Renal imaging Flashcards
First line image in suspected renal colic
X-ray
Which other conditions can simulate renal colic?
Pyelonephritis
Gynaecological disease
Imaging used in pregnancy
US and/or MRI
Which muscles do normal ureter pass inferiorly over?
Psoas muscle
Which sites are calculi prone to getting stuck in?
Pelviureeric junction
Pelvic brim
Vesicoureteric junction
Causes of calcification on x-ray (other than renal calculi)
Phleboliths
Lymph nodes
Uterine fibroids
Arterial calcification
What is the most definitive test to confirm ureteric calculus?
CT
Downsides to CT scanning for calculi
Ocassionally struggles to distinguish between claculi & phleboliths in the absence of secondary symptoms
Radiation
How is renal colic followed up?
Check progress using simplest test that showed the calculus at presentation
Causes of macroscopic haematuria
Calculi Infection Tumour Urethritis/prostatitis Trauma Clotting disorders
First line investigation of macroscopic haematuria in over 50’s
CT urography
Uses of cystoscopy
To confirm tumour
To ablate tumour in patients unfit for nephrourectomy
What is CT contrast urography best for detecting?
Renal parenchymal tumours
Urothelial tumours of thew collecting system or ureters
Why is the first line investigation of macroscopic haematuria in the under 50’s not CT urogram?
Incidence of urothelial tumours is very low so it’s unjustified radiation
First line investigations of macroscopic haematuria in the under 50’s?
US
Cystoscopy
When is an MR urography indicated?
Contrast allergy
Renal impairment
Pregnancy
What is a fat mass found on CT most likely to be?
Angiomyolipoma
Solid masses of what size tend to be malignant?
> 3cm
Imaging for pre-renal disease
MR angiography to detect RAS
Imaging in renal disease
US to guide biopsy
What, other than obstruction, can cause hydronephrosis?
Ureteric reflux
Why is renal size on US helpful in renal impairment?
Distinguish between acute & chronic
Findings of epididymo-orchitis on US
Testis and/or epididymis is hypervascular
Findings of testicular torsion on US
Testis are avascular
Findings of varicoele on US
Dilated scrotal venous plexus
Typically on left side
Tortuous veins >2mm in diameter
Finding of hydrocoele on US
Black anechoic fluid surrounds the testicle
Findings of epididymal cyst on US
Typically rise within epididymal head
Findings of testicular tumour on US
Soft tissue mass
May have demonstratable vascularity
How is renal trauma best assessed?
CT
How is bladder rupture best imaged?
Cystography or CT cystography (contrast leaks through rupture)
What is urethral druption associated with?
Anterior pelvic fracture/dislocation
Straddle injury
What should you do clinically if you have suspiscion of urethral disruption (meatal bleeding, unable to pee)?
Call urology (don’t attempt catheterisation)
What imaging is used to define long term stricture formation?
Urethrography
What non-vascular procedures can be done by interventional radiology?
Relief of ureteric obstruction
Drainage of abscess or renal cyst
Biopsy of renal masses
Guided ablation of tumours
What vascular procedures can be done by an intervention radiologist?
Correction of renal artery stenosis
Control of arterial bleeding sites (embolzation)
Varicocoele embolization
