imaging renal pathology Flashcards
1
Q
familiarise your self with kidney anatomy, including nephron
A
1
Q
what is a duplex collecting system
A
- incomplete fusion of upper and lower moiety
- kidney has two ureters (tubes that carry urine from the kidney to the bladder) rather than one.
2
Q
what causes a duplex collecting system of the kidney
A
- formed by duplication of the ureteric buds embryologically
3
Q
what do you call the duplication of the renal pelvis only and what is this
A
- bifid renal pelvis
- a congenital renal tract abnormality characterized as a duplication of the ureter (two ureters) that unite before emptying into the bladder.
4
Q
how can entering the superior or inferior pole of the duplex system affect the position an endoscope travels
A
- if it enters inferior pole, endoscope travels inferiorly and laterally
- if it enters superior pole, endoscope travels superiorly and medially (which is correct)
5
Q
what kidney abnormalities is signified by a horse shoe appearance
A
fusion of lower end of kidney
- kidneys can fuse at upper pole but this is not horseshoe appearance
6
Q
what band of tissue forms the fusion of kidney
A
isthmus
7
Q
why does the horseshoe/ lower end fused kidneys sit low in the body
A
- restricted by the inferior mesenteric artery on the isthmus
- sits low in body as it gets caught on inferior mesenteric artery and doesnt rise
8
Q
describe how the ureters are situated on a horseshoe kidney
A
- inferior pole is orientated more medially
- ureters pass superiorly then anteriorly to isthmus
9
Q
why is a horse shoe kidney more prone to infection
A
- harder for kidney to drain substances due to the horse shoe shape
10
Q
what is a crossed fused renal ectopia
A
- fused kidneys will come to lie on same side of the body / one side of the body
11
Q
what are the 6 types of crossed fused renal ectopia
A
- inferiorly crossed fused
- sigmoid kidney
- lump kidney
- disc kidney
- l-shaped kidney
- superiorly crossed fused
12
Q
what is renal ectopia
A
abnormal location of one or both kidneys
13
Q
what are the 3 main types of renal ectopia
A
- crossed fused
- pelvic kidney (most common)
- ectopic thoracic kidney
14
Q
what causes Renal ectopia
A
arrested superior migration of kidneys during embryological development
15
Q
what is pelvic kidney
A
kidney found in pelvic region
16
Q
what is ectopic thoracic kidney
A
partial or complete protrusion of kidney above the level of diaphragm into the posterior mediastinum.
17
Q
what is ureterocoele
A
Swelling at the bottom of the ureter
18
Q
what is renal agenesis / classic potter syndrome
A
- congenital absence of one or both kidneys
19
Q
if there is only one kidney absent, what can happen to the other one
A
- experience compensatory hypertrophy, huge kidney to compensate for missing kidney
20
Q
what is persistent foetal lobulation
A
incomplete fusion of the renal lobules
- causes the surface of the kidney to appear as several lobules instead of smooth, flat and continuous.
- relatively smooth so not to be confused with scarring
21
Q
what is dromedary (splenic) hump
A
a prominent focal bulge on the lateral border of the left kidney
22
Q
what causes dromedary (splenic) hump
A
splenic impression onto superolateral aspect of left kidney
- only on left side as the spleen presses down on it
23
Q
what is hypertrophied column of bertin
A
extension of cortical sinus into renal sinus (normal variant)
- medulla (pyramid) extends further towards the renal pelvis than normal
24
what is extra renal pelvis
renal pelvis is outside the normal renal hilum
25
what can extra renal pelvis be confused with
hydronephorosis or pelvi-uteric junction obstruction (PUJ)
26
how can you tell if what looks like a extra renal pelvis on a radiograph is not obstruction
- despite both looking thicker/larger
- extra renal pelvis has finger nail shaped structure/ sharp edges
- obstruction has clubbed looking structure
27
what classification is used to characterise cysts/lesions of kdiney
Bosniak classification
28
what are the levels of Bosniak classification of renal cysts
1 (0% are malignant)
2 (o% are malignant, micro calcification seen)
2F (5% malignant)
3 (50% malignant)
4 (100% malignant)
29
2F of the bosniak ranking is where alarms are raised as it may develop to be malignant
cysts are fluid filled lesions
30
what is polycystic renal disease
large number of cysts in kidney
31
cortical cysts are outside kidney
32
how are renal cysts seen on radiograph
- they do not appear highlighted, rather you can only see the outline of the shape of the cyst faintly from the difference in contrast between the cyst and surrounding tissue
33
if there is obstruction seen with something similarly looking to cyst, it confirms presence of cyst as that is what is causing the obstruction
34
how can you spot ureterocoele on a radiograph
abnormal dilation of distal ureter
35
uretercoele is often associated with ectopic insertion of ureter into bladder (not going where ti should )
36
what can a uretercoele be associated with
reflux
obstruction
37
what is urolithiasis/nephrolithiasis
- a term used to describe calculi or stones that form the urinary tract.
- This condition involves the formation of calcifications in the urinary system, usually in the kidneys or ureters, but may also affect the bladder and/or urethra.
- urinary tract calculi/calcification
38
do not confuse nephrocalcinosis with urolithiasis, what is nephrocalcinosis
- calcification within the medulla of the kidney
- depositing of calcium into kidney
39
what is the best imaging scan for identifying/visualising urolithiasis
CT KUB
40
what is the biggest cause of urolithiasis
dehydration
41
understand that nephrocalcinosis can lead to nephroliathiasis
42
what does nephrocalcinosis look like on ultrasound
- lots of white areas in medulla of kidney
43
what is an acoustic shadow
when sound waves attenuate causing signal loss and dark areas
44
what is an acoustic enhancemetn
increased echoes deep to structures that transmit sound exceptionally well causing brighter looking areas
45
what is pyelonephritis
upper urinary tract infection affecting the kidneys
- reflux of urethra
46
there are 5 types of pyelonephritis :
- acute
- chronic
- renal TB
- emphysematous
- fungal
47
what can form as a result of pyelonephritis
- access
- necrosis/scaring
- impairment
48
how does pyelonephritis appear on a CT
regions of reduced contrast enhancement / dark area around kidney indicating infection
49
how does pyelonephritis appear on ultraasound
- reduced areas of vasculatiry or abnormal echogenicity
50
how does chronic pyelonephritis look difference to acute on radiograph
- renal scarring, atrophy
- cortical thinning
- calyces clubbing
- renal asymmetry
51
what is renal TB
genitourinary tuberculosis (infection)
52
what can renal TB be mistaken for on imaging
can mimic tumour
53
what is the result of early, progressive and end-stage renal tuberculossis
early = papillary necrosis
progressive = stricture and hydronephrosis
end-stage = hydronephrosis, parenchymal thinning, dystrophic calcification
54
what is emphysematous pyelonephritis
infection with gas forming around kidneys
55
emphysematous pyelonephritis if not treated early can cause high mortality due to sepsis
56
what is xanthogranulomatous pyelonephritis
aggressive variant of chronic pyelonephritis resulting in a non-functioning kidney.
57
how can you identify xanthogranulomatous pyelonephritis on CT
- bear paw looking structure of kidney
58
what is vesicoureteric reflux
- abnormal flow of urine from bladder into upper urinary tract
59
what causes vesicoureteric reflux
angle of urethra valve isnt correct resulting in reflux
- can lead to infection
60
what can vesicoureteric reflux lead to if untreated
renal failure
- reflux itself can lead to pyelonephritis
61
what is renal obstruction
any holdup of flow of urine
62
what might happen to the kidney upon obstruction
can get enlarged
63
how can you identify if a kidney is worth saving
if the work output of the kidney is around 40%+, it still does adequate work so should be saved
64
what are the 3 common carcinomas of the renal system, whats the difference between them
- renal cell carcinoma RCC (most common) (renal) (malignant)
- transitional cell carcinoma TCC (urinary tract, commonly bladder) (malignant)
- angiomyolipa (benign neoplasm)
65
which population most commonly has RCC
50-70 yr olds, predominately men 2:1
66
where does RCC likely metastasis to
lungs
bones
lymph nodes
liver
adrenal
brain
67
which population most commonly has TCC
greater than 60 yrs old, predominately men 4:1
68
how can you tell a TCC on CT
- mass that should be highlighted by contrast but isnt
69
between TCC and RCC which has a greater reoccurent rate
TCC
70
angiomyolipoma is benign, what is this tumour composed of
- blood vessels
- plump sprinkle cells
- adipose tissue
71
what does angiomyolipoma look like on US
- enhanced/bright as it is majority fat content
72
what does angiomyolipoma look like on CT
- dark as it is majority fat content
73
what is renal artery stenosis
narrowing of renal artery
74
how might you identify RAS from kidney size
RAS causes decrease in kidney size
75
what are the 2 main causes of renal artery stenosis
- secondary hypertension
- atherosclerosis of renal artery
76
what imaging modality is used to identify renal artery stenosis
fluroscopy
- picked up on doppler ultrasound as well by measuring systolic velocities and restrictive indices
77
what is AAST scale
american association for surgery of trauma
- grading of kidney trauma
78
where would a renal transplant usually be placed
- right iliac fossa
79
what are some complications of renal transplant
- rejection
- renal artery stenosis
- urinary obstruction
- infection
- perinephric fluid collection
80
what is ileal conduit
new bladder made from small art of ileum
81
complications with ileal conduit
- stricture
- anastomotic leak
- tumour reoccurance
82
what is nephroectomy
- remove or partial removal of kidney
- ureter is usually removed too
- other kidney gets enlarged to compensate
83
what is a nephrostomy
insertion of tube into collecting system through skin to drain kidney
- stent can be used to aid draining
84
why should stents used in nephrostomy be changed every 6-12 weeks
- they can get crusted with stone/calcification
85
what is TURP/TURBT
- trans-urethral resection of prostate or bladder tumour
- operation to remove cancer
or
- reduce prostate size if issues with prostate
86
