Lecture 22 - Imaging Flashcards
What vertebral levels do the kidneys lie between?
L1 - L3
What do you remember to analyse an abdomen x-ray?
ABDO X
What does ABDO X stand for when analysing an abdomen x-ray?
A = air
B = bowel
D = dense structures and calcification
O = organs and soft tissues
X = eXternal objects, lines and tubes
Slide 3: Image 1
What is the abnormality?
What wll the patient experience?
Renal stone in right ureter
Right sided loin to groin pain
What are renal stones most commonly made of?
Calcium Oxalate / phosphate
What are some ways of identifying renal tract stones?
CT (kidneys, Ureter and bladder)
US for hydronephrosis
MRI for pregnancy
What are some complications of renal stones?
Infection
Urine leak
What is steinstrasse?
Translates to stone street
When there are multiple stones (usually fragments) in the distal ureters post-lithotripsy
They are usually small fragments of stones in a row
Slide 4 X-ray 2:
What is the abnormality?
How does the patient present?
Steinstrasse
Multiple renal stones in the distal ureter
Urine retention
Pain
May get infection
Slide 4 X-ray 3:
What is the abnormality?
How does the patient present?
Right sided kidney mass (swollen indistinct kidney)
Could be renal cell carcinoma
Slide 4 X-ray 4:
What is the abnormality?
How does the patient present?
Left sided accessory ureter
Asymptomatic (usually an incidental finding)
Slide 4 X-ray 5:
What is the abnormality?
What is this?
Cystectomy
Where the bladder is removed and the ureters are put into the ileum (ilisotomy)
What is Fluroscopy?
Series of moving x-rays
Slide 4 Fluroscopy 6:
What is the abnormality?
How does the patient present?
Diverticula
Prolapse of bladder mucosa through bladder wall
Asymptomatic unless become inflamed or infected
What is ultrasounds used to image?
Hydronephrosis
Stones
How are the dark areas on ultrasound described?
How are the light areas on ultrasound described?
Dark = hypoechoic
Light = hyperechoic
Slide 5 ultrasound 7:
What is the abnormality?
How does the patient present?
Diverticula of bladder
Asymptomatic
If a patient has a renal tract stone how should they lie in the CT scanner and why?
Lie on their front
Ureters enter the bladder posteriorly
Therefore by lying patient on their front it means if stone is stuck in ureter it’ll stay where it is, if its in the bladder it will fall and press against the anterior wall of the bladder
Slide 5 CT 8:
What is the abnormality?
How does the patient present?
Left sided ureteric stone
Loin to groin pain
Can get infection
Could eventually develop into hydroureter then hydronephrosis
Slide 5 CT 9:
What is the abnormality?
How does the patient present?
Horseshoe kidney (where the poles of the kidneys fuse)
Asymptomatic but the kidney is vulnerable to trauma
What vertebral level does a horseshoe kidney reside at and why?
L3
Since it gets trapped by the inferior border of the inferior mesenteric artery branching from the aorta
What is the most common type of renal tract malignancy?
Renal cell carcinoma
What is the use of CT n Renal Cell carcinoma?
Measure invasion and metastases
What is the use of US for renal cell carcinoma?
Screening for haematuria and biopsy guidance
Why are MRIs used with renal cell carcinoma?
Used specifically to assess and follow up cystic lesions
What is the most next common types of renal tract malignancy following renal cell carcinoma?
Transitional cell carcinoma (ureteric cancer/urothelial cell carcinoma)
What imaging is done for transitional cell carcinoma and why?
CT = locate measure and follow up
US = for hydronephrosis
Fluroscopy = nephrostomy
What is crossed fused ectopia?
Where the 2 kidneys end up being fused together so 1 side is without a kidney
What are patients with crossed fused ectopia at risk of?
Stones
Infection
Hydronephrosis
What is the most common anatomy anomaly?
Duplex collecting system
So can be 2 renal pelvises, bifold ureter or double ureters
Slide 7 CT 10:
What is the abnormality?
How does the patient present?
Right sided pyelonephritis
Kidney is swollen and has poor contrast uptake
Fever
Flank pain
Nausea or vomiting
Pain on urination
Urgency
Slide 7 CT 11:
What is the abnormality?
Calcification in kidney
Slide 7 CT 12:
What is the abnormality?
How does the patient present?
Right sided kidney injury due to trauma
Blood in perinephric space visible
What is bright in a T1 MRI?
What is bright in a T2 MRI?
T1 = fat
T2 = fluid (water/H20. H two 0, T Two)
Slide 13 MRI 13:
What is the abnormality?
How does the patient present?
Polycystic kidney Disease (PKD)
30-40yrs
Hypertension
Acute loin pain
Haematuria
Bilateral palpable kidneys
What imaging procedure is usually done to aid a nephrostomy?
X-rays/fluroscopy
Slide 7 Image 14:
What is the abnormality?
Crossed fused ectopia
