Renal imaging Flashcards
What is the first-line investigation for suspected renal colic ?
non contrast CT-KUB
What is the definite test for diagnosing renal colic ?
non-contrast CT KUB
What is the first investigation done for suspected pylonephritis ?
US
If the patient is pregnant with suspected renal colic what is the first investigation you would do ?
US and/or MRI to avoid radiation exposure
What are the common areas that ureteric calculi get stuck ?
- Pelviureteric junction (PUJ)
- pelvic brim
- vesicoureteric junction (VUJ).
For follow up of renal calculi what investigation is done to image to see if the calculi is still there ?
The simplest investigation which showed the calculi in the first place - but don’t expect the calculi to show up on X-ray when it only showed up on CT when it was first diagnosed
What are some of the causes of macroscopic haematuria ?
- Calculi
- Infection
- Tumour (renal cell carcinoma at all ages, TCC over 50 years)
- Urethritis/prostatitis
- Trauma
- Clotting disorders
What is the investigations of choice for macroscopic haematuria in patients over 50 ?
CT urography + cytoscopy
Describe the technique of how CT urography is done
- Initially CT scan before contrast is done - as this is the most sensitive test for calculi
- Then contrast is given and a CT scan is done following this - as this is the most sensitive test for renal parenchymal tumours and urothelial tumours of the collecting systems or ureters
What is the investigation of choice for macroscopic haematuria in under 50s?
- US - of kidneys to detect calculi and renal parenchymal tumours
- Cystoscopy to look for occasional bladder TCC, bladder calculi, other bladder tumours or evidence of urethritis/prostatitis
- CTU only when US and cystoscopy are normal and macroscopic haematuria persists
What is MR urogrpahy useful ?
In patients who have:
- contrast allergy
- renal impairment
- pregnancy
What investigation is done to assess renal masses ?
CT
What is the classification of renal masses?
- Masses which contain fat are angiomyolipomas - these are benign
- Fluid density masses are cysts and uniform cysts are benign
- Complex cysts, containing solid areas or thick septa are often malignant
- Solid (non-cystic) masses larger than 3cm are often malignant
Is a solid mass < 3cm usually benign or malignant and what management is usually done for them ?
Usually benign so is followed up rather than operated on
When would CT not be used to assess renal masses and what imaging is done instead ?
If the patient is young or pregnant - do a MR with contrast
