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Year 2 - Renal (DP) > Radiology > Flashcards

Radiology Flashcards

1
Q

Where do the kidneys lie in the retroperitoneum?

A

Paravertebral gutters

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2
Q

What is the level of the hila for each kidney?

A

Left -> L1

Right -> L1/L2

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3
Q

Why is the left renal vein longer than the right?

A

Passes across the aorta anteriorly to join to the right sided IVC

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4
Q

What CT phase is best to depict calculi?

A

Pre-contrast

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5
Q

After the injection of contrast, how long should be waited for the corticomedullary phase of CT?

A

25-70 seconds

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6
Q

After the injection of contrast, how long should be waited for the Nephrographic phase of CT?

A

80-180 seconds

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7
Q

After the injection of contrast, how long should be waited for the excretory phase of CT?

A

5-15 minutes

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8
Q

Which of the following is not a risk factor for contrast nephropathy:

  • Renal impairment - +/- diabetes mellitus
  • Dehydration
  • Congestive heart failure
  • LV ejection fraction > 40%
  • Acute MI (within 24 hours)
  • Nephrotoxic drugs
A

LV ejection fraction > 40%

If it is

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9
Q

What are the hydration protocols to prevent contrast nephropathy?

A

1-1.5 ml/kg/h 0.9% normal saline 6-12hrs before and after contrast administration
Sodium bicarbonate instead of sodium chloride – urine alkalinization – prevention of oxygen free radicals
Bicarbonate administered from 1 hour pre-procedure to 6 hrs post

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10
Q

How do cysts appear on MRI in the following phases:

  • T1
  • T2
A

T1 -> Low/no signal

T2 -> High signal

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11
Q

What causes nephrogenic systemic sclerosis?

A

Exposure to gadolinium containing contrast medium used in MRI

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12
Q

What is a CT urogram used to image?

A

Collecting system
Ureters
Bladder

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13
Q

What is the commonest imaging modality for viewing the bladder?

A

USS

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14
Q

What does a bladder USS allow us to see?

A

Internal calculi (if Calcium)
Bladder wall irregularities
Diverticula

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15
Q

What condition needs met for a bladder USS to be most useful?

A

Bladder must be full

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16
Q

What is cystography the gold standard investigation for?

A

Bladder wall tears

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17
Q

What tumour staging is CT best for?

A

Nodal mets

Distant mets

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18
Q

What tumour staging is MRI best for?

A

Local staging of bladder wall tumours

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19
Q

What is a retrograde urethrogram used for?

A

Urethral:

 - Strictures
 - Trauma
 - Diverticula
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20
Q

What is the modality of choice for imaging the testes, uterus, ovaries and prostate?

A

USS

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21
Q

What is the modality of choice for imaging infertility (tubal patency) and uterine abnormalities?

A

Hysterosalpingogram

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22
Q

What is the mediastinum testis?

A

Infolding of tunic albuginea

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23
Q

What is the first line investigation is pyelonephritis or a gynaecological condition is thought to be the source of renal colic?

A

USS

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24
Q

If a patient with renal colic is pregnant, what investigations should be done?

A

USS and/or MRI

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25
Q

Which calculi can be seen on x-ray?

A

Calcium (dense)

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26
Q

What is the first line investigation for suspected renal colic?

A

KUB X-ray

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27
Q

Where do the ureters pass in relation to the psoas muscles?

A

Anteriorly over them

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28
Q

Where do the ureters descend in relation to the tips of the lumbar transverse processes?

A

Anteriorly

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29
Q

How can we visualise the collecting systems, ureters and bladder on x-ray?

A

IV urogram (contrast)

30
Q

Where do ureteric calculi often get stuck?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

31
Q

Where do renal calculi mimics tend to lie?

A

More lateral in the pelvis

32
Q

How can you tell the difference between a renal stone and a phlebolith?

A

Phlebolith:

 - Lie more laterally
 - Calcified but have a slightly radiolucent centre
           - > Calculi are completely radio-opaque
33
Q

What are phleboliths?

A

Dislodged clots

34
Q

How does USS help diagnose renal stones?

A

Can’t see stone itself due to bowel obscuring image, but it will show associated hydronephrosis

35
Q

What is the definitive test to confirm a symptomatic ureteric calculus?

A

Non-contrast enhanced CT

36
Q

What will a CT alo show in renal calculi?

A

Signs of obstruction:

 - Perinephric stranding
 - Hydroureteronephrosis
37
Q

What are some potential differentials for renal calculi that will be seen on CT?

A

Appendicitis

Hernia

38
Q

Where does macroscopic haematuria tend to arise from?

A

Kidney
Ureter
Bladder
Urethra

39
Q

If the source of haematuria is suspected to be from the kidneys, collecting system or ureters, what modality is the first line if the patient is older than 50?

A

CT urography

40
Q

If the source of haematuria is suspected to be from the bladder or urethra, what modality is the first line if the patient is older than 50?

A

Cystoscopy

41
Q

What is the most sensitive way to detect renal parenchymal tumours or urothelial tumours of the collecting systems or ureters?

A

CT urogram

42
Q

In patients younger than 50 with macroscopic haematuria, why are USS and cystoscopy preferred?

A

Incidence of urothelial tumours is low, so routine CTU which gives a double dose of radiation is unjustified

43
Q

When is a CTU used in patients younger than 50 with macroscopic haematuria?

A

If USS and cystoscopy are normal and haematuria persists

44
Q

In what patients is an MR urography useful?

A

COntrast allergy
Renal impairment
Pregnancy

45
Q

How would an angiomyolipoma appear on CT?

A

Dark grey:

 - High fat content
           - > Less dense than surrounding parenchyma
46
Q

When would a CT scan be taken if there is a suspected renal cortex tumour?

A

100 seconds after contrast

47
Q

What is the ‘density’ or normal fluid on CT?

A
48
Q

If the ‘density’ of a substance inside a cyst on CT is >20 what might you suspect?

A

Malignancy

49
Q

What are features of complex cysts on CT?

A

Solid areas

Thick septa

50
Q

Fluid density filled cysts and uniform cysts are usually what?

A

Benign

51
Q

Solid (non-cystic) masses >3cm are usually what?

A

Malignant

52
Q

‘Cannon ball’ mets

A

Renal tumours mets in the lungs

53
Q

What investigation can be used to diagnose renal artery stenosis?

A

MRI

54
Q

If the kidney appears small on imaging, what process is occurring?

A

A chronic cause

55
Q

What will a USS of hydronephrosis show?

A

Dilated renal pelvis and calyces

56
Q

If the kidney appears normal/large on imaging, what process is occurring?

A

Acute injury

57
Q

On an US doppler of epididymo-orchitis, how will the testis appear?

A

Hypervascular (lots of colour)

58
Q

On an US doppler of testicular torsion, how will the testis appear?

A

Hypovascular (no/very little colour)

59
Q

Which of the following is not a common cause of painless testicular swelling:

  • Hernia
  • Tumour
  • Varicocoele
  • Hydrocoele
  • Epididymal cyst
A

Tumour

60
Q

What is a varicocoele?

A

Dilated scrotal venous plexus with tortuous veins usually >2mm in diameter

61
Q

Why do varicocoeles typically occur on the left?

A

Renal tumour may extend into left renal vein, which can result into the left gonadal vein being occluded

62
Q

What else must also be scanned in a varicocoele?

A

Kidneys

63
Q

How does a hydrocoele appear on USS?

A

Black anechoic fluid surrounding the testicle

64
Q

How does an epididymal cyst appear on USS?

A

Anechoic uni/multilocular lesion typically arising within the epididymal head

65
Q

A testicular mass with vessels inside is probably what?

A

Malignant

66
Q

How is renal trauma best assessed?

A

CT

67
Q

What type of bladder rupture is most common and how is it treated?

A

Extraperitoneal

Treated conservatively

68
Q

What type of bladder rupture is rarer and how is it treated?

A

Intraperitoneal:
- Due to compression of full bladder
Requires surgery

69
Q

How is bladder trauma diagnosed?

A

Cystography
or CT cystography:
- Contrast leaks into intra- or extraperitoneal space

70
Q

If you have clinical suspicion of urethral trauma (meatal bleeding, anuria) what must NOT be done?

A

Catheterisation

71
Q

How can a urethral stricture be imaged?

A

Retrograde urethrogram

72
Q

How can a post-biopsy haemorrhage be treated?

A

US-guided arterial embolisation

Year 2 - Renal (DP) (15 decks)

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