Imaging Renal and Urinological Conditions# Flashcards

1
Q

what usually causes renal colic and how does it present?

A

ureteric calculus

colicky pain localised to left or right side

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2
Q

what may present similar to renal colic?

A

pyelonephritis
gynaecological disease
AAA

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3
Q

types of renal calculi?

A

most are rich in calcium and are dense

some are calcium poor and of lower density (contain urate)

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4
Q

investigation of renal calculi

A

KUB plain X ray
CT
MRI

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5
Q

what is KUB X ray

A

first line imaging in suspected renal colic

typically comprise an image of the upper/mid abdomen and secondary image of pelvis

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6
Q

path of ureters?

A

pass inferiorly over psoas
descend anterior to tips of lumbar transverse processes
cross iliac bifurcation and enter pelvis
posteriormedially and enter posterior bladder

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7
Q

where do calculi commonly get stuck?

A

pelviureteric junction
pelvic brim
vesicoureteric junction

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8
Q

drawback of KUB X ray?

A

lacks specificity as many other causes of calcification can mimic renal calculi
lacks sensitivity as small or radiolucent calculi are not shown

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9
Q

what can mimic calculi?

A

phleboliths
lymph nodes
uterine fibroids
arterial calcification

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10
Q

what is the definitive test for ureteric calculus?

A

non-contrast CT (CT stone search)

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11
Q

benefits of stone search CT?

A

shows all calculi irrespective of size or calcium content
shows signs of obstruction raising diagnostic confidence
may show alternative diagnosis

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12
Q

drawbacks of CT stone search?

A

struggles to distinguish small pelvic calculi and phleboliths when there are no secondary signs
high radiation dose (should be avoided in pregnancy, all young females where MRI/US could give similar info)

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13
Q

renal colic follow up?

A

most calculi pass spontaneously
use simplest test which showed calculus initially to check its progress (don’t use a CT to check a stone which was shown on X ray, don’t expect an X ray to show a stone which was only seen on CT initially)

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14
Q

what can cause macroscopic haematuria?

A
calculi
infection
tumour
urethritis/prostatitis
trauma
clotting disorders
can be multifocal
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15
Q

how are over 50s investigated?

A

CT urography
cystoscopy (examines bladder and urethra)
- gives option for ureteroscopy if needed (to confirm tumour, ablate tumours unfit for nephroureterectomy etc)

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16
Q

what do over 50s need different investigation?

A

higher cancer risk

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17
Q

how is CT urography performed?

A

CT scan before contrast
administer IV contrast which is concentrated and excreted by kidneys over 15 mins
top up does of IV contrast to enhance renal parenchyma
second CT scan following contrast

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18
Q

CT urography is good at detecting what?

A

renal parenchymal tumours

urothelial tumours of collecting system/ureters

19
Q

what type of tumour commonly occurs in the renal tract?

A

transitional cell carcinoma

20
Q

investigation of under 50s with macroscopic haematuria?

A

kidney US
cystoscopy
CTU only when US and cystoscopy are normal and macroscopic haematuria persists

21
Q

MR urography is useful in which patients?

A

contrast allergy
renal impairment
pregnancy
(as doesn’t require contrast or radiation)

22
Q

how does CT characterise renal masses?

A

size
density
uniformity
internal morphology

23
Q

what renal masses are generally safe?

A

those under 3cm rarely meatstasize so usually just monitored rather then excised

24
Q

what characteristics indicate a benign renal mass?

A

containing fat

uniform cysts

25
Q

what type of renal masses are often malignant?

A

complex cysts containing solid areas or thick septa

solid (non-cystic) masses larger than 3cm

26
Q

how is malignant renal tumour staged?

A

CT

  • shows spread, other organ involvement, vascular involvement
  • shows nodal disease
  • shows meatstases (cannon ball lung mets)
27
Q

what do kidneys look like on CT?

A

sliced bananas

28
Q

renal artery stenosis is what type of renal impairment?

A

pre renal

29
Q

how is pre-renal renal impairment imaged?

A

MR angiography to detect renal artery stenosis

30
Q

how is renal renal impairment imaged?

A

US used to guide biopsy

31
Q

how is post renal renal impairment imaged?

A

US shows hydronephrosis (dilated renal pelvis), effectiveness of bladder emptying
- associated with obstruction
CT needed for other causes of obstruction

32
Q

how can US be used to distinguish acute from chronic renal impairment?

A

assessment of renal size

33
Q

3 causes of painful scrotum?

A
epididymo-ochitis
- viral/bacterial infection which may be complicated by an abscess or ischaemia 
- testes and/or epididymis are hypervascular on US
testicular torsion
- young males
- testicle is avascular on US
- surgical emergency
trauma
34
Q

common causes of painless scrotal swelling?

A

hernia
variocele
hydrocele
epididymal cyst

35
Q

good imaging for painless scrotal swelling?

A

US

36
Q

how does variocele present on US?

A

dilated scrotal venous plexus
typically on left side
tortuous veins usually >2mm in diameter

37
Q

how does hydrocele present on US?

A

black anechoic fluid surrounding the testicle

38
Q

how does epididymal cyst present on US?

A

anechoic uni or multiocular cyst typically arise within epididymal head

39
Q

how does testicular seminoma present on US?

A

intra-testicular soft tissue mass

often have demonstrable vascularity

40
Q

renal trauma/injury is best assessed via what imaging?

A

CT

41
Q

bladder injury/trauma is best assessed via what imaging?

A

cystography
CT cystography
e.g in bladder rupture,
- after filling the bladder, contrast leaks through the bladder tear into the intra or extraperitoneal space

42
Q

how is imaging used I urethral trauma?

A

limited in an acute setting

urethrography used to define long term stricture

43
Q

how can uroradiology be used interventionally?

A

relief of ureteric obstruction (nephrostomy)
drainage of abscess/cyst
biopsy of renal mass
guided ablation of renal tumours
correction of renal artery stenosis
control of arterial bleeding sites (embolization)
varicocoele embolisation