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Uroradiology > inflammatory diseases > Flashcards

inflammatory diseases Flashcards

1
Q

What are the two main groups of renal infection?

A

1 - glomerulonephritis - immunologic injury to the glomerulus

2 - interstitial nephritis - infection/toxic injury to renal parenchyma

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2
Q

What bug is most common in UTI?

A

E coli, due to p fimbriae protein that allows the bug to climb the urinary tract

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3
Q

What is the sex predilection for UTI?

A

50, male (stasis due to BPH)

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4
Q

Which population is at higher risk for complications of renal infections?

A

Diabetics

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5
Q

What is the pathophysiology of pyelonephritis? How do chronic abscess form?

A

Infiltration of the interstitium with PMN resulting in swelling. Can coalesce to form microabscesses

If small microabscesses coalesce, liquefaction can occur and form an abscess, with fibroblast migration to this area that forms a wall, resulting in chronic abscess.

If incomplete wall formation, a perinephric abscess can occur as the infection can spread past the capsule

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6
Q

What is pyonephrosis?

A

Infection confined to the collecting system with ureteral obstruction.

Collecting system is filled with pus, can have inflammatory changes in the renal parenchyma

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7
Q

What nm test is used in kids to detect renal parenchymal infection?

A

Tc99m DMSA

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8
Q

What percentage of uncomplicated pyelonephritis cases are normal on imaging?

A

75%

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9
Q

What are the imaging features of acute pyelonephritis?
ct
us

A

1 - Diffuse enlargement, due to enlargement, focal bulge in renal contour
2- delayed enhancement of collecting system
3 - attenuation of renal collecting system due to edema
4 - decrease in density of nephrogram in affected kidney
5 - wedge shaped striated enhancement of parenchyma
6 - perinephric fat stranding

US - normal or diffuse hypoechoic parenchyma
US - can have focal pyelonephritis with poorly marginated sonolucent mass, lowlevel echoes that disrupt corticomedullary junction
Decrease in power doppler flow

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10
Q

How does partially treated pyelonephritis appear on CT?

A

Rounded or ovioid area of decreased enhancement with poorly defined margins, more masslike with homogeneous hypoattenuation/enhancement

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11
Q

What is the flare pattern on nm scan?

A

Striate distribution of decreased radioactivity

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12
Q

What is the disadvantage of using gallium for pyelonephritis?

A

Normally excreted by kidney in 24 hours

Cant differentiate between kidney and perinephric stranding

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13
Q

How does an acute pyelonephritis appear on US? CT?

A

US - sonolucent lesion with low amplitude echoes reflecting necrosis. Poor through transmission. “Complex mass”

CT - low attenuation (10-20HU) round/ovioid mass without enhancement (Walled off). Borders are indistinct due to surrounding inflammation. +/- gas, can have perinephric inflammation too

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14
Q

How does a chronic pyelonephritis abscess appear?

A

Hypoattenuation core with hypervascular rim on CT.

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15
Q

How does a perinephric abscess form?

A

1 - intrarenal anscess breaks through the capsule

2 - obstruction with urine extravasation

3 - direct extension from adjacent infection

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16
Q

What are the risk factors for perinephric abscesses?

A

Staghorn calculi
Pyonephrosis
Diabetes
Neurogenic bladder

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17
Q

How do perinephric abscesses appear on US?CT?

A

US - masses of variable echogenicity with gas (dirty shadowing)

CT - loculated fluid collection with rim enhancement adjacent to kidney

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18
Q

What are the imaging findings in pyonephrosis?

A

XR - urinary tract calculi
US - dependent echoes, shifting urine debris levels, dense peripheral echoes with shadowing secondary to gas, low level echoes within the dilated collecting system with poor through transmission

CT - grossly dilated collecting system with urine debris level or air fluid level. Will have hydronephrosis. Can have layering of contrast material above purulent material

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19
Q

What patients/bugs are prone to emphysematous pyelonephritis?

A

E coli, klebsiella, aerobacter, proteus

Diabetics

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20
Q

Extension of gas into the perirenal space is important why?

A

Increased mortality than with gas confined to parenchyma

Good survival with nephrectomy

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21
Q

What is emphysematous pyelitis?

A

Gas within the lumen of the renal pelvis or calyces with/without pyelogram or gas within the walls of the renal pelvis

22
Q

Describe

Emphysematous pyelonephritis
Renal abscess
Emphysematous pyelitis

A

Air infiltrating renal parenchyma
Focal parenchymal air collection with fluid
Air in the walls of the renal pelvis or calyces

23
Q

What is the difference between emphysematous pyelonephritis and pyelitis?

A

Pyelonephritis - gas within the parenchyma, poor prognosis

Pyelitis - gas within the collecting system, benign, better prognosis

24
Q

Where is the most common renal fistula formed?

A

Colon

25
Q

What is xanthogranulomatous pyelonephritis?

A

Presence of lipid laden macrophages (xanthoma cells), and other inflammatory cells (plasma, leukocytes, histiocytes)

Usually staghorn calculus

26
Q

Is there a sex predominance in XGP?

A

FEmale 4:1

27
Q

What are the features of XGP?

A

Indolent process, rarely fulminant

Nonfunctiong kidney

Female predominance

28
Q

What are the two types of XGP?

A

Diffuse involvement or focal infection (tumefactive, can simulate mass)

29
Q

What is the imaging in XGP?

A

US - diffuse renal enlargement with central echogenic focus representing stone. Dissue anechoic parenchyma due to inflammation/abscess, calyceal fluid may simulate pyonephrosis

CT - enlarged kidney with poorly defined pelvis. Calculi usually present. High density peripheral areas representing atrophic parenchyma with inflamed columns of bertin

Enhanced scan shows hyperemia at the periphery, around the calyces and into the renal fascia

Tumefactive may simulate a localized water density mass with calculus

30
Q

What is malacoplakia?

A

Granulomatous renal inflammation with presence of distinct histiocytes with basophilic stained inclusion bodies (Michaelis Gutmann bodies) - represent phagocytozed bacterial fragments

Due to enzymatic defect in histiocytes that result in fragmented phagocytaion of bacteria

31
Q

What are the two types of malacoplakia? Which sex gets it more?

A

Female

Multifocal
Unifocal - masslike

32
Q

What are the imaging features of malacoplakia?

A

Multifocal - diffuse enlargement, diminished excretion of contrast enhancement, secondary to extensive renal replacement

US - can have multiple soft tissue masses with less enhancement than normal parenchyma

Can extend to retroperitoneum

Rarely diagnosed preoperatively as it simulates masses and or pyelonephritis

33
Q

How does most chronic atrophic pyelonephritis and scarring occur?

A

Due to papillary anatomy, especially at the poles with compound calyceal opening being more circular and prone to reflux.

34
Q

What is the characteristic appearance of intrarenal reflux scarring?

A

Extends entire thickness of renal parenchyma and associated with deformity of the calyx adjacent tot eh scar

Scar with compensatory hypertrophy of the adjacent normal tissue

US- focal parenchymal loss with hyperechoic scar

35
Q

Who gets reflux scarring most commonly?

A

Kids, usually

36
Q

How does TB affect the kidney (route)

A

Hematogenous spread with bacterial lodging in the corticomedullary junction

Usually bilateral due to hematogenous spread

The lesions spread along nephron and rupture into pelvocalyceal system

37
Q

What are the classic findings of renal TB

A 
Parenchymal calcification
Parenchymal scars
Papillary necrosis
Infundibular structures
Autonephrectomy
38
Q

What are the appearances of the following with TB

Papilla
Parenchyma
Calyces

A

Papilla - ends will have moth eaten irregular appearance. Extensive papillary necrosis develops with formation of frank cavities

Parenchyma - amorphous granular calcification with granulomatous masses, or dense punctate calcification with healed tuberculomas. Can scar as well.

Calyceal - multiple irregular infundibular stenoses or strictures with subsequent hydrocalycosis. “Large calyces with stenosed pelvis and ureter”.

39
Q

What is a putty kidney?

A

Dystrophic calcification within the renal parenchyma seen in TB

40
Q

What is the US appearance of renal TB?

A

Dilated renal calyces without hydropelvis

41
Q

What is the most common fungal agent in renal infection?

A

Candida

42
Q

What is the pattern of involvement of candida in the kidney?

A

Bacteria lodge in the distal tubule, causing multiple medullary and cortical abscesses, leading to acute fungal pyelonephritis.

Fungal involvement of the renal papilla leads to papillary necrosis, which then extrudes into the collecting system leading to mycetoma formation.

43
Q

What is the characteristic finding of candida on imaging?

A

Demonstration of multiple filling defects 1-4cm within the collecting system representing fungus balls

Also get scalloping of the ureters due to submucosal edema

US - multiple nonshadowing fungus balls in dilated calyces

44
Q

What are the findings with infection by

Coccidiomycosis
Cryptococcus
Brucellosis
Actinomycosis

A

Coccidio - papillary necrosis, cavitation, parenchymal calcification

Crypto - cavitation, papillary necrosis, multiple parenchymal abscesses

B - extensive calcification, cavitation, and infundibular strictures

A - usually through GI fistula. Acute pyelonephritis, pyonephrosis, granulomatous renal abscess

45
Q

Who gets brucellosis

A

Meat packers, unpasteurized milk

46
Q

What is the renal appearance of hydatid disease?

A

3 layered hydatid cyst that rapidly grows and destroy the kidney parenchyma, or can be indolent

Daugher cysts form within the mother cyst

Well defined ST mass in renal fossa with curvilinear calcification

Crescent sign - distortion of renal pelvis or calyces

47
Q

What is the crescent sign?

A

Hydatid disease results in distortion of the renal pelvis or calyces

48
Q

What is the bunch of grapes sign?

A

Filling of daugther cysts in connection with pelvis

49
Q

What is the falling snowflake sign

A

Movement of internal echoes within the hydatid cyst (“sand”, hooks, scolices, brood capsules) when patient moves

50
Q

Which type of AIDS (sex vs IDVA) has more renal symptoms

A

IVDA

51
Q

What is the renal appearance of pneumocystis carinii involvement

A

Multiple punctate calcifications

Can be seen in MAI and CMV as well

52
Q

Calcification is seen only in the active forms of what diseases? when is it seen in both active and inactive disease?

A

TB, candidiasis

Pneumocystis, CMV, MAI

Uroradiology (11 decks)

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