Radiology Flashcards
causes of renal colic
calculi
pyelonephritis
gynaecological disease
what are calculi made of?
most are calcium dense
some are urate
imaging for calculi
KUB XR
non-contrast enhanced CT (CT stone search)= GOLD standard
what extra does non-contrast enhanced CT show in calculi diagnosis?
signs of obstruction e.g. perinephric stranding and hydroureteronephrosis
what does non-contrast enhanced CT struggle to differentiate?
calculi and phleboliths
when should CT be avoided?
pregnancy
non-pregnant young females
management of calculi
IM diclofenac
causes of macroscopic haematuria
calculi infection tumour urethritis/prostatitis trauma clotting disorder
investigations of macroscopic haematuria in over 50
CT urography (CTU)= upper tracts cystoscopy= lower tracts
describe CT urography
first scan without contrast then administer IV which is excreted by the kidneys over 15 minutes
detects renal parenchymal and urothelial tumours
describe cystoscopy
bladder and urethra
option for ureteroscopy and ablate tumours in patients unfit for nephrourecterectomy
what is different in investigation of macroscopic haematuria in under 50
incidence of tumours low in this age group so CT radiation dose unjustified
investigations for macroscopic haematuria for under 50
US
cystoscopy
CTU (only if other tests normal)
what does MR urography not require?
contrast and does not use radiation
when is MR urography useful in macroscopic haemturia?
contrast allergy
renal impairment
pregnancy
phases of using CT with contrast
- pre-contrast= best to depict calculi
- corticomedullary= cortex 25-70seconds
- nephrogenic= 80-180 seconds medulla
- excretory= 5-15 minutes collecting system
risk when using CT with contrast?
CT-contrast induced nephropathy within 3 days in absence of alternative aetiology
risk factors for CT-contrast induced nephropathy
renal impairment (DM) dehydration CHF LV ejection fraction <40% acute MI (within 24 hours) nephrotoxic drugs
how to reduce risk of CT-contrast nephropathy
- eGFR >60
- hydration protocols (saline NaHCO3 before and after scan)
- check renal function before
imaging in pre-renal
MR angiography for RAS
imaging in renal
US to guide biopsy
imaging in post-renal
US to exclude hydronephrosis (may require CT)
imaging for painful scrotum?
USS
Epididymo-orchitis presentation on USS
hypervascular
testicular torsion appearance on USS
avascular
scrotal swelling imaging
USS (if prostate cancer can use MRI)
what is used to assess fertility (tubal patency) and uterine anomalies?
hysterosalpingogram
imaging for urinary tract trauma
CT
USS
diagnosis of bladder rupture
cystography or CT cystography
types of bladder rupture
extraperitoneal (conservative)
intraperitoneal (surgery)
causes of urethral disruption
anterior pelvic fracture /dislocation
straddle injury
when do you not attempt catheterisation?
suspicion of urethral disruption
presentation of urethral disruption
meatal bleeding
can’t pass urine
what is used to assess stricture formation in urethral trauma?
urethrography
non-vascular interventional radiology
nephrostomy- catheter and stent
drainage
biopsy
guided ablation of tumours (RFA, cryoablation)
vascular interventional radiology
embolisation
stenting
risk in kidneys when using MRI
nephrogenic systemic fibrosis
cause of nephrogenic systemic fibrosis
exposure to gadolinium contrast in MRI
presentation of nephrogenic systemic fibrosis
skin erythema pruritis pain joint contractures, respiratory insufficiency and muscular atrophy skin thickens and appears wood-like
what increases risk of nephrogenic fibrosis?
renal impairment
