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Y3 Lecture weeks > Imaging of renal tract > Flashcards

Imaging of renal tract Flashcards

1
Q

As a GP (in the community). When do you consider renal imaging?

A
  • abdominal mass
  • drop in renal function
  • infection -> but not everyone (if recurrent UTI and in men)
  • haematuria
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2
Q

In hospital (acute setting), when would you consider renal imaging?

A
  • abdominal mass
  • decreased renal function
  • infection
  • renal trauma - haematuria (?)
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3
Q

When to consider renal imaging in a hospital (outpatient) setting?

A
  • follow up of malignancy
  • congenital abnormalities
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4
Q

What pathologies of kidney is a renal imaging good to look at? What are not?

A
  • Good: masses, stones
  • Not suitable: glomerulus, tubular conditions *

* these are diagnosed by renal biopsy

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5
Q

Advantages of X-ray

A

cheap, quick and lower dose compared to CT

*but limited information provided (as compared with CT)

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6
Q

What can we use x-ray for (in terms of the renal system)?

A
  • useful for radiopaque stones

*not used for gallstones as they contain fat/cholesterol

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7
Q

What landmarks on X-ray would allow us to identify kidney?

A
  • psoas muscle
  • L2 vertebra
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8
Q

What is this?

A

Opacity in renal region -> renal calculi

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9
Q

What’s that?

A

Could be renal but also ureteric calculi

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10
Q

What’s the abnormality?

A

Some sort of calculi (we cannot really determine if it is within the ureters or in the bladder)

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11
Q

What’s that?

A

Staghorn calculi

*opacity in the vertebra -> belly bottom piercing

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12
Q

How do we achieve intravenous urograms?

What are they used for?

A
  • contrast is injected IV -> it goes through the kidney
  • delayed radiograph would show opacification of the collecting system
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13
Q

What conditions do we assess for by the use of intravenous urogram?

A
  • hydronephrosis (dilatation of renal pelvis/urethra)
  • ureteric reflux (incompetent valve in the bladder -> urine backup) *

*now CT used more for that

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14
Q

What’s that?

A

Hydronephrosis (on the R) - dilated ureter

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15
Q

How does ultrasound work? How is the image formed?

A

USS

  • high-frequency sound waves transmitted through the tissues
  • forms an image by measuring the time taken by the echoes to return
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16
Q

Advantages of USS

A
  • do not use radiation
  • portable
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17
Q

look at the image of the kidney on USS

A
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18
Q

What’s that?

A

Hydronephrosis - renal pelvis is seen and grossly dilated

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19
Q

What’s that?

A

Image of the bladder - used also to assess the volume

*scan before the pt goes to wee -> then scan after -> to assess the amount of residual volume

20
Q

What’s that?

A

Calculi in the bladder -> stone

21
Q

What the difference between these two images?

A

on the first one: we cannot see past the mass’ -> possibly stone

on the right one: we can see it has a similar structure to the tissue around it -> bladder polyp

22
Q

Pros and cons of ultrasound

A
  • Pros: cheap, quick, portable, no ionising radiation, good detail in children, can assess vascularity (doppler function), real-time imaging
  • Cons: difficult in obese (as the waves go through lots of fat), operator dependent, technical limitations
23
Q

What’s the principle of CT scan?

A

multiple x - rays from different angles

24
Q

Just look at the picture of that CT scan

A
25
Q

What’s the abnormality?

A

L kidney - looks dilated -> cyst-like structures

*polycystic kidney with hydronephrosis

26
Q

What’s that?

A

R renal stone causing slight hydronephrosis

27
Q

What’s that?

A

Crossed-fused renal ectopia

*kidney came from another side and fused with the other - kidney function is normal

*however, need to monitor as may lead to CKD

28
Q

What is the abnormality?

A

Renal cell carcinoma

29
Q

Pros of CT scan

A

  • great detail of information on an image
  • quick
  • cheper than MRI
  • easy access
30
Q

Cons of CT scan

A

Cons:

  • high radiation dose
  • contrast induced nephropathy (avoid if eGFR <30)
  • epensive
  • not portable
31
Q

What if there is a clinical need for CT scan in pt with eGFR <30?

A

We consider alternative methods or hydrate the patient -> bag of fluid before and after the scan *

* but careful in HF

32
Q

The principle of MRI scan

A
  • cross-sectional image (similar to CT)
  • use magnetic properties of hydrogen atoms within human tissues

*magnet on -> hydrogen atoms flip/ go to one side

* magnet off -> hydrogen atoms relax (by differing amounts)

  • lots of hydrogen -> relax fast
  • little hydrogen -> relax slowly

Image formed by working out by how quickly hydrogen atoms relax

33
Q

Can MRI be used in pregnant women?

A

Yes, it does not use ionising radiation

*MRI imaging of foetal heart can be even measured

34
Q

Look at the normal MRI scan (anatomy)

A

*look from feet up (like in CT scan)

35
Q

Pros of MRI scan

A
  • functional imaging
  • ecellent diagnostic detail
  • not ionising
36
Q

Cons of MRI scan

A
  • expensive
  • time consuming
  • claustrophobia
  • limited indications
37
Q

Nuclear medicine

  • principle
A
  • gamma camera and radioactive isotopes are utilized
  • Radioisotopes emit radiation as they travel through the body -> so it can be ‘traced’

* can be tagged with an organ

38
Q

Pros of nuclear medicine imaging

A

Pros

  • functional imaging
  • split function -> useful in kids and transplant patients (to see which kidney is problematic)
  • good sensitivity and specificity
39
Q

What is an abnormality on this nuclear medicine scan?

A

R side is not draining the contrast -> some sort of obstruction

40
Q

16 years old girl with R iliac fossa pain

  • differentials
A

Differentials:

  • renal/uretetic stone
  • appendicitis
  • ovarian torsion
  • ectopic pregnancy
41
Q

16 years old girl with R iliac fossa pain

  • what mode of imaging would you use?
A

Ultrasound

  • ultrasound -> stone, pregnancy and ectopic pregnancy

* possibly (if not much bowel gas) - to indicate appendicitis

42
Q

AKI in an 87 y old nursing home resident (GP detected AKI from the bloods)

Causes

A
  • pre-renal: dehydration, sepsis, bleeding elsewhere (not enough perfusion)
  • renal: ACE inhibitors, glomerulonephritis
  • post-renal: kidney stone obstructing
43
Q

AKI in an 87 y old nursing home resident

What causes would imaging show?

A
  • Imaging would only show post-renal causes (e.g. obstruction)
44
Q

Painless haematuria in elderly patient

causes

what imaging would you use?

A
  • cancer: renal, bladder
  • stone disease
  • renal disease (e.g. nephritic syndrome)

Imaging: CT or MRI (malignancy, stone disease)

but definitive would be with biopsy

45
Q

Middle-aged woman presenting with right flank pain, fever and high WBC

  • differentials
  • imaging and why
A
  • UTI -> pyelonephritis
  • infection
  • appendicitis
  • abscess - intraabdominal
  • urolithiasis

Imaging:

  • Pyelonephritis - no need to image unless not resolving
  • kidney stones -> CT -> is there an urinary stasis, obstruction
  • appendicitis -> USS, CT

Y3 Lecture weeks (65 decks)

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