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RAD415 PT2 > imaging renal pathology > Flashcards

imaging renal pathology Flashcards

1
Q

familiarise your self with kidney anatomy, including nephron

A
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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.
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2
Q

what causes a duplex collecting system of the kidney

A
  • formed by duplication of the ureteric buds embryologically
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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.
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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)
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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
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6
Q

what band of tissue forms the fusion of kidney

A

isthmus

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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
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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
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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
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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
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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
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12
Q

what is renal ectopia

A

abnormal location of one or both kidneys

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13
Q

what are the 3 main types of renal ectopia

A
  • crossed fused
  • pelvic kidney (most common)
  • ectopic thoracic kidney
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14
Q

what causes Renal ectopia

A

arrested superior migration of kidneys during embryological development

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15
Q

what is pelvic kidney

A

kidney found in pelvic region

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16
Q

what is ectopic thoracic kidney

A

partial or complete protrusion of kidney above the level of diaphragm into the posterior mediastinum.

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17
Q

what is ureterocoele

A

Swelling at the bottom of the ureter

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18
Q

what is renal agenesis / classic potter syndrome

A
  • congenital absence of one or both kidneys
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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
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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
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21
Q

what is dromedary (splenic) hump

A

a prominent focal bulge on the lateral border of the left kidney

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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
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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
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24
Q

what is extra renal pelvis

A

renal pelvis is outside the normal renal hilum

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25
Q

what can extra renal pelvis be confused with

A

hydronephorosis or pelvi-uteric junction obstruction (PUJ)

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26
Q

how can you tell if what looks like a extra renal pelvis on a radiograph is not obstruction

A
  • despite both looking thicker/larger
  • extra renal pelvis has finger nail shaped structure/ sharp edges
  • obstruction has clubbed looking structure
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27
Q

what classification is used to characterise cysts/lesions of kdiney

A

Bosniak classification

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28
Q

what are the levels of Bosniak classification of renal cysts

A

1 (0% are malignant)
2 (o% are malignant, micro calcification seen)
2F (5% malignant)
3 (50% malignant)
4 (100% malignant)

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29
Q

2F of the bosniak ranking is where alarms are raised as it may develop to be malignant

A

cysts are fluid filled lesions

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30
Q

what is polycystic renal disease

A

large number of cysts in kidney

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31
Q

cortical cysts are outside kidney

A
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32
Q

how are renal cysts seen on radiograph

A
  • 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
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33
Q

if there is obstruction seen with something similarly looking to cyst, it confirms presence of cyst as that is what is causing the obstruction

A
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34
Q

how can you spot ureterocoele on a radiograph

A

abnormal dilation of distal ureter

35
Q

uretercoele is often associated with ectopic insertion of ureter into bladder (not going where ti should )

A
36
Q

what can a uretercoele be associated with

A

reflux
obstruction

37
Q

what is urolithiasis/nephrolithiasis

A
  • 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
Q

do not confuse nephrocalcinosis with urolithiasis, what is nephrocalcinosis

A
  • calcification within the medulla of the kidney
  • depositing of calcium into kidney
39
Q

what is the best imaging scan for identifying/visualising urolithiasis

A

CT KUB

40
Q

what is the biggest cause of urolithiasis

A

dehydration

41
Q

understand that nephrocalcinosis can lead to nephroliathiasis

A
42
Q

what does nephrocalcinosis look like on ultrasound

A
  • lots of white areas in medulla of kidney
43
Q

what is an acoustic shadow

A

when sound waves attenuate causing signal loss and dark areas

44
Q

what is an acoustic enhancemetn

A

increased echoes deep to structures that transmit sound exceptionally well causing brighter looking areas

45
Q

what is pyelonephritis

A

upper urinary tract infection affecting the kidneys

  • reflux of urethra
46
Q

there are 5 types of pyelonephritis :
- acute
- chronic
- renal TB
- emphysematous
- fungal

A
47
Q

what can form as a result of pyelonephritis

A
  • access
  • necrosis/scaring
  • impairment
48
Q

how does pyelonephritis appear on a CT

A

regions of reduced contrast enhancement / dark area around kidney indicating infection

49
Q

how does pyelonephritis appear on ultraasound

A
  • reduced areas of vasculatiry or abnormal echogenicity
50
Q

how does chronic pyelonephritis look difference to acute on radiograph

A
  • renal scarring, atrophy
  • cortical thinning
  • calyces clubbing
  • renal asymmetry
51
Q

what is renal TB

A

genitourinary tuberculosis (infection)

52
Q

what can renal TB be mistaken for on imaging

A

can mimic tumour

53
Q

what is the result of early, progressive and end-stage renal tuberculossis

A

early = papillary necrosis
progressive = stricture and hydronephrosis
end-stage = hydronephrosis, parenchymal thinning, dystrophic calcification

54
Q

what is emphysematous pyelonephritis

A

infection with gas forming around kidneys

55
Q

emphysematous pyelonephritis if not treated early can cause high mortality due to sepsis

A
56
Q

what is xanthogranulomatous pyelonephritis

A

aggressive variant of chronic pyelonephritis resulting in a non-functioning kidney.

57
Q

how can you identify xanthogranulomatous pyelonephritis on CT

A
  • bear paw looking structure of kidney
58
Q

what is vesicoureteric reflux

A
  • abnormal flow of urine from bladder into upper urinary tract
59
Q

what causes vesicoureteric reflux

A

angle of urethra valve isnt correct resulting in reflux

  • can lead to infection
60
Q

what can vesicoureteric reflux lead to if untreated

A

renal failure

  • reflux itself can lead to pyelonephritis
61
Q

what is renal obstruction

A

any holdup of flow of urine

62
Q

what might happen to the kidney upon obstruction

A

can get enlarged

63
Q

how can you identify if a kidney is worth saving

A

if the work output of the kidney is around 40%+, it still does adequate work so should be saved

64
Q

what are the 3 common carcinomas of the renal system, whats the difference between them

A
  • renal cell carcinoma RCC (most common) (renal) (malignant)
  • transitional cell carcinoma TCC (urinary tract, commonly bladder) (malignant)
  • angiomyolipa (benign neoplasm)
65
Q

which population most commonly has RCC

A

50-70 yr olds, predominately men 2:1

66
Q

where does RCC likely metastasis to

A

lungs
bones
lymph nodes
liver
adrenal
brain

67
Q

which population most commonly has TCC

A

greater than 60 yrs old, predominately men 4:1

68
Q

how can you tell a TCC on CT

A
  • mass that should be highlighted by contrast but isnt
69
Q

between TCC and RCC which has a greater reoccurent rate

A

TCC

70
Q

angiomyolipoma is benign, what is this tumour composed of

A
  • blood vessels
  • plump sprinkle cells
  • adipose tissue
71
Q

what does angiomyolipoma look like on US

A
  • enhanced/bright as it is majority fat content
72
Q

what does angiomyolipoma look like on CT

A
  • dark as it is majority fat content
73
Q

what is renal artery stenosis

A

narrowing of renal artery

74
Q

how might you identify RAS from kidney size

A

RAS causes decrease in kidney size

75
Q

what are the 2 main causes of renal artery stenosis

A
  • secondary hypertension
  • atherosclerosis of renal artery
76
Q

what imaging modality is used to identify renal artery stenosis

A

fluroscopy

  • picked up on doppler ultrasound as well by measuring systolic velocities and restrictive indices
77
Q

what is AAST scale

A

american association for surgery of trauma

  • grading of kidney trauma
78
Q

where would a renal transplant usually be placed

A
  • right iliac fossa
79
Q

what are some complications of renal transplant

A
  • rejection
  • renal artery stenosis
  • urinary obstruction
  • infection
  • perinephric fluid collection
80
Q

what is ileal conduit

A

new bladder made from small art of ileum

81
Q

complications with ileal conduit

A
  • stricture
  • anastomotic leak
  • tumour reoccurance
82
Q

what is nephroectomy

A
  • remove or partial removal of kidney
  • ureter is usually removed too
  • other kidney gets enlarged to compensate
83
Q

what is a nephrostomy

A

insertion of tube into collecting system through skin to drain kidney

  • stent can be used to aid draining
84
Q

why should stents used in nephrostomy be changed every 6-12 weeks

A
  • they can get crusted with stone/calcification
85
Q

what is TURP/TURBT

A
  • trans-urethral resection of prostate or bladder tumour
  • operation to remove cancer
    or
  • reduce prostate size if issues with prostate
86
Q
A

RAD415 PT2 (14 decks)

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