Imaging Flashcards
if pyelonephritis is suspected, what investigation should be done
US
- to exclude ureteric obstruction
Then Contrast-CT
if a gynaecological disease is suspected, what investigation should be done
US
- to visualise uterine, ovarian and uterine tubal pathology
when is an US (or MRI) done instead of a CT
patient is pregnant
- avoid radiation exposure to foetus
Renal colic Ix
1st - Non contrast CT
2nd - KUB x-ray
If CT contraindicated then MRI
what is the normal ureter course
Pass inferiorly over the psoas muscles
Descend anterior to the tips of the lumbar transverse processes
Cross the iliac bifurcation and enter the pelvis
Pass posteromedially and enter the posterior aspect of the bladder
where do ureteric calculi often get stuck at
pelviureteric junction (PUJ) pelvic brim vesicoureteric junction (VUJ)
what are the flaws in KUB x-ray
lacks specificity
- phleboliths, lymph nodes, uretine fibroids and arterial calcification are also shown
what are phleboliths
calcification within a vein
- of no clinical importance
what is the definitive test to confirm SYMPTOMATIC ureteric calculus
Non-contrast enhanced CT
when is CT avoided
In pregnant females
if possible, non-preganant young females
contrast induced nephropathy
how can renal colic be followed up
by using the simplest test that showed the calculus at presentation
what is the aim in macroscopic haematuria investigation
to examine the whole urinary tract by simplest means possible
Ix of frank haematuria in the over 50s
1 - CT urography (CTU)
2 - Cystoscopy
what does the CTU look at
the kidneys, collecting systems and ureters
what does the cystoscopy examine
the bladder and urethra
what is the CTU technique
First CT scan before contrast
Administration of IV contrast (wait 15 mins)
Top up dose of IV contrast
Second CT scan
what can be seen in the first CT scan before contrast
renal or ureteric calculi
what can be seen in the second CT scan with contrast
renal parenchymal tumours
urothelial tumours of the collecting systems or ureters
what is an advantage of finding a tumour on a CT scan with contrast
any tumour detected can be staged at the same time
Ix of the under 50s with macroscopic haematuria
US of kidneys to detect calculi and renal parenchymal tumours
Cystoscopy to look for occasional bladder TCC, bladder calculi, other bladder tumours or evidence of urethritis/prostatitis
when is a CTU done in under 50s with macroscopic haematuria
only when US and cystoscopy are normal and macroscopic haematuria persists
when is MR urography useful
as it does not require contrast or radiation, useful in patients who have;
- contrast allergy
- renal impairment
- pregnancy
when is MR urography used
when CTU contra-indicated
how are most renal masses detected
incidentally when imaging for another reason
when is a renal mass not investigated
when it is
what is used to assess a large renal mass
CT scan
what are benign masses containing fat and blood vessels
angiomyolipomas
how are angiomyolipomas treated
only removed if very large
no malignant potential but can burst and bleed
what are fluid density masses called and what is the best way to image them
simple cysts
US
what imaging is best for complex cysts
US
what can be used to image renal masses if CT cannot be used
MR with contrast
where can kidney cancer metastasis to and what does it appear as
to the lung
cannon ball mets
what is used to investigate Renal artery stenosis
MR angiography
if renal impairment is due to renal cause what is used to investigate it
US guided Biopsy
what suggest chronic disease of the kidneys
If they appear small on an Ultrasound
what can show hydronephrosis
US
what is needed to investigate post renal causes of impairment (apart from hydronephrosis)
CT scan
what can cause hydronephrosis apart from obstruction
ureteric reflux
what are causes of the painful scrotum
epididymo-orchitis
testicular torsion
trauma
what is epididymo-orchitis and what can cause it
inflammation of the epididymis and/or testis
can be caused chlamydia, viral or bacteria infection
what can complicated epididymo-orchitis
abscess formation or rarely ischaemia
what are symptoms of epididymo-orchitis
sudden-onset tender swelling
dysuria
sweats/fever
Ix of epididymo-orchitis
US
- the testis and/or epididymis is typically hypervascular
how does testicular torsion normally appear on IS
avascular
what are causes of painless scrotal swelling
hernia
varicocoele
hydrocoele
epididymal cyst
what is the investigation of choice for scrotal swellings
US
what is varicocele
veins become enlarged inside your scrotum
what is hydrocoele
build up of fluid around the testicles
how is renal trauma best imaged
CT
how is bladder rupture diagnosed
Cystography
CT cystography
what should not be attempted if urethral disruption is suspected
cathererisation
Ix for urethral trauma
Urethrography
what could ureteric obstruction be treated
NEPHROSTOMY
- artificial opening created between the kidney and the skin
in macroscopic haematuria what is the two investigations
CT urography for upper tracts
Cystoscopy for lower tract
