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FRCR 2A > GU/ Womens > Flashcards

GU/ Womens Flashcards

1
Q

Paeds renal

A

Nephroblastomastosis- persistent rests, hypointense T1/2 no nehancement, rind, can be plaque like/ nodule

Mesoblastic nephroma- tends to involve renal sinus, heterogenous, mimics a wilms

Multilocular nephroma- cystic mass, herniates into renal sinus

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2
Q

Nephrocalcinosis

A

-Hyperparathyroidism
MM
RTA
Medullary sponge kidney
Sarcoid
Hypothyroidism

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3
Q

Bosniak criteria

A

*Class 1: Simple

*Class 2: Nonenhancing (excludes thin septa/wall, which may enhance).
<4 septa with thickness ≤2 mm.
Proteinaceous/hemorrhagic cysts (nonenhancing, homogeneous, hyperattenuating ≥70 HU or intrinsically T1 hyperintense) ≤3 cm in size.

*Class 2F: Cystic mass violating any of the above rules but less than Category III falls here.
Note that Ca++ is no longer included, as this isolated feature has little predictive value.

*Class 3: Any enhancing thick (≥4 mm) septation/wall.
Any enhancing irregular protrusion with obtuse margins, ≤3
mm) septation/wall.

*Class 4: Any enhancing nodule (>15HU)

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4
Q

Renal trauma

A

I. Haematoma/contusion only
II. Haematoma and <1 cm laceration, no urine leak
III. >1 cm laceration, no urine leak*
IV. Cortex laceration and urine leak, vascular injury*
V. Shattered kidney, avulsed pedicle, main artery thrombosis*

> 3 managed surgically

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5
Q

Renal cancer

A
  • Clear cell (commonest)- avidly enhances, heterogenous, T2 hyperintense VHL
  • Papillary: hypovascular, low T1/T2
  • Chomrophobe: best prognosis- large + homogenous, seen in BHD
  • Oncocytoma: pseudocapsule, central scar
    > bilateral think Birt Hogge Dube
  • Renal medullary cancer: young men, sickle cell, ill-defined, infiltrative, hypovascular central renal mass. Necrosis and hemorrhage = common
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6
Q

MEN syndromes

A

MEN 1
‘PAN PAR PIT’
Pancreatic tumours
Parathyroid adenoma
Pituitary adenoma

MEN 2A
‘PARAMEDPHE’
Parathyroid adenoma
Medullary thyroid carcinoma Pheochromocytoma

MEN 2B
‘MPMPMC’
Medullary thyroid carcinoma Pheochromocytoma
Mucosal neuromas of GI tract
Prognathism
Marfanoid
Cutaneous neuromas

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7
Q

Urethral injury

A

ABOVE UG diaphragm> posterior urethra injury > contrast into retropubic space

BELOW> anterior urethra - contrast into perineum ie. in scrotum

Type II= DISRUPTION AT MEMBRANOUS PROSTATIC JUNCTION- above UG> Contrast in pelvis

Type III= Membranous urethra disrupted, extends to proximal bulbous, disruption at UG- contrast in PELVIS + PERINEUM

Straddle injury= anterior urethral injury
Blunt trauma +/- pelvic fractures = posterior

Post traumatic strictures = short. In straddle injury- bulbous urethra
Infectious strictures = long > distal bulbous

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8
Q

FMD

A

DISTAL renal arteries
Angioplasty when symptomatic

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9
Q

RAS

A

Arterial peak velocity >180cm/s
Parvus et tardus waveform DISTAL to stenosis
Atheroma: proximal renal arteries

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10
Q

Infantile haemangioendolethlioma

A

Early peripheral enhancement + delayed PV enhancement
calc/ central necrosis/ hemorrhage
AFP normal, endolethlial growth factor raised
Enlarged celiac artery, decreased caliber of aorta distally

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11
Q

Medullary sponge kidney

A

Tubular ectasia + calc
“Paintbrush strokes” / striated nephrogram
> leads to stasis/ stone formation
Assoc: Caroli disease

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12
Q

Causes of medullary nephrocalcinosis

A

Hyperparathyroidism
Acidosis (renal tubular type 1) Medullary sponge kidney

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13
Q

Pyeloureteritis cystica

A

Proximal third ureter and renal pelvis
Assoc: horseshoe kidney

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14
Q

Leukoplakia

A

Flat mass / focal thickening of renal pelvic or ureteral wall that may produce a characteristic corduroy appearance

PRE MALIGNANT
BLADDER > RENAL PELVIS > URETER, mural filling defects
Assoc: SCC if bladder involved

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15
Q

Malakoplakia

A

Middle aged women, chronic UTI (ecoli), IMmunocompromised
Multiple flat filling defects
Affects bladder +/- ureter

  • Diffuse bladder wall thickening*
    can manifest as mucosal mass
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16
Q

ATN features

A

3–4 days post op surgery **perioperative ischemia.
Normal perfusion, poor renal function
Increased cortical retention, delayed clearance and decreased urine excretion.

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17
Q

Acute rejection

A

Weeks - three months post op
Decreased perfusion and marked cortical retention.

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18
Q

Testicular seminoma

A

Commonest testicular tumour
Normal tumours markers
Homogenously hypoechoic
Increased risk if undescended testes
Raised bHCG, can have microcalc

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19
Q

Yolk sac tumour

A

Commonest mass in young boys
Heterogenous testicular mass
Raised AFP

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20
Q

Uterine choriocarcinoma

A

Most aggressive, hypervascular
Early mets brain and lung
Haemorrhagic
assoc: GTD

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21
Q

Non seminomatous GCT

A

> embryonal (yolk sac), teratoma, chorio, mixed type
20-30yo
Heterogenous, solid cystic + coarse calc

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22
Q

Sex cord tumours

A

Can look malignant
Leydig cell tumor > gynecomastia - estrogen, virilisation, precocious puberty
Sertoli cell tumor > Peutz-Jeghers and Klinefelter syndromes, can be bilateral, burnt out tumours

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23
Q

Papillary necrosis

A

echogenic material in collecting system- CLUB SHAPED, EGG IN CUP, lobster claw
Causes: pyelo, obstruction, sickle cell, TB, RVT, diabetes, analgesia

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24
Q

Percutaneous nephrostomy approach

A

Puncture of posterior calyces in mid/lower pole

If stenting then interpolar region

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25
Perirenal sapce content
Kidneys, proximal Ureters, Adrenals
26
Anterior pararenal space content
Pancreas, Duodenum, Ascending & Descending Colon
27
Testicular teratoma
<2yo - calc/ soft tissue Adults- heterogenous
28
Testicular lymphoma
males > 60yo Multiple hypoechoic vascular masses Unilateral, can be bilateral IMMUNOCOMPROMISED Testicular mets should spread to the para-aortic, aortic, caval region (N1-N3).
29
Urinary tract TB features
Multifocal stenoses in ureters thickened bladder + reflux Parenchymal calc / scarring > cavity formation Calcified mesenteric nodes Starts in kidneys, moves to bladder IVU: Beaded appearance + stirctures
30
Renal artery stenosis features
Velocity > 100cm/s Renogram: Decrease in total kidney function , delayed time to peak max activity, increased renal transit time F
31
Post kidney transplant collections
Urinoma= 2 weeks after Haematoma= immediately post op Lymphocele = 4-8 weeks after (photopenic) Photopenic areas
32
Multiple theca luteal cysts
Multilocular, spokewheel appearance Molar pregnancy, multiple pregnancies Gonotrophoblastic disease Infertility Increased bHCG
33
Renal oncocytoma
Central scar Homogenous enhancement Spokewheel vascularity scar US Flip flop enhancement of scar vs tumour Can look like RCC HOTTER THAN RENAL PARENCHYMA ON PET (CF RCC)
34
RCC Enhancement features
>Non con- 20-70HU > 20HU post contrast nephrographic phase (80-180 seconds) = most sensitive phase Enhance less than renal cortex initially
35
Delayed nephrogram
Slow enhancement Acute ureteral obstruction. Renal artery stenosis. Renal vein thrombosis/compression. Acute pyelonephritis.
36
Persistent nephrogram
Prolonged enhancement, delayed excretion
37
Bilateral persistent
Systemic hypotension. ATN Contrast nephropathy. Acute urate nephropathy. Proteinuria (e.g., myeloma kidney). Bilateral obstructive uropathy.
38
Unilateral striated nephrogram
Acute urinary obstruction (unilateral). Acute pyelonephritis. Renal infarct. Renal vein thrombosis or vasculitis. Renal contusion (typically focal). Acute radiation therapy. > NO ATN
39
Bilateral striated
Acute urinary obstruction (bilateral). Acute pyelonephritis. ATN Hypotension. ARPKD
40
Adrenal adenoma characterisation
Non con <10 hu RAPID WASHOUT >60% ABSOLUTE washout (delayed + PV + non con) >40% RELATIVE (delayed + PV) MRI - chemical shift/ india ink artefact
41
Bladder rupture
Extraperitoneal- pelvic fracture Intra - bladder dome
42
Male urethra segments
ANTERIOR= Penile + Bulbous POSTERIOR= Membranous + Prostatic
43
Urethral stricture location
BULBOUS urethra Gonorrhoea= long + irregular Post traumatic straddle injury = short
44
BPH
Transitional zone enlarges "fish hook" appearance of uteres
45
Schistomiasis
Grossly dilated ureters + tortuous + multiple filling defects + SMALL/ fibrosed bladder *predisposes to SCC* thin curvilinear calcs
46
Ovarian hyperstimulation
Post fertility rX, Theca luteal cyst + ascites + pleural effusion Enlarged ovaries, peripheral follicles
47
Prostatic utricle
Focal dilation PROSTATIC urethra- communicates with urethra Pear shaped, DOES NOT extend above base of prostate Assoc: hypospadias
48
Mullerian duct cyst
Teardrop shaped, EXTENDS ABOVE base of prostate DOES NOT COMMUNICATE WITH URETHRA
49
Corpus luteal cyst
Solid, hypoechoic, ring of fire, high diatolic flow
50
Ectopic pregnancy US
Looks like corpus luteal cyst RI <0.4 OR >0.7 Ampullary segment fallopian tube > tubal/ adnexla ring/ ill defined adnexal mass bHCG plateau
51
Dermoid cyst
FAT Solid- cystic mass, hyperechoic "tip of the iceburg"
52
Serous cystadenocarcinoma
COMMONEST, child bearing age UNILOCULAR, bilateral mixed solid cystic, more likely to have papillary projections
53
Mucinous cystadenocarcinoma
MULTILOCULATED + UNILATERAL OLDER Can be bright T1 as mucin filled Pseudomyxoma peritonei
54
Endometroid
Large complex cystic mass, can be bilateral, low T2 Assoc: endometrial hyperplasia, endometriosis
55
Granulosa theca tumour cell
Secrets estrogen> endometrial hyperplasia / cancer usually solid but can be solid-cystic LOW T2> dense stroma Juvenile form> precocious puberty, assoc: Ollier
56
Meigs syndrome
Ovarian fibroma + ascites + bilateral pleural effusion *fibroma- low t1/2 NON ENHANCING
57
Struma Ovarii
multilocular cystic mass LOW T2 contains thyroid tissue very low T2 signal in the “cystic” areas = thick colloid Intensely enhancing solid component
58
Breast curves
Type 1 = benign Types 2+3 = malignant
59
Malignant breast tumour
Hypoechoic halo Posterior shadowing
60
Retrocaval ureter
trapped behind IVC sharp turn medially at L3-4, then passes anterior to IVC > reverse J/ fishook
61
Intraductal papilloma
Round hypoechoic/ complex cystic mass within enlarged duct, discharge
62
Implant rupture
Intracapsular: linguine sign MRI Extracapsular: snowstorm
63
Juvenile Papillomatosis
Younger, <30 ILL DEFINED INHOMOGENOUS HYPOECHOIC MASS + SMALL PERIPHERAL CYSTS, dilated ducts located periphery of breast
64
PASH
hormonal influence US = round, oval, non calcified mass, well circumscribed, indisctinct, focal asymmetry MRI= high T2 signal slit-like spaces, cystic components
65
Radial scar
spiculated mass/ distortion, hypoechoic MRI= distortion + central lucency assoc: DCIS
66
Prostate CA
Peripheral zone Increased choline : citrate If Gleason <7 and PSA <10= prostatectomy + brachytherapy + external beam *Peripheral zone enhances more than central zone
67
Uretrocele
Cobra head on IVP, radiogenic halo Filling defect at trigone US= cystic mass
68
Adrenal mets
lung, breast, melanoma
69
Scrotal TB
diffusely enlarged hypoechoic testes or small hypoechoic nodules Or just orchitis
70
Gartner cyst
Paravaginal, anterolateral Skene cyst= paraurethral Bartholin = posterior to vagina *near bum
71
Mullerian duct anomalies
Bicornuate uterus- external fundal contour, there appears to be x2 uterine horns but not completely separated - one cervix= unicollis - two cervix= bicollis Dideplhys =- x2 uterine cavities, x2 cervices, x2 upper third vagina Septate= highest rate of reproductive failure (didelphys least)
72
Gestational trophoblastic disease
Theca luteal cysts COMPLETE MOLE- involves entire placenta US= echogenic, solid, highly vascular, snowstorm. can progress to chorio PARTIAL MOLE- foetus US: enlarged placenta, multiple diffuse anechoic lesions
73
Choriocarcinoma
INFILTRATIVE, highly vascular Rising bHCG 8-10 weeks following molar pregnancy RX= methotrexate
74
Placenta abnormalities
Previa: low lying, 2cm from os Accreta: loss of border between myometrium + placenta Increta: deeper invasion, can be into bladder
75
Endometrioma vs haemorrhagic cyst
Endometrioma= homogenous + low level echoes Haemorrhagic= lacey fishnet appearance
76
Nutcracker kidney
left sided loin pain + haematuria compression of left renal vein between aorta + SMA
77
Normal MIBG uptake
myocardium/ liver/ spleen/ bladder/ colon/ salivary glands/ nasopharynx/ thyroid Malignancy: neuroblastoma, carcinoid, paraganglioma, medullary thyroid, ganglioneuroma
78
Cervical cancer
IIA= upper 2/3 IIB= parametrial invasion 3 A= Involves lower third IV= bladder, rectum, mucosa
79
Peyronie disease
Plauq in tunica albuginea
80
TCC order of involvement
Bladder> renal pelvis > ureter
81
Duplicated renal system
Upper moiety OBSTRUCTS Lower moiety REFLUXES Drooping lily on IVU
82
Endometrial polyps
Hyperechoic +/- cystic spaces Feeding vessel MRI: fibrous core, enhances
83
Tumour thrombus vs clot
MRI with contrast
84
Pagets disease of nipple
DCIS in ducts
85
Ovarian torsion
Echogenic stroma Absent/ reversed diastolic flow Medialised Free fluid Peripheral follicles
86
Liposarcoma
<20yo Minimally FDG avid Atypical: large, enhancing nodular septa, thickened septa Dedifferentiated / Pleomorphic: Large mass with heterogeneous enhancement and usually central necrosis Myxoid liposarcoma = T2 bright
87
Pheochromocytoma
NO CALC Assoc: VHL, MEN 2, NF 1 ● Soft tissue adrenal mass, rapid, arterial phase homogeneous enhancement, prone to haemorrhage (heterogenous) +/- peripheral calcification MRI = Flow voids, INTENSE T2 MIBG Can be bilateral
88
Brenner tumour
Older woman Multi cystic mass No mets / invasion/ lymphadenopathy Calc = common, Fibrous = low T2
89
Retroperitoneal leiomyosarcoma
Woman Near IVC Big cystic component
90
Lithium nephropathy
Tiny kidneys + many cysts
91
HIV nephropathy
Bilateral, enlarged echogenic kidneys
92
Renal lymphoma (NHL)
Middle aged mne, IMMUNOCOMPROMISED Bilateral, low attenuation, renal contour preserved, vessel encasement, poor vascularity
93
Wolfman disease
Bilateral calcified adrenals + hepatosplenomegly
93
THECOMA/ FIBROTHECOMA
V similar to fibroid PMP Solid + hypoechoic, low T1/T2 with band of low T2 surrounding the tumour Oestrogen producing
94
Endometrial thickness + investigation
>11mm, no bleeding - work up <8mm, no bleeding- no work up >8mm on cyclical HRT + bleeding- repeat when off >5mm + bleeding - Work up **if on HRT, ET needs to be <8mm
95
Krukenberg
Bilateral, solid, well defined
96
Conns syndrome
Hyperfunctioning adrenal adenoma iNCREASED ALDOSTERONE> HTN
97
Oil cyst
Egg shell calc, lucent centre
98
Phyllodes tumour
Soft tissue, homogenous, rapdily increasing in size *HAEMATOGENOUS SPREAD
99
Endometriosis
Can get PTX at time of period +/- haemothorax
100
Indications for MRI Breast
Find primary Dense breast + high risk lesions BRCA +ve - annual mri Reponse to neo adjuvant chemo Suspected multifocal cancer Lobular
101
BPH
heterogenous T2 nodules in TRANSITIONAL zone IVP: J shaped, fishook, hockey stick shaped
102
What is a high PSA?
>4 >20= worrying
103
PIRADS
T2/ DWI/ enhancement PIRADS 3 - if enhances becomes a 4 (peripheral zone) PIRADS 2/3 - if has restricted diffusion gets upgrade (transitional zone) extraprostatic extension = PIRADS 5
104
Clinically signficant prostate cancer
PSA> 10, PSA density > 0.15 Tumour volume >0.5 Gleason score > 617 **T3 = extracapsular spread
105
Prostate cancer diagnosis + staging
Bone scan + gallium PSMA PET FDG PET if PSMA -VE with aggressive cancer or to assess response
106
Renal characterisation
Unenhanced Corticomedullary - 60 Nephrogram - 100
107
RCC mets
Lungs> mediastinum> bone > liver FDG PET used to assess response
108
Microlithiasis associations
Klinefelters Undescneded testes Infertility Granuloma Downs
109
Ovarian pathology with raised AFP
Immature teratomas Yolk sac tumours
110
RMI
Ovarian malignancy U X M X CA125 >ultrasound features x menopause > 200= HIGH RISK gynae and staging CT <25 LOW
111
Acute cortical necrosis
tramline calcfication commonest cuase = obstectric shock ARF secondary to placental abruption, infected abortion, eclampsia
112
Neuroblastoma
Heterogenous + calc + cystic areas Encases IVC, displaces kidney, extends across midline
113
Plasma cell mastitis
Dilated ducts >2mm uniform, linear, needle shaped calc
114
Rhabdoid tumoir
Agressive, <1 yo heterogenous mass, peripheral crescent shaped subcapsular fluid +/- brain mass (medullablastoma mimic)
115
Adrenocortical carcinoma associations
Hemihypertrophy Beckwith Wiedemann Astrocytoma Large, heterogenous, necrosis/ haemorrhage Cushing syndrome, hyperaldosteronism, virilization
116
Ovarian cyst follow up
PMP >7CM 2-6 or 6-12 Pre menopasual >5cm 3-6 or 6-12 2–6 months: Early follow-up if proper characterization desired. 6–12 months: To assess growth.
117
Galactocele
Egg shell peripheral calc CYSTIC OR SOLID/ CYSTIC Fat fluid level
117
Oligohydraminos
Renal anomalies IUGR PROM Severe growth restriction
118
Mucinous breast Ca
Posterior acoustic enhancement
119
Urachal remnant
Adenocarcinoma of bladder
120
Collision tumour
2 tumours in one adrenal mass
121
adrenal AML
Small punctate calc
122
Adrenal mets
lung> colorectal> breast> pancreatic hypervascular: think HCC/ RCC
123
Fibrocystic change breast
prominent fibroglandular tissue + cysts Tea in cup calc- horizontal view Changes with hormonal status- pregnancy, ovulation
124
Cervical cancer imaging characterisitic
High t2
125
Fibroids
Internal cystic / myxoid degeneration = high T2 signal Red (carneous) degeneration - hemorrhagic= T1 hyperintense. Pregnancy/ COCP
126
Bladder cancer
SCC- likes posterior wall TCC- COMMONEST Favours the base- inferior posterior RF: smoking, diverticulum, amines/ fumes
127
Previous breast cancer F/U
Annual mammo for 5 years or until age 50 (whatever comes LAST) *can consider MRI is dense breasts
128
Post breast cancer comp
Angiosarcoma
129
Silicone implant rupture
Intracapsular= stepladder sign Extracapsular= linguine sign snowstorm
130
PAN
affects medium-small sized renal vessels moth eaten nephrogram
131
Clear cell ovarian cancer
young unilocular, cystic mass + solid nodules Assoc: endometriosis
132
Gynaecomastia
Retroareolar Nodular, fan shaped, hypoechoic
133
Lobular breast cancer
Distortion, no mass MRI
134
Parathyroid adenomas
MIBI:increased activity on delayed images CF thyroid, no uptake of Tch99m US- well defined, oval, hypoechoic CT-hypodense to thyroid, early arterial enhamcenet > thyroid + quick washout, and washout more than thyroid in the delayed phase Large= heterogeneous enhancement, atypical enhancement patterns.
135
Dysgerminoma
Most common malignant GCT Young 20-30 Multilobulated solid mass + prominent fibrovascular septa
136
Causes of cortical nephrocalcinosis
Acute cortical necrosis Chronic glomerulonephritis Chronic rejection Alport > anaemia, polyuria and renal failure. Ocular abnormalities- congenital cataracts, nystagmus, myopia and spherophakia
137
Testicular chorio
* Seen 2nd decade. * Aggressive, highly vascular * High Mortality * Bleeding Mets * b-HCG elevated
138
High risk for breast cancer F/U
BRCA, TP53, Li fraumeni, radiation above diaphragm (eg HL) > 40 Annual Mammo + MRI, <40 just MRI
139
Breast hamartoma
- breast within breast - oval circumscribed heterogeneous echotexture lesion,echogenic pseudocapsule.
140
Best sequence for papillary cancer TCC/ bladder?
T1

FRCR 2A (6 decks)

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