Pelvocalyceal System And Ureter Flashcards
1
Q
Imaging method of choice for evaluation of hematuria and a screening examination of the pelvicalyceal system and ureters
A
CT urogram
2
Q
CT urogram is limited by
A
Low spatial resolution
3
Q
If contrast is contraindicated for MR, what can be utilised
A
Heavy T2WI - due to high signal from urine
4
Q
Performed by cystoscopic catheterization of the ureteal orifice followed by contrast injection, is independent of renal function, provides high-quality images of the ureter and collecting system and is another alternative commonly utilized by urologists
A
Retrograde pyelopgraphy
5
Q
Imaging choice if percutaneous nephrostomy catheter is present
A
Antegrade pyelography
6
Q
Imaging method of choice for screening for hydronephrosis but is limited in its ability to demonstrate small uroepithelial tumors
A
Ultrasound
7
Q
Collecting tubules of medullary pyramid coalesce into a variable number of papillary ducts that pierce the tip of the papilla and drain into the receptacle of the collecting system
A
Minor calyx
8
Q
Projection of a papilla into the calyx produces what shape
A
Cup shape
9
Q
Sharp-edged portion of the minor calyx projecting around the sides of a papilla is called
A
Fornix
10
Q
Formed by the projection of two or more papilla into the calyx, usually found at the poles of the kidney
A
Compound calyces
11
Q
Triangular in shape with its base within the renal sinus
A
Renal pelvis
12
Q
Predominantly outside the renal sinus and is larger and more distensible than the more common intrarenal pelvis, which is surrounded by renal sinus fat and other structures
A
Extrarenal pelvis
13
Q
Responsible for ureteral peristalsis
A
Outer circular muscularis and inner longitudinal muscle bundles
14
Q
Lined by transitional epithelium
A
Pelvicalyceal system, ureters and bladder
15
Q
Ureters enter the bladder at an ______ angle
A
Oblique
16
Q
When the bladder wall contracts, ureteral orifices are closed or open?
A
Closed
17
Q
Three main points of ureteral narrowing, where calculi are likely to become impacted
A
Ureteropelvic junction
Site at which the ureter crosses the pelvic brim
Ureterovesical junction
18
Q
in ureteral duplication, what is more common, unilateral or bilateral?
A
unilateral
19
Q
states that with complete ureteral duplication, the ureter draining the upper pole passes thru the bladder wall to insert inferior and medial to the normally placed ureter draining the lower pole
A
Welgert-Meyer rule
20
Q
In females, ectopic ureter may insert into
A
lower bladder, upper vagina or urethra
21
Q
in males, ectopic ureter may insert into
A
lower bladder, prosthetic urethra, seminal vesicles, vas deferent or ejaculatory duct
22
Q
the upper pole ureter in ureteral duplication often ends as an
A
ectopic ureterocele
23
Q
where does the lower pole ureter inserts in relation to the bladder trigone in ureteral duplication
A
in or near the normal location in the bladder trigone
24
Q
lower ectopic ureter is susceptible to
A
vesicoureteral reflux
25
complications of complete ureteral duplication
UTI, vesicoureteral reflux, UPJ obstruction of lower pole system
26
lower pole system in ureteral duplication when displaced inferiorly commonly shows a _____ appearance
drooping lily appearance
27
True or false: bifid renal pelvis has no pathologic consequence
true
28
common congenital ureteral anomaly that may go undiagnosed until adulthood
ureteropelvic junction obstruction
29
Developmental variant in which the right ureter passes behind the IVC and aorta to return to its normal position
Retrocaval ureter
30
Retrocaval ureter is usually associated with
urinary stasis and proximal pyeloureterectasis
31
This anomaly is due to faulty embryogenesis of the IVC, with abnormal persistence of the right sub cardinal vein anterior to the ureter instead of the right supra cardinal vein posterior to the ureter
Retrocaval ureter
32
Most common etiology of renal calculi
calcium oxalate, calcium phosphate
33
unique form of calcium phosphate stones that tends to recur quickly if patients are not treated aggressively
Brushite
34
stones that are resistant to shock wave lithotripsy
Brushite
35
Stones that are formed in the presence of alkaline urine and infection
Struvite (magnesium ammonium phosphate)
36
Most common component of stag horn calculi
Struvite
37
Mildly radiopaque stones and are found only in patients with congenital cystinuria
Cystine stones
38
Radiolucent stones
Uric acid, xanthine and indinavir stones
39
CT attenuation of calculi
>200 HU
40
CT attenuation of other collecting system lesions such as tutors, hematoma, fungus balls or sloughed papilla
<50 HU
41
Modality used to determine chemical composition of stones
Dual-energy CT
42
Common complaint of patients with urolithiasis
acute flank pain
43
most common cause of acute flank pain, caused by a calculus obstructing the ureter
renal colic
44
Modality of choice for detecting urolithiasis
non contrast enhanced CT
45
CT attenuation of calcium oxalate stones
1700-2800 HU
46
CT attenuation of calcium phosphate stones
1200- 1600 HU
47
CT attenuation of brushite stones
1700- 2800 HU
48
CT attenaution of uric acid stones
200-450 HU
49
CT attenuation of struvite stones
600-900 HU
50
CT attenuation of cystine stones
600-1100 HU
51
CT attenuation of indinavir calculus
15-30 HU
52
halo of soft tissue surrounding the calculus is called ____ which confirms the stone location within the ureter
tissue rim sign
53
what sign is present representing a thromboses vein, which is a tubular tail extending from the calcification
tail sign
54
Attenuation value of phleboliths
160 HU
55
High attenuation in renal pyramids is a sign of ______ and must not be mistaken for stones
dehydration
56
Stones that are less than ___mm in size are likely to pass spontaneously thru the ureter within 6 weeks
<6 mm
57
defined as dilatation of the upper urinary tract
hydronephrosis
58
Multiple or multolobulated cysts that occupy the renal sinus. Contains clear fluid and may be lymphatic or post traumatic in origin
Parapelvic cysts
59
Postcontrast MDCT signs of obstruction include
- increasingly dense nephrogram with time
- delay in appearance of contrast in collecting system
- dilated pelvicalyceal system and ureter to the point of obstruction
60
complication that may result from rupture of fornix precipitated by contrast-induced diereses superimposed on the increase hydrostatic pressure of an obstructed pelvicalyceal system
pyelosinus reflux
61
infection in an obstructed kidney. it must be treated promptly by relief of obstruction by ureteral stent or nephrostomy tube placement and antibiotics
pyonephrosis
62
modality of choice for pyonephrosis
CT
63
common cause of hydronephrosis in children
vesicoureteral reflux
64
in adults, vesicoureteral reflux is usually associated with
neurogenic bladder or bladder outlet obstruction
65
modality of choice for vesicoureteral reflux
cystourography or radionuclide cystography
66
basic defect causing vesicoureteral reflux in children
abnormal ureteral tunnel at the UVJ
67
Sequelae of chronic vesicoureteral reflux
reflux nephropathy
68
due to an aperistaltic segment of the lower ureter 5-40 mm in length causing a functional obstruction and resulting in dilation of the proximal ureter. Ureter demonstrates smoothly tapered narrowing without evidence of mechanical obstruction
congenital megaureter
69
ureteral dilation in congenital megaureter exceeds
7 mm
70
also called Eagle-Barrett syndrome, a congenital disorder manifest by absence of abdominal wall musculature, urinary tract anomalies and cryptorchidism
Prune belly syndrome
71
nearly all patients with prune belly syndrome are male or female?
male
72
Ureteral defect in prune belly syndrome
markedly dilated and tortuous ureters, enlarged bladder, dilated posterior urethra
73
Associated with acute diuresis, diabetes insipidus and may cause mild to severe hydronephrosis
Polyuria
74
Most common cause of filling defects in contrast-filled collecting system or ureter
Calculi
75
Accounts for 85-90% of all uroepithelial tumors and is the second most common primary renal malignancy
Transitional cell carcinoma
76
Most common pattern of growth of TCC
papillary growth, that is exophytic, polypoid and attached to the mucosa by a stalk
77
Stippled pattern of contrast material within the intersticrs of the papillary lesion is characteristic of
Transitional cell carcinoma
78
Nodular of flat form oF TCC that tend to be infiltrating and aggressive
Nonpapillary tumors
79
Type of TCC that cause strictures of the collecting system or ureter rather than a focal mass
Nonpapillary
80
Most TCC occurs in what age and gender
Men,age 60 years old and older
81
Chemical agents used in the textile and plastic industries, drugs including cyclophosphamide and phenacetin, chronic urinary stasis (horseshoe kidney) and smoking play a role in the etiology of what tumor
TCC
82
Standard tx for upper tract TCC
Total nephroureterectomy and excision of a cuff of the bladder surrounding the ureteral orifice
83
3 typical appearance of TCC of the upper urinary tract
Focal intraluminal mass, thickening of wall and narrowing of lumen of ureter and renal parenchyma
84
Attenuation of TCC
8 to30 HU
85
MR appearance of TCC
T1- isointense compared to renal medulla
| T2- isointense, outlined by high signal urine
86
Appearance of Tcc on ultrasound
Slightly hypo or hyperechoic mass within the renal sinus, absent acoustic shadowing
87
major predisposing factors for squamous cell carcinoma
chronic infection, calculi, phenacetin abuse
88
true or false: metastasis is a rare cause of collecting system mass
true
89
ischemic necrosis of the tips of the medullary pyramids. causes include infection, TB, sickle cell trait and disease, diabetes and analgesic nephropathy
papillary necrosis
90
benign fibrous polyp covered by transitional epithelium. most common in young adult men
fibroepithelial polyp
91
benign process of subcumucosal cyst formation associated with chronic urinary tract infection. multiple , small (2 to 3 mm) smooth, round filling defects in the ureter are characteristic. cysts in renal pelvis tend to be larger, up to 2cm
pyeloureteritis cystica
92
rare inflammatory condition of the uroepithelium related to chronic urinary tract infection and calculi. squamous metaplasia with keratinization and desquamation results in irregular plaques in the renal pelvis, proximal ureter and bladder
leukoplakia
93
clinical feature is passage of flakes or desquamated epithelium in the urine
leukoplakia
94
leukoplakia is considered a premalignant condition in the ____
bladder, but not in the ureter
95
rare granulomatous condition of the uroepithelium associated with chronic infection, especially due to E.coli. Smooth submucosal nodules composed of histiocytes produce multiple smooth nodules in the distal ureter and bladder. this condition is not premalignant but can be aggressive extending outside of the urinary system
malacoplakia
96
fixed narrowing of the pelvicalyceal system
stricture
97
True or false: a diagnosis of ureteral stricture should never be made unless dilation of the ureter or pelvis above the point of narrowing is present
true
98
what type of tumor manifest as a stricture of the pelvis and ureter
squamous cell carcinoma
99
extrinsic encasement of ureter by tumor or inflammatory processes is common cause of stricture which include
lymphoma, cervical carcinoma, colon carcinoma, endometriosis, Crohn disease, diverticulitis and PID
100
uropethelium-lined cavities in the renal parenchyma that communicate via a narrow channel with the fornix of a nearby calyx
calyceal diverticuli
101
minimum amount of contrast agent that is instilled into the bladder via catheter in CT cystogram
250 cc
102
part of the bladder that is covered by peritoneum
superior and lateral walls
103
lies superior to the urinary bladder and may cause mass impressions on the bladder dome
sigmoid colon, loops of small bowel and uterus in females
104
extraperitoneal part of the urinary bladder
inferior
105
urinary bladder is oval, with the floor parallel to and __ mm above the superior aspect of the symphysis pubis
5-10 mm
106
anteriorly, the bladder is separated from the symphysis pubis by
fat in the extraperitoneal space of Retzius
107
posteriorly, the bladder is separated from the uterus by the
uterovesical peritoneal recess in females and rectovesical peritoneal recess in males
108
four layers of the urinary bladder wall
outer connective tissue adventitia, smooth muscle consisting of circular muscle fibers sandwiched between inner and outer layers of longitudinal fibers, submucosal connective tissue (lamina propria) and mucosa of transitional epithelium
109
triangle at the bladder floor formed by the two ureteral orifices and the internal urethral orifice
trigone
110
with voiding, the trigone descends ___ cm and transforms from a flat surface into a cone with the urethra and apex
1-2 cm
111
congenital deficiency in the development of the lower anterior abdominal wall. bladder is open, and its mucosa is continuous with the skin
bladder exstrophy
112
associated with bladder exstrophy
epispadias and wide diastasis of the symphysis pubis
113
management of bladder exstrophy
urinary diversion, bladder augmentation and skin grafting
114
vestigial remnant of the urogenital sinus and allantois, tubular structure that extends from the bladder dome to the umbilicus along the anterior abdominal wall
urachus
115
obliterated residual of urachus
median umbilical ligament
116
50% of urachal remnant conditions
patent urachus
117
blind-ended dilation of the urachus at the umbilical end that may cause a persistent umbilical discharge
umbilical-urachal sinus
118
presents as tubular structure in the midline abdominal wall extending caudally from the umbilicus
umbilical-urachal sinus
119
an outpouching of the bladder in the anterior midline location of the urachus. this is seen in adults with bladder outlet obstruction as a fluid-filled sac extending cranially from the bladder in midline abdominal wall
vesical-urachal diverticulum
120
develops if the urachus is closed at both ends but remains patent in the midline. imaging shows a fluid-filled cyst in the midline abdominal wall usually in the lower 3rd region of the urachus
urachal cyst
121
urachal carcinoma is usually a ____ and represents 0.5% of bladder carcinoma
adenocarcinoma
122
normal wall of a well-distended bladder should not exceed ___ mm in thickness
5-6 mm
123
may cause uplifting of the bladder trigone, causing J-hooking of the distal ureters, seen in males, particularly those older than 50
BPH
124
chronic bladder outlet obstruction results in
thickening and trabeculation of the bladder wall
125
neurogenic bladder may be
spastic or atonic
126
causes of neurogenic bladder
meningomyelocele, spinal trauma, DM, poliomyelitis, central nervous system tumor and MS
127
causes of cystitis
infection (bacteria, adenovirus, TB, schistosomiasis), drugs (cyclophosphamide), radiation, and autoimmune reaction
128
characterized by multiple fluid-filled submucosal cysts
cystitis cystica
129
further progression of cystitis cystica with proliferation of mucus secreting glands in the lamina propria
cystitis glandularis
130
cystitis glandularis may be a precursor of what type of Ca
adenocarcinoma
131
usually associated with chronic irritation from indwelling catheters. Appears as grape-like cysts that elevate the mucosa
Bullous edema of the bladder wall
132
chronic, idiopathic inflammation of the bladder found most often in women
interstitial cystitis
133
characterized by hemorrhage into the mucosa and submucosa
hemorrhagic cystitis
134
hemorrhagic cystitis is caused by
bacterial or adenovirus
135
imaging features of cystitis
bladder wall thickening and edema
136
infiltration of the bladder wall by eosinophils
eosinophilic cystitis
137
form of bladder inflammation with gas within the bladder wall. associated with poorly controlled DM, bladder outlet obstruction and infection with E.coli, which ferment sugar in the urine to release carbon dioxide and hydrogen gasses
emphysematous cystitis
138
gas within the bladder lumen is seen with
emphysematous cystitis, instrumentation and vesicocolic fistula
139
pathophysiology of bladder wall schistosomiasis
laval cercariae penetrate the skin, enters the lymphatic vessels and circulate eventually to the portal venous system, adult females migrate to the vesical venous plexus and lay their eggs in the wall of urinary bladder and ureter. eggs incite a fibrosing granulomatous reaction that results in a beaded stenosis and irregular dilatation of the ureters and calcification of the eggs
140
sequela of schistosomiasis in ureters
become aperistaltic, resulting in vesicoureteral reflux
141
sequela of schistosomiasis in bladder
become shrunken, fibrotic and contracted
142
complications of bladder schistosomiases
fistulas may develop in perineum and scrotum. renal disease may develop slowly due to functional obstruction and reflux
143
KUB tb affects the primarily the ___ and ____ secondarily
kidneys primarily; ureters and bladder secondarily
144
tuberculous infection of the bladder causes
wall thickening and reduced capacity
145
calcifications in tb are seen in
proximal ureters and may eventually extend into the distal ureters and bladder. calcification of the bladder wall is uncommon and patchy
146
bladder wall calcifications from cystitis include
postradiation cystitis, chronic infection, cyclophosphamide induced cystitis
147
cystic dilatation of the intravesicular segment of the ureter caused by a congenital prolapse of the distal ureter into the bladder lumen at the normal insertion site of the ureter into the trigone
simple ureterocele
148
characteristic appearance of simple ureterocele
cobra head or spring onion appearance
149
usually associated with ureteral duplication
ectopic ureterocele
150
ectopic ureterocele may insert where
distal to the external sphincter into the vestibule, uterus or vagina in females; inserts proximal to external sphincter in males
151
ectopic ureterocele that cause incontinence is usually seen in males or females?
females
152
most common urinary tract neoplasm
TCC
153
hallmark of TCC is
multiplicity and recurrence
154
4% of bladder malignancy that tends to develop in bladders chronically irritated by stones and infection and is highly associated with bladder schistosomiasis
squamous cell carcinoma
155
malignancy that is associated with bladder exostrophy or urachal remnant
adenocarcinoma
156
benign bladder tumors
leiomyoma, hemangioma, pheochromocytoma and neurofibroma
157
most common in the bladder producing hematuria and signs of UTI
malacoplakia
158
herniations of the bladder mucosa between interlacing muscle bundles
bladder diverticula
159
most bladder diverticula are located
posterolaterally near the UVJ
160
complications of bladder diverticula
urinary stasis, infection, stone formation, vesicoureteral reflux and bladder outlet obstruction
161
vesicocolonic fistula commonly occur as a complication of
diverticulitis
162
vesicoenteric fistula is almost always attributable to
Crohn disease
163
80% of bladder ruptures, results from puncture of the bladder by a spicule of bone from a pelvic fracture
extraperitoneal bladder rupture
164
in extraperitoneal bladder rupture, contrast extravasates into the extraperitoneal compartments, most commonly in the
retropubic space of Retzius
165
results from blunt trauma applied to a distended bladder
intraperitoneal bladder rupture
166
intraperitoneal bladder rupture may clinically mimic
acute renal failure
167
contrast extravasation in intraperitoneal bladder rupture is seen in
paracolic gutters
168
true or false: complete filling of the posterior urethra is not possible because contrast runs freely into the bladder
true
169
in VCUG, anterior urethra normally distends fully because of resistance of the
external sphincter at the level of the urogenital diaphragm
170
male urethra is divided into posterior and anterior portions by the
inferior aspect of the urogenital diaphragm
171
posterior urethra in males consists of
prostatic urethra within the prostate gland, from the bladder neck to urogenital diaphragm, and short membranous urethra, which is totally contained within the 1 cm thick urogenital diaphragm
172
anterior urethra of males consists of
extends from the urogenital diaphragm to the external urethral meatus, consists of bulbous urethra extending from the urogenital diaphragm to the penoscrotal junction, penile urethra extending to the urethral meatus
173
anterior urethra in males is entirely contained within the
corpus spongiosum penis, except for the proximal 2 cm of bulbous urethra, called the pars nuda
174
this unprotected part of anterior urethra is particularly susceptible to straddle injury
pars nuda
175
runs vertically through the prostate over a length of 3-4 cm
prostatic urethra
176
oval filling defect in midportion of posterior wall of prostatic urethra is called
verumontanum
177
ejaculatory ducts open into the urethra on either side of the
verumontanum
178
a mullerian remnant that is small, saccular depression in the middle of verumontanum
utricle
179
distal end of verumontanum marks the beginning of ____ which extends to the apex of the cone of bulbous urethra
membranous urethra
180
the voluntary external urethral sphincter within the urogenital diaphragm entirely surrounds the
membranous urethra
181
pea-sized accessory sex glands within the urogenital diaphragm on either side of the membranous urethra. their ducts empty into the bulbous urethra 2 cm distally
cowper gland
182
marks the division between the membranous and bulbous urethra
apex of the cone shape formed by the tapering bulbous urethra
183
divides the bulbous and penile urethra that is marked by suspensory ligament of the penis, which causes a normal bend in the urethra
penoscrotal junction
184
the entire anterior male urethra is lined by
glands of Littre
185
visualization of glands of Littre represent
always abnormal; associated with chronic inflammation and urethral stricture
186
reflux of contrast into prostatic ducts represent
abnormal; associated with prostatitis and distal urethral stricture
187
female urethra varies in length from
2.5 to 4 cm
188
female urethra is embedded in
anterior wall of vagina
189
periurethral abscess usually develops on what part
ventral surface
190
most common complication of urethral stricture
false passage
191
most urethral carcinoma are
squamous cell
192
urethral carcinoma commonly involve the
anterior urethra
193
rare tumors of the posterior urethra are usually
TCC
194
thick-valve membrane that extends obliquely across the lumen from verumontanum to the distal prostatic urethra obstructing the flow of urine
posterior urethral valve
195
most common site of urethral injury in males secondary to trauma
prostatic and membranous urethra
196
classification of posterior urethral injury: contusion without imaging finding
type 1
197
classification of posterior urethral injury: stretch injury with elongation of urethra without extravasation
type 2
198
classification of posterior urethral injury:partial disruption with extravasation of contrast agent from urethra with opacification of bladder
type 3
199
classification of posterior urethral injury:complete disruption of urethra without opacification of bladder and with urethral separation of <2cm
type 4
200
classification of posterior urethral injury: complete disruption of urethra without opacification of bladder and with urethral separation of >2cm
type 5
201
commonly injured male urethral part in straddle injury
bulbous urethra
202
autodigestion of urethra has been reported because of
drainage of pancreatic exocrine enzymes as a complication of pancreatic transplantation with pancreatic drainage into the bladder
