Part 2 Flashcards
what are renal calculi also called?
nephroliths, nephrolithiasis, uroliths, urolithiasis, kidney stones
where are renal calculi located?
collecting (pelvico-calaceal) system
80-90% of renal calculi are?
opaque and probably could be seen on plain film
what do renal calculi look like?
small and homogeneously dense structures (no lucent centers)
round, oval, irregular in shape, often with a peak
where are renal calculi located on a lateral film?
they ill overlie the spine often over the arch or posteiror aspect of the vertebral bodies
when are renal calculi painful?
when they obstruct, can cause LBP
staghorn calculi
when calcium may fill calyces and renal pelvis
are ureteral calculi visible?
yes, usually
what do ureteral calculi look like? how big are they?
homogenous and oval or irregular in shape
1-3 mm, can be up to 5 mm
locations where ureteral stones tend to lodge.
L1-3 paraspinally at pelvicoureteral junction
brim of pelvis
within 1 inch of ischial spine superiorlyly at teh vesicoureteral junction (MC)
differences between ureteral calculi and phelboliths
phleboliths- below the ischial spines not move much on future films
what can obstruction because of renal calciuli cause?
significant pain, hydronephrosis
how soon do stones usually pass?
3-4 days
bladder calculi can be overlooked when?
they are small, they can be large
what do bladder calculi look like?
usuallyround, oval or stellate
what are the usual causes of bladder calculi?
urinary stasis (MC)
infection
elderly males
where are bladder calculi located on xray?
suprapubic region close to midline
could be found higher or laterally positioned if there is prostatic hypertrophy
nephrocalcinosis
appear as small clumps of stippled (punctate) calcifications in the kidney parenchyma
bilateral and widespread
are gallstones visible on xray?
not usually
what are more commonly seen in chiropractic offices?
gallbladder stones
what do gallstones look like on film
multiple stones with faceted (flat) surfaces and a peripheral rim of calcification
can be laminated if old
lucent internal branching cracks filled with nitrogen gas may be seen internally (mercedes benz sign
when do you see a mercedes benz signs?
when old stones dehydrate and shrink
where are gallstones located on film?
RUQ
when can a patient experience pain with gallstones?
small stones pass easily
recurrent cholecystitis
obstruction of a duct
perforation of gallbladder with fistula formation (to duodenu or colon
what is the gas often found in the ducts from gallbladder stones called?
pneumobilia
what other disorder can occur from gallstones?
peritonitis
a large stone can cause bowel obstruction
what is the worst case senario concerning the gallbladder?
cancer
describe milk of calcium bile
bile that has a lot of calcium
gallbladder looks white
upright films demonstrate a horizontal fluid level
what is a petrified gallbladder due to?
unknown, maybe cholecysitis
describe what you would see on a film with petrified gallbladder?
thin linear calcification in the muscular wall or submucosal layer of the gallbladder
pear, ovoid or round shaped
usually cystic duct obstruction, but may not be seen
describe pancreastic calcifications seen on film
punctate densities in the pancreatic duct
usually located on both sides of the spine (cross midline)
what are pancreatic calcifications usually due to?
chronic inflammatory process
chronic alcoholics
where are adrenal gland calcifications located?
paraspinally at L1 level on AP film
lateral film: overly spine
pattern of adrenal gland calcifications
punctate and cystic- curvilinear or ringed
why might someone get adrenal gland calcifications?
neonatal hemorrhage (punctate)
post traumatic hemorrhage (punctate or cystic)
TB and histoplasmosis (punctate, TB cystic too)
31% of cortical malignancies contain?
calcium
what do lymph node calcifications look like?
small solid calcifications clumped in clusters
irregular and mottled interior
often multiple, could be singular
where are the lymph node calcifications usually located?
close to psoas muscle on AP
mesenteric nodes are anterior to spine on lateral
what are the MC calcific abdominal lymphatics?
mesenteric
where are para-aortic nodes located?
close to the spine at L2-4 (rare)
calcified lymphnodes are due to?
healed infections (TB)
what is the most common region of have lymph node calcifications?
hilar region of the chest
what are splenic calcifications usually due to?
TB, histoplasmosis, maybe brucellosis
what do splenic calcifications look like?
small, solid, scattered (punctate)
what else can appear like a splenic calcification?
phleboliths in hemangiomas
cystic calcifications of spleen are due to?
echinococcal infestation (hydatid disease)
hemorrhage cyst
congenital
hepatic calcifications look like what?
usually small solid densities scattered throughout the liver
usually punctate
rarely cystic (due to hydatid disease) or a single solid density may be found
very rarely small “sand like” or “poppy seed” densities are found with some metastatic carcinoma
the small hepatic calcifications are usually due to?
TB or histoplasmosis (granulomatous)
hemangiomas of the liver may have?
dense phleboliths
what is the most common coprolith?
appendicolith
who can get appendicoliths?
child or adult
many demonstrate calcium, but not all
what do appendicoliths look like?
homogenous, laminated or ringed calcifications within the appendix
small, up to 4 cm
where are appendicoliths located?
RLQ superimposed over ilium and anterior to the spine of the pelvis
what are appendicoliths usually due to?
calcification around a swallowed pit or seed
are appendicoliths associated with appendicitis?
yes, in over 1/2 of patients
what can appendicoliths bee seen with in appendicitis?
a lot of bowel gas
much higher rate of rupture with appendicoliths
are appendicoliths usually symptomatic?
no
describe what a cyst calcification looks like?
wall is a smooth calcific curvilinear rim of density
if there is internal calcification it is ill definied and less dense than the periphery
cysts demonstrate 3 basic shapes, what are they?
round
ovoid
flattened
what are the most common cyst sites?
kidney (benign or malignant) pancreas (rarely calcify) spleen liver adrenal gland
what are the 2 major types of cysts?
congenital
acquired
congenital cyst
true cyst
epithelial lined, less common
acquired cysts
(pseucocytes)
lined by fibrous tissue and more common
what can cause acquired cysts?
trauma (blood)
infection (pus)
parasites
tumors
when tumors calcify, what do they look like?
sand-like
poppy-seed densities
what are the most often mentioned calcifications?
ovarian serous adenocarcinomas
its metastases are the most often mentioned and are called psammomatous bodies or psammoma
neuroblastoma
same pattern as an ovarian serous adenocarcinoma
but in a young child and found aroun dhte area of the adrenal gland and kidney
