and assess fetal well-being
-With ultrasound’s real-time motion images, you can observe fetal cardiac motion and fetal movements
75
when are you able to see the gestational sac, yolk sac, fetal pole, and cardiac activity
-Gestational Sac (GS) → First visible structure
TVUS: 4.5–5 weeks | TAUS: 5–6 weeks
-Yolk Sac → First structure within GS
TVUS: 5–5.5 weeks | TAUS: 5.5–6 weeks
-Fetal Pole (Embryo): TVUS 5.5–6 weeks
-Cardiac Activity: TVUS 6–6.5 weeks | TAUS 6.5–7 weeks
76
patient comes in with + pregnancy test, what does this show?
Transabdominal ultrasound (see bladder) of the normal gestational sac at six weeks
77
how many weeks?
Transvaginal ultrasound of a 12-week-old fetus.
78
What is this showing the US? What does it usually present with? What type is + and what is a risk factor?
mass structure inside tube
79
Postmenopausal Bleeding:
* Differential almost always includes what?
* What is the initial study of choice?
* What can MRI help with?
* What does the image show?
-Differential almost always includes malignancy
-Ultrasound is the initial study of choice
-MRI can help stage the malignancy or if US is inconclusive
-Image depicts endometrial cancer
80
What is the endometriumal thickness for pre and postmenopausal women?
> 15mm in premenopausal
> 5mm in postmenopausal women (thinner because you do not need lining for baby)
81
Men’s Imaging:
* What is the imaging of choice for scrotal ? why?
Ultrasound is the imaging method of choice for scrotal imaging because of its general availability, low cost, high accuracy, and utilization of nonionizing radiation.
82
Men’s Imaging:
* US can identify what?
* Indications of US are what?
* What is MRI used for?
-Ultrasound can identify inguinal hernias, testicular tumors,testicular torsion (Duplex), testicular trauma, hydrocele and manyother conditions
-Indications of US are acute testicular pain, a palpable mass or scrotal swelling
-MRI is a diagnostic alternative in evaluation of cancer
83
What does this US show?
Ultrasound of infarction of the right testis (nectroic so dark). More echolucent than left testicle.
Presence of blood flow does not rule out testicular torsion
84
how can the prostate be evaluated?
using IVP (can show prostatic hypertrophy), ultrasound, or CT
85
You are seeing a 16yo sexually active male with complaints of RLQ abdominal pain radiating to right scrotum. No prior surgical history is reported. What study will be most important to order to screen for potential issues considering patients age?
1. CT abdomen and Pelvis with IV and Oral Contrast
2. CT abdomen and Pelvis without contrast
3. KUB
4. Ultrasound of scrotum and testes
Ultrasound of scrotum and testes
86
Mammography:
* What is the leading cause of non-preventable cancer death in women?
* Mammography can detect what?
* Mammography cannot rule out what though?
-Breast cancer is the leading cause of non-preventable cancer death in women
-Mammography can detect the presence of early breast cancer at the non-palpable stage
-Mammography cannot rule out breast cancer in a patient with a palpable mass or other abnormality on clinical
examination (mammography can rule in cancer, but it cannot rule it out)
87
Mammography:
* Screening mammograph is performed when?
* Diagnostic mammography (problem- solving mammography) is performed when?
* When should mammogram be done?
-Screening mammography is performed on asymptomatic women to detect unsuspecting cancer at an early age
-Diagnostic mammography (problem-solving mammography) is performed to evaluate abnormal clinical findings
-general agreement that all women over the age of 50 should have biennially screening mammograms(some sources say over 40).
88
what can mammography rule in or out?
Mammography can only rule IN the possibility of breast cancer. Biopsy is needed to fully rule out breast cancer.
89
Mammography is the modality of choice in who?
Ultrasound is the imaging modality of choice for who?
Women aged 30-39 could what?
90
What is negative predictive value?
Negative predictive value of combined mammography and sonographyin patients with focal/ diffuse breast pain but without highly suspicious exam findings is nearly 100%.
-Takeaway: In mammography +/- US, NPV is very high (~99%), meaning a negative mammogram result is very reliable for “ruling out” cancer. However, a false negative can still occur, especially in women with dense breasts
91
Highly suspicious exam findings warrants what? (breast mammography)
Highly suspiciousexam findings warrant biopsy regardless of what the imaging shows
* Skin tethering, Peau d’ orange, nipple inversion, axilla lymphadenitis
92
What are the two views of mammogram?
What can cause problems with mammography and what are the special imaging techniques?
What is the kvp and mAs levels for mammograms?
93
What do these images show?
94
what does this show?
A sample mammography exam with the right breast assessed with BI-RADS 5, density B and the left breast with BI-RADS 1, density B. CC denotes craniocaudal and MLO denotes mediolateral oblique.
95
Tomosynthesis (3D Mammography)
* What procedure is whis?
* While traditional MMG takes pictures of the breast from two angles — up and down, and left and right — tomosynthesis takes the image how?
* What is the benefit? (2)
96
Which one is the mammogram and tomosynthesis? What does the imaging show?
97
What are the breast cancer risk factors?
An overweight women with history or BC that had her period for 40 years without any children
98
What does this imaging show? What do you need to do with the more dense breast tissue?
More dense breast should be evaluated with US.
99
What are the structures of the boob on mammogram?
100
BIRADS: (Breast Imaging Reporting andData System)defines five type of margins, what are they ⭐️
-Circumscribed: Circumscribed margins are well defined and sharply demarcated with an abrupt transition between the lesion and the surrounding tissue.
-Obscured: Obscured margins are hidden by superimposed or adjacent normal tissue
-Micro-lobulated: Microlobulatedmargins have small undulating circles along the edge of the mass
-Ill-defined: Ill-defined margins are poorly defined and scattered.
-Spiculate: Spiculatedmargins are marked by radiating thin lines.
101
What is needed for additional imaging? Which ones need biopsy and determined after biopsy?
102
for BIRADS what is 1,2,3,4,5,6
103
What does this show?
A spiculated, dense mass especially when not palpated is
almost always carcinoma.
104
Value of Ultrasound when you are seeing a middle aged female with breat pain? What can be the diagnosis?
105
what are red flags that warrant biopsy during ultrasound for breast cancer?
106
what is this?
Skin Calcifications
* Skin calcifications have a typical lucent center and polygonal shape. Although skin calcifications are not in the breast parenchyma, they may project as such on a mammogram.
107
what is this?
Vascular Calcifications
* Vascular calcifications can be seen as parallel tracks or linear tubular calcifications that run along a blood vessel.
108
What is this? What disease is it found in?
Coarse or Popcorn-like Calcifications
* These calcifications are typically found in involuting
fibroadenomas. Fibroadenomas usually regress with menopause and microcalcifications will develop into coarse macrocacifications.
109
What does this show? What can they be from from?
needle shaped
110
what does this show?
111
What does this show? (+associated with?)
112
what do these show?
Benign– breast pain Hx - well defined and circumscribed on left.
On right – asymptomatic breast – malignant due to spiculation
113
Breast Specific Gamma Imaging:
* How does this techique work?
* Who is it used for?
* High or low rad?
114
Breast Specific Gamma Imaging
* What will metabolic imaging show?
* better tolerated than what?
* What is the sensitivity and specificity?
-Metabolic imaging will show hypermetabolic uptake of t-99
– Better tolerated than MRI, less expensive
– Sensitivity is equal, specificity is increased compared to MRI
115
What do these images show?
116
What type of image is this? What is the downside?
MRI can result in more biopsies
117
MRI Breast:
* Should be done on who?
* What is done first?
* MRI may be miss what?
118
What does this show?
119
what do these show
normal MRI
120
What is the diagnostic study of choice for a palpable breast mass in a 23yo female?
1. Mammogram
2. Ultrasound
3. MRI
4. CT
US
