Radiology Flashcards
two modalities for visualising ureteric calculi
- KUB XR
2. non-contrast enhanced CT
which modality is first line for imaging ureteric calculi?
non-contrast enhanced CT
also shows complications and alternative diagnoses (appendicitis, hernia)
when should non-contrast enhanced CT be avoided for imaging ureteric calculi?
pregnant
young females
management of ureteric calculi
IM diclofenac
causes of macroscopic haematuria
calculi infection tumour trauma clotting disorders
investigations in >50s for macroscopic haematuria
- CT urography
2. cystoscopy
describe CT urography
scan then add contrast which is excreted over 15 minutes
what does CT urography detect?
renal parenchyma and urothelial tumours
typically used for upper tracts
what does a cystoscopy examine?
bladder and urethra
allows ureteroscopy or ablation of tumours
why is investigations for macroscopic haematuria different if <50?
incidence of tumours is low so CT radiation unjustified
methods used to investigate macroscopic haematuria in <50s?
USS
cystoscopy
CTU
what does USS show?
calculi
renal parenchymal tumours
what can cystoscopy diagnose?
bladder TCC
bladder calculi
tumours
urethritis/prostatitis
when is CTU used in macroscopic haematuria of the <50s?
when other tests are norma
when is MR urography useful?
contrast allergy
renal impairment
pregnant
four phases of CT with contrast
- pre-contrast (best to depict calculi)
- corticomedullary
- nephrogenic
- excretory
what is the corticomedullary phase of CT with contrast?
cortical enhancement 25-70 seconds after IV injection
what is nephrogenic phase of CT with contrast?
80-180 seconds where the renal medulla enhances
what is the excretory phase of CT with contrast?
5-15 minutes there is opacification of renal collecting systems
what is the risk of using contrast in renal CT scan?
contrast-induced nephropathy (ATN)
what is contrast-induced nephropathy?
impairment of renal function within 3 days of CT contrast
management of contrast-induced nephropathy
follow hydration protocols (saline before and after using NaHCO3 rather than NaCl)
check renal function before CT
imaging option in pre-renal impairment
MR angiography for RAS
imaging in renal impairment
USS to guide biopsy
imaging in post-renal impairment
USS to exclude hydronephrosis
may require CT
imaging for painful scrotum or swelling
USS
diagnosis of epidiymo-orchitis on USS
hypervascular
testicular torsion diagnosis on USS
avascular
what is hysterosalpingogram (HSG) used for?
infertility investigation into tubal patency
uterine anomalies
two types of bladder rupture
- extraperitoneal (conservative management)
2. intraperitoneal (surgery)
imaging modalities used for bladder rupture
cystography
CT cystography as contrast leaks through
causes of urethral disruption
anterior pelvic fracture/dislocation
straddle injury
management of urethral disruption
if suspicious DO NOT catheterise
non-vascular interventional radiology
relief of obstruction (nephrostomy- catheter and stent)
drainage of abscess or cyst
biopsy of renal masses
guided ablation of renal tumours (RFA, cryoablation)
vascular interventional radiology
control bleeding (embolisation) varicocoele embolisation
risk to the kidneys when using MRI?
nephrogenic systemic fibrosis caused by exposure to gadolinium
presentation of nephrogenic systemic fibrosis
skin erythema
pruritis
pain
can cause joint contractures, respiratory insufficiency and muscular atrophy
