Peds GU Flashcards
vesicoureteral reflux –> predisposes to what?
predispose to acute pyelonephritis –> renal scarring –> irrev loss of renal fx
vesicoureteral reflux –> grading?
I: reflux into ureter II: reflux into renal pelvis III: blunted calyces IV: mod hydroureter V: severe tortuous hydroureter
vesicoureteral reflux –> what nuc med studies can evaluate VUR? (2)
- radionuclide cystogram (RNC)
- Tc-99m DMSA renal scintigraphy (DMSA scan)
vesicoureteral reflux –> preferred initial study?
VCUG
vesicoureteral reflux –> most sensitive study?
radionuclide cystogram (RNC)
radionuclide cystogram (RNC) –> grading?
1: ureteral reflux
2: reflux up to calyces
3: hydroureter
renal cortical scarring –> gold standard study?
Tc-99m DMSA renal scintigraphy (DMSA scan)
radionuclide cystogram (RNC) –> what radionuclide?
Tc-99m pertechnetate
what is Weigert-Meyer rule?
renal duplex system:
- upper moiety –> ectopic insertion –> inf-med
- lower moiety –> orthotopic insertion –> sup-lat
renal duplex system –> upper vs lower moiety –> predisposed to what?
- upper moiety –> ureterocele –> obstruction
- lower moiety –> VUR
hydronephrosis –> ddx? (2)
- VUR
- UPJ obstruction
hydroureteronephrosis –> at UVJ level –> ddx? (2)
- VUR
- UVJ obstruction
what is renal ptosis (nephroptosis?
“floating kidney” –> kidney drops down into pelvis when pt stand
hydronephrosis –> unilat –> MCC?
UPJ obstruction
UPJ obstruction –> cause? (3)
- aberrant renal A –> compress ureter
- ureter –> aperistaltic segment
- idiopathic
congenital bladder outlet obstruction –> MCC?
posterior urethral valve
posterior urethral valve –> bladder –> US findings?
dilated bladder –> trabeculations
posterior urethral valve –> what is “keyhole”?
dilated posterior urethra + bladder
posterior urethral valve –> which structures will be dilated? (3)
- prostatic urethra
- bladder
- renal collecting system
prune belly synd –> consists of what triad?
- hydroureteronephrosis, renal dysplasia
- ant abd underdevelopmt
- cryptorchidism
urethra, bladder, renal collecting system –> dilated –> ddx? (2) how to differentiate?
- posterior urethral valve –> only posterior urethra dilated
- prune belly synd –> entire urethra dilated
ureterocele –> 2 types?
- ectopic –> ectopic ureter
- simple –> orthotopic ureter
ureterocele –> US appearance?
cyst within bladder
ureterocele –> VCUG appearance?
round filling defect in the bladder
obstruction at the UVJ–> causes? (2)
- ureterocele
- primary obstructive megaureter
bladder outlet obstruction –> causes? (2)
- posterior urethral valve
- neurogenic bladder
multicystic dysplastic kidney –> pathophys?
fetal urinary obstruction –> progressive renal dysplasia –> kidney gradually involutes
multicystic dysplastic kidney –> key finding?
mult NON-communicating cysts –> replace renal parenchyma
isolated simple renal cyst –> common or rare in children?
rare
isolated simple renal cyst –> if seen, may reflect what condition? (2)
- tuberous sclerosis
- von Hippel-Lindau
tuberous sclerosis –> synd? (6)
- renal cysts
- renal angiomyolipoma
- cardiac rhabdomyoma
- CNS cortical hamartoma
- subependymal nodule
- subependymal giant cell astrocytoma
von Hippel-Lindau –> synd? (5)
- renal cysts
- RCC
- adrenal pheochromocytoma
- pancreatic cyst/islet cell tumor/serous cystadenoma
- brain/spinal cord hemangioblastoma
multilocular cystic nephroma –> benign or malig?
benign
multilocular cystic nephroma –> epidemiology?
- 3mo-2yo M
- middle age F
multilocular cystic nephroma –> appearance?
multiseptated cystic mass –> enhancing septa
multilocular cystic nephroma –> characteristic finding?
herniate into renal pelvis –> hydronephrosis
kidney –> multiseptated cystic mass –> ddx? (2)
- multilocular cystic nephroma
- cystic Wilms tumor
pediatric population –> ADPKD or ARPKD?
recessive
ARPKD –> kidneys –> US appearance?
cysts too small to see –> kidneys are enlrged & echogenic
ARPKD –> assoc w what fetal conditions? (2)
- oligohydramnios
- pulm hypoplasia
Wilms tumor –> arises from what embryologic tissue?
persistent metanephric blastema
what conditions have increased risk for Wilms tumor? (4)
- Beckwith-Wiedemann synd
- WAGR synd
- horseshoe kidney
- trisomy 18
Beckwith-Wiedemann synd –> synd? (5)
- hemihypertrophy
- macroglossia
- omphalocele
- neonatal hypoglycemia
- childhood malig (ie Wilms tumor, hepatoblastoma)
WAGR synd –> synd? (4)
- Wilms tumor
- aniridia
- GU anomaly
- mental retard
Wilms tumor –> imaging appearance?
heterogeneous solid renal mass
heterogeneous solid renal mass –> pediatric –> ddx? (2) how to differentiate?
- Wilms tumor: 3-5yo
- mesoblastic nephroma: <1yo
what is claw sign?
normal parenchyma surrounding large mass –> indicates that the mass is arising from that organ
Wilms tumor –> like to metastasize where? (3)
- liver
- lung
- bone
sickle cell –> predisposed to what kind of RCC?
renal medullary CA
rhabdoid tumor –> occurs in what organ? (2)
- kidney
- brain
rhabdoid tumor –> imaging appearance?
lrg heterogeneous soft tissue mass –> ill-defined –> infiltrate renal hilum
clear cell sarcoma –> like to metastasize where? (1)
bone
pediatric –> renal mets –> MC primary? (2)
- neuroblastoma
- leukemia/lymphoma
lymphoma –> renal mets –> imaging appearance? (2)
- mass
- diffuse infiltration
mesoblastic nephroma –> benign or malig?
benign
heterogeneous solid renal mass –> may be benign mesoblastic nephroma –> tx? why?
can’t differentiate from Wilms tumor –> surgical resection
mesoblastic nephroma –> arises from what embryologic tissue?
persistent mesonephric blastema
what is nephroblastomatosis?
persistence of metanephric blastema
nephroblastomatosis –> imaging appearance?
bilateral enlrged kidneys –> nonenhancing lobular masses/nodules
nephroblastomatosis –> precursor to what condition?
Wilms tumor
multiple renal angiomyolipomas –> what condition?
tuberous sclerosis
renal AML –> what size (cm) has risk of hemorrhage?
> 4cm
renal AML –> key imaging characteristic?
macroscopic fat
persistent metanephric blastema –> can lead to what condition? (3)
- Wilms tumor
- mesoblastic nephroma
- nephroblastomatosis
pediatric –> mult solid renal masses –> ddx? (4)
- nephroblastomatosis
- lymphoma
- multifocal pyelonephritis
- multiple infarcts
neuroblastoma –> arises from what kind of tissue?
primitive neural crest cell –> sympathetic change
neuroblastoma –> MC arises from what organ?
adrenal gland
Wilms tumor –> displace or encase vessels?
displace
neuroblastoma –> displace or encase vessels?
encase
neuroblastoma –> calcifications or no calcifications?
50% have calcifications
neuroblastoma –> MRI –> does it demonstrate restricted diffuse? why?
hypercellular –> restricted diffusion
what NM scan can be used to evaluate neuroblastoma?
I-123 MIBG scintigraphy
metastatic neuroblastoma –> classic presentation?
intracranial subdural mass arising from BM
neuroblastoma –> MRI –> often seen invading into what?
neuroforamina & spinal canal
neuroblastoma –> mets –> MC organ?
BM
imaging features suggestive of neuroblastoma –> what is another differential consideration?
ganglioneuroma
ganglioneuroma –> benign or malig?
benign
neuroblastoma vs ganglioneuroma –> how to differentiate? (2)
neuroblastoma: very young (2yo) –> MRI restricted diffusion
ganglioneuroma: slightly older (6yo) –> no restricted diffusion
neuroblastoma –> benign or malig?
malig
adrenal hemorrhage –> US appearance?
hypoechoic avascular suprarenal mass
hypoechoic avascular suprarenal mass –> ddx? (2)
- adrenal hemorrhage
- neuroblastoma
hypoechoic avascular suprarenal mass –> adrenal hemorrhage vs neuroblastoma –> how to differentiate? (2)
followup:
- adrenal hemorrhage –> involute
- neuroblastoma –> not involute
adrenal cortical CA –> assoc w what condition? (2)
- Beckwith-Wiedemann synd
- Li-Fraumeni synd
urachal anomaly –> possible complication?
adenoCA
urachal anomaly –> 4 types?
- patent urachus
- urachal cyst
- urachal sinus
- vesicourachal diverticulum
what is duplication cyst?
rare congenital cystic malformation of GI tract
rectal duplication cyst –> locaiton?
retrorectal space
rectal duplication cyst –> tx? why?
malig potential –> surgical resect
what is hydrometrocolpos? can be seen in what pt pop?
neonatal –> fluid-filled vagina + uterus
what is hematometrocolpos? can be seen in what pt pop?
puberty –> blood-filled vagina + uterus
hydrometrocolpos or hematometrocolpos –> what does it indicate?
outflow tract obstruction (ie. congenital imperforate hymen)
mullerian duct cyst –> occur in M or F?
M only
mullerian duct cyst –> location?
midline pelvis –> usu prostate
midline prostatic cyst –> ddx? (2) how to differentiate? (3)
mullerian duct cyst:
- present 30s-40s yo
- not comm w urethra
- usu larger than utricle cyst –> extend above prostate
prostatic utricle cyst
- 10s-20s yo
- comm w urethra
- small –> not extend above prostate
what is prostatic utricle? normal or abnormal?
terminal remnant of Mullerian duct –> normal
MC sarcoma of childhood?
rhabdomyosarcoma
rhabdomyosarcoma –> MC locations? (2)
- head/neck
- pelvis
8yo –> painless proptosis –> no infx –> dx?
rhabdomyosarcoma
US –> unilat empty renal fossa –> ddx? (2)
- renal agenesis
- cross fused renal ectopia
