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The Renal System > Imaging Renal and Urological Diseases > Flashcards

Imaging Renal and Urological Diseases Flashcards

1
Q

What causes renal colic?

A

Usually ureteric calculus

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2
Q

Which conditions may simulate renal colic?

A
  1. Pyelonephritis
  2. Gynaecological disease
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3
Q

Which investigation is done if either pyelonephritis or gynaecoligical disease are suspected to be simulating renal colic?

A

USS

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4
Q

Which investigations are carried out in a patient with suspected renal colic caused by ureteric calculi?

A
  1. KUB x-ray
  2. CT
  3. MRI
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5
Q

What is a KUB x-ray?

A

An abdominal x-ray of the kidneys, ureters and bladder

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6
Q

In which instance would different tests be used to examine renal colic as a result of ureteric calculi and which tests would be utilised?

A

Pregnancy

USS or MRI

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7
Q

Which test is generally done first for suspected renal colic as a result of ureteric calculi?

A

KUB x-ray

  • Easy to obtain
  • Only shows a minority of the most severe renal tract calculi
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8
Q

How can the renal collecting system including the ureters and bladder be made visible on imagine?

A

IV contrast

(intravenous urogram)

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9
Q

At which sites do ureteric calculi generally become stuck?

A
  1. Pelviureteric junction
  2. Pelvic brim
  3. Vesicoureteric junction (ureteric orifice)
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10
Q

For which two main reasons does a KUB x-ray lack specificity and sensitivity respectively?

A

Many other causes of calcification can be picked up e.g. uterine fibroids, lymph nodes, arterial calcification

Small or radiolucent calculi are not shown

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11
Q

What is the definitive test for detecting ureteric calculi?

A

Non-contrast enhanced CT

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12
Q

For which 3 reasons is a non-contrast enhanced CT a suitable test for diagnosing a patient with suspected ureteric calculi?

A

Shows almost all calculi irrespective of size or calcium content

Highlights areas of obstruction increasing diagnostic confidence

Can point to alternative diagnoses e.g. appendicitis or hernia

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13
Q

What are the two downsides to non-contrast enhancing CT in detecting ureteric calculi?

A

Occasionally struggles to distinguish between small calculi and phleboliths

High radiation dose should be avoided in pregnancy, young females or when USS/MRI could get the same information

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14
Q

What is a phlebolith?

A

A small local, usually rounded, calcification within a vein

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15
Q

What is macroscopic haematuria?

A

Visible blood in the urine

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16
Q

Where can macroscopic haematuria arise?

A
  1. Kidney
  2. Ureter
  3. Bladder
  4. Urethra
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17
Q

Which investigations can a used for those over 50 to determine the cause of macroscopic haematuria?

A

CT urography

Cytoscopy

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18
Q

What parts of the urinary tarct can cytoscopy examine?

A

Bladder and urethra

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19
Q

What additional options does ureteroscopy (cytoscopy) give when examining for macroscopic haematuria?

A

Confirms tumour if CTU is equivocal

Ablation of tumours in patient unable for nephroureterectomy

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20
Q

A non-contrast CT scan of the urinary tract is the most sensitive way to detect what?

A

Ureteric calculi

21
Q

A contrast enhanced CT scan of the urinary tract is the most sensitive way to detect what?

A

Renal parenchymal tumours

Urothelial tumours of the collecting systems or ureters

22
Q

Which investigations can be used in those under 50 with macroscopic haematuria?

A

USS of kidneys

Cytoscopy

CTU (ony when other tests are normal and macroscopic haematuria persists)

23
Q

What is the purpose of USS in those under 50 with macroscopic haematuria?

A

Detects calculi

Detects renal parenchymal tumours

24
Q

What is the purpose of cytoscopy in those under 50 with macroscopic haematuria?

A

Occasional bladder transitional cell carcinoma (TCC)

Bladder calculi

Other bladder tumours

Urethritis/prostatitis

25
Q

For which reason(s) is CT urography (CTU) unjustified in those under 50 with macroscopic haematuria?

A

Incidence of urothelial tumours is rare

(extra radiation dose is unjustified)

26
Q

What are the benefits to MR urography?

A

No contrast

No radiation

27
Q

In which patients may MR urography be useful for determining the cause of macroscopic haematuria?

A

Contrast allergy

Renal impairment

Pregancy

28
Q

Why is CTU a better test than MRU?

A

More sensitive for small calculi or upper tract TCC

29
Q

In terms of renal masses, what information may a CT be able to acquire?

A

Size

Density

Uniformity

Internal morphology e.g. nodules, septa

30
Q

Why are renal masses smaller than 3cm followed up rather than operated on?

A

They very rarely metastasize

31
Q

What is the term given to renal masses containing fat?

A

Angiomyolipomas

32
Q

Which imaging modality is usually sufficient to diagnose a simple cyst in the renal system?

33
Q

What imaging modality is used to assess malignant renal tumours for staging?

A

CT

(assesses local extent, nodal disease and metastatic disease)

34
Q

How are the causes of renal impairment classified?

A

Pre-renal (dehydration, hypotension, renal artery stenosis)

Renal (parenchymal disease, drugs, toxins)

Post-renal (obstruction)

35
Q

How will pre-renal disease generally be imaged?

A

MR angiography

(to detect renal artery stenosis)

36
Q

How will renal disease generally be imaged?

A

USS

(in order to guide biopsy)

37
Q

How can post-renal disease be imaged?

A

USS useful for hydronephrosis and assessing completeness of bladder emptying

CT for other causes of obstruction

38
Q

How can epididymo-orchitis and testicular torsion be differentiated on USS?

A

Epididymo-orchitis - Highly vascular

Testicular torsion - Typically avascular

39
Q

Which imaging test is used primarily for testicular pathologies?

A

USS

(excellent for superficial soft tissue structures)

40
Q

How does a hydrocele present on USS?

A

Black anechoic fluid surrounds the teste

41
Q

How does a epididymal cyst classically present on USS?

A

Anechoic uni or multilocular cysts typically arising in the epididymal head

42
Q

Renal injury is best assessed via which imaging modality?

43
Q

What are the two categories for bladder rupture?

A

Intraperitoneal

Extraperitoneal

44
Q

How is a bladder rupture diagnosed?

A

Cystography

CT cystography

(contrast can be seen leaking through the bladder tear into intra or extraperitoneal space)

45
Q

What is cystography?

A

Using a urinary catheter, radiocontrast is instilled in the bladder, and X-ray imaging is performed

46
Q

Urethral disruption is often associated with which kinds of injury processes?

A

Anterior pelvic fracture/dislocation

Straddle injury

47
Q

If there is clinical suspicion of urethral disruptuion, what should not be attempted?

A

Catheterisation

(e.g. if there’s meatal bleeding, or urine cannot be passed)

48
Q

What are the commonest causes for a painless scrotal swelling?

A

Hernia

Varicocele

Hydrocoele

Epididymal cyst

(testicular tumour is rare)

The Renal System (37 decks)

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