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2MBChB Renal > Imaging > Flashcards

Imaging Flashcards

1
Q

What is contrast-induced nephropathy?

A

A condition in which impairment in renal function occurs within 3 days following intravascular administration of a contrast medium in the absence of an alternative aetiology.

Rise in serum creatinine and urea – usually peaks at 72 – 96 hours post contrast.

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2
Q

Name A, B and the arrows.

A

A - right lobe of the liver.

B - dilated calyx.

C - renal cortex.

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4
Q

Which CT phase best depicts the calculi in the kidney?

A

Pre-contrast.

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5
Q

Which CT phase best depicts the cortex of the kidney?

A

Corticomedullary phase.

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6
Q

Which CT phase best depicts the renal medulla and cortex in the kidney equally?

A

Nephrographic phase.

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7
Q

Which CT phase best depicts the renal collecting system and ureters?

A

Excretory phase.

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8
Q

What are the risk factors for contrast-induced nephropathy?

A

Renal impairment - +/- diabetes mellitus.

Dehydration.

Congestive heart failure.

LV ejection fraction < 40%.

Acute MI (within 24 hours).

Nephrotoxic drugs.

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9
Q

What measures are put in place to reduce the risk of contrast-induced nephropathy?

A

Hydration protocols:

  • 1-1.5 ml/kg/h 0.9% normal saline 12 or 6 hrs before and after contrast administration.
  • Sodium bicarbonate instead of sodium chloride – urine alkalinization – prevention of oxygen free radicals; bicarbonate administered from 1 hour pre-procedure to 6 hrs post.
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10
Q

What vessels are seen on a renal angiogram?

A

Abdominal aorta.

Right renal artery.

Left renal artery.

Aortic bifurcation into common iliacs (right and left).

Splenic artery.

Lumbar arteries.

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11
Q

What is nephrogenic systemic sclerosis?

A

Severe systemic fibrosing disorder associated with the exposure to gadolinium-containing contrast media.

Initial skin erythema, pruritis, pain.

Involvement of other organs:

  • Neuropathic symptoms
  • Joint contractures
  • Respiratory insufficiency
  • Muscular atrophy

With time, the skin thickens, hardens and appears wood-like.

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12
Q

What are the risk factors for nephrogenic systemic sclerosis?

A

Renal impairment.

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13
Q

Should the bladder be full or empty for USS?

A

Full - to adequately assess the outline.

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14
Q

What structures is USS the primary choice for?

A

Testes/scrotum.

Uterus and ovaries.

Prostate biopsies.

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15
Q

What structures is hysterosalpingogram the primary choice for?

A

Infertility - tubal patency.

Uterine abnormalities.

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16
Q

What structures is MRI the primary choice for?

A

Prostate cancer - local staging.

Troubleshooting for adnexal, uterine, ovarian abnormalities not characterisable by USS.

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17
Q

What is renal colic?

A

Usually due to ureteric calculus (stone in ureter).

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18
Q

What is the presentation of renal colic?

A

Unilateral, severe pain going from loin to groin area.

Colicky pain.

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19
Q

What conditions can cause renal colic?

A

Ureteric calculus.

Pyelonephritis - better doing USS.

Gynaecological disease - better doing USS.

Ithe n elderly patient, potentially leaking AAA.

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20
Q

What is the composition of most renal calculi?

A

Most are rich in calcium and are dense - show up on plain radiograph or CT scans.

Some are calcium poor and of lower density due to urate (5-10%).

21
Q

What is a KUB x-ray?

A

An xray of the kidneys, ureters and bladder (KUB; bladder view is separate to that of kidneys and ureters).

Usually first imaging test in patients with renal colic.

Only a minority of renal tract calculi are visible on KUB x-ray.

22
Q

At what vertebral level do ureters leave the kidney?

A

L1.

23
Q

What is the course of a normal ureter?

A

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.

24
Q

What are the predictable sites that renal calculi get stuck at?

A

Pelviureteric junction (PUJ).

Pelvic brim.

Vesicoureteric junction (VUJ).

25
Q

What conditions can mimic ureteric calculus on a plain film xray?

A

Calcified veins (phleboliths).

Calcified lymph nodes.

Uterine fibroids.

Arterial calcification.

26
Q

Why is contrast not used in CT renal stone search?

A

The contrast tends to be dense and so are the stones, so the contrast will hide the stone.

27
Q

What are the causes of macroscopic haematuria?

A

Calculi.

Infection.

Tumour (renal cell carcinoma at all ages).

Urethritis/prostatitis.

Trauma.

Clotting disorders.

28
Q

In someone with macroscopic haematuria who is over 50, what imaging modalities would be used?

A

CT urography (examines the kidneys, collecting systems and ureters).

Cystoscopy (examines bladder and urethra) - by urologists.

Ureteroscopy - by urologists.

29
Q

What is macroscopic haematuria?

A

VIsible blood in the urine.

30
Q

In someone with ureteric calculi, what imaging modalities would be used?

A

CT stone search.

KUB x-ray (kidneys, ureters and bladder).

31
Q

In someone with macroscopic haematuria who is under 50, what imaging modalities would be used?

A

USS of kidneys to detect calculi and renal parenchymal tumours.

Cystoscopy to look for bladder transitional cell carcinoma (TCC), bladder calculi, other bladder tumours or evidence of urethritis/prostatitis.

CT urography only when USS and cystoscopy are normal and macroscopic haematuria persists.

32
Q

What is the rule of thumb for renal mass size on imaging?

A

Renal masses smaller than 3cm very rarely metastasize, whatever their appearance, so these are often followed up rather than operated upon.

33
Q

What are renal masses that contain fat?

A

Tend to be benign angiomyolipomas.

34
Q

What are renal masses that are fluid dense?

A

Benign cysts and uniform cysts.

35
Q

What appearance on CT suggests a renal cyst is malignant?

A

Complex cysts containing solid areas or thick septa.

36
Q

Where do malignant renal tumours tend to metastasise to?

A

Lung (canon ball metastases).

Bone.

37
Q

What are the main causes of renal impairment?

A

Pre-renal (dehydration, hypotension, renal arter stenosis) - MR angiography.

Renal (parenchymal disease, drugs, toxins) - USS.

Post-renal (obstruction) - USS/CT.

38
Q

How does epididymo-orchitis present on USS?

A

The testis and/or epididymis appear hypervascular on USS.

39
Q

How does testicular torsion present on USS?

A

The testis is typically avascular on USS.

40
Q

What is epididymo-orchitis?

A

A viral or bacterial infection that may be complicated by abscess formation or rarely ischaemia.

41
Q

What is testicular torsion?

A

Tends to occur in young males.

A surgical emergency as delayed diagnosis results in testicular infarction.

42
Q

What are the common causes of painless scrotal swelling?

A

Hernia.

Varicocoele - dilated vein.

Hydrocoele - fluid in the testis.

Epididymal cyst.

Testicular tumour (rare).

USS best modality for diagnosis.

43
Q

How does a varicocoele appear on USS?

A

Dilated scrotal venous plexus.

Typically on left side.

Tortuous veins usually >2mm in diameter.

44
Q

How does a hydrocoele appear on USS?

A

Black anechoic fluid surrounding the testicle.

45
Q

How does an epididymal cyst appear on USS?

A

Anechoic uniocular or multiocular cyst typically arise within epididymal head.

Extremely common condition.

46
Q

How does a testicular seminoma appear on USS?

A

Intra-testicular soft tissue mass.

Often have demonstrable vascularity.

2MBChB Renal (20 decks)

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