Radiology of Urinary Tract Flashcards
How do we make a urological diagnosis as a clinician?
- H&P
- urinalysis
- laboratory studies
- mirco studies
- radiologic studies
What is one of the most common tests used in urology and why?
- ultrasound because it is easy to perform in the office.
What is the study of choice for all intrascrotal pathology?
- scrotal ultrasound
What is testicular torsion?
- urological emergency when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum.
What is Bell Clapper deformity?
- predisposing factor for testicular torsion in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate (aka the attachments of the testicle to the scrotal wall and to the septum in the middle of the scrotum are deficient).
How do we use US to determine testicular torsion?
- use doppler to look at blood flow
What would you see on US in epididymitis?
- hypervascularity
What is intravenous pyelogram (IVP)?
- study that uses repetitive flat x-rays after injecting contrast into a vein and observing it as it is filtered in the kidneys and goes into the bladder.
What are some problems with IVP?
- requires bowel prep (must be empty so you can see)
- requires a lot of contrast
Why is CT scan used over IVP now?
- spiral CT stone search
- get axial, sagital, coronal or any angled image.
- is limited however to patients with normal renal function bc you can’t give them contrast if they have abnormal renal function.
What things can you see on CT?
- hydronephrosis
- stones
- masses
- stranding (secondary signs of stone)
Is a CT urogram very detailed?
YES and much better than old school IVP
What can we do if a patient has a contrast allergy or has impaired renal function?
- MRI bc no contrast is needed and you get multiplanar imaging.
- problem is length (45 mins) and claustrophobia.
Can you give gadolinium as contrast to a patient getting an MRI who has renal impairment?
- YES bc it is not renal toxic. Must still be careful with this however.
*** What are the simple rules of MRI?
- FATTY 1= in T1 images, fat is bright.
- FLUIDY 2= in T2 images, fluid is bright.
What is MRA?
- magnetic resonance angiography= used to look at vasculature more closely.
When would we use a nuclear medicine study?
- to assess FUNCTION and OBSTRUCTION of kidneys.
- also to assess for bone metastasis in prostate cancer.
- not good for looking at anatomy.
Do you need contrast with a nuclear medicine test?
NO :)
What are the 4 types of fluoroscopic studies?
- retrograde pyelogram
- retrograde urethrogram
- antegrade nephrostogram
- cystogram
What is a retrograde pyelogram?
- physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast (up from the bladder to the kidney) is opposite the usual flow of urine, hence the retrograde name.
What is a retrograde urethrogram (RUG)?
- injecting dye in through the penile urethra to observe the integrity of the urethra.
- have patient void afterward to observe flow.
What is an antegrade nephrostogram?
- contrast injected to determine if the kidneys drain sufficiently into the ureters and bladder.
What is a cystogram?
- x-ray of the bladder that uses dye.
- used for trauma mostly.
Does the bladder have a portion that sits outside of the peritoneal cavity and a portion that sits inside the peritoneal cavity?
YES the dome sits inside the peritoneal cavity
