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radiology > Urinary > Flashcards

Urinary Flashcards

1
Q

general outline of kidney

A
  • pericapsular fat continuous w/ renal sinus

- thick capsule

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2
Q

column of bertin

A

cortex extending btw pyramids

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3
Q

variant kidney anatomy

A
  • fetal lobulation
  • Dromedary hump (left kidney via adaptation to adj spleen)
  • prominent/Htr column of Bertin (most likely to be shown on US)
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4
Q

fetal lobulation vs scar

A
  • lobulation: indentation overlie space BTW pyramids

- scar: indentation over pyramid. LOSS OF CORTEX

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5
Q

UL renal agenesis associations

A
  • F-unicornuate uterus
  • M-ø IL epididymis & vd OR IL seminal vesicle cyst
  • add: ø IL ureter, hemitrigone
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6
Q

Mayer-Rokitansky-Kuster-Hauster

A

Mullerian duct anomalies ass w/ UL renal agen

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7
Q

basic breakdown renal phases

A
  • cortical- characterizing tumor enh, staging/treatment
  • nephrographic -tumors
  • excretory-papilla morphology, urothelial cell/TCC lesions
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8
Q

RFs RCC

A
  • tobacco
  • syndromes-VHL
  • dialysis >3 yrs
  • family hx
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9
Q

RCC subtypes

A
  • clear cell-general pop, VHL
  • papillary-hereditary papillary renal Ca, Tx
  • medullary-SCD
  • chromophobe-Birt Hogg Dube
  • translocation-kids s/p cytotoxic chemo
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10
Q

T2 dark kidney lesions

A
  • papillary
  • lipid poor AML
  • hemorrhagic cyst
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11
Q

RCC staging

A

1) kidney, <7cm
2) kidney, >7cm
3) Gerota’s fascia- A) renal vein invasion B) IVC above diaphragm C) IVC below diaphragm

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12
Q

renal leukemia

A
  • MC visceral orgn envolved
  • smooth, enlarged
  • cortically based hypodense lesions
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13
Q

Bourneville disease aka

A

Tuberous Sclerosis

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14
Q

what % AMLs are lipid poor, for TS?

A

5%

30% for TS

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15
Q

MC tumor to met to kidney

A

lymphoma

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16
Q

“protrudes into renal pelvis”

A

multilocular cystic nephroma

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17
Q

BL oncocytomas and chromophobe RCC

A

Birt Hogg Dube

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18
Q

kidney benign tumors to consider

A

a) AML (MC)

b) oncocytome (2nd MC)

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19
Q

ways to show oncocytoma

A

1) solid mass + central scar
2) spoke wheel on US
3) HOT on pet

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20
Q

mx oncocytoma

A

resect (indist from RCC)

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21
Q

img multilocular cystic nephroma

A

“non-communicating, fluid filled locules surr by thick fibrous capsule”

-“protrude into renal pelvis”

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22
Q

what abd organs are part peritoneal and RP?

A

pancreas
duo
rectum

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23
Q

what % of 1˚ retroperitoneal neoplasms are mal?

A

75%

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24
Q

RP lesions

A
  • lipomatosis
  • liposarcoma
  • RMS-kids
  • EMH
  • RP hem
  • lymphoma
  • RP fibrosis-uncommon above renal a’s
  • Erdheim Chester
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25
Q

lipomatosis

A
  • fat person w/ “incomplete bladder emptying”
  • overgrowth benign fat in pelvis (perirectal, per vesicular)
  • anterosup bladder displ. Pear/tear drop shaped.
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26
Q

liposarcoma-how many recurr, when is it bad, MC loc

A
  • 2/3 local recurrence
  • looks bad=bad
  • deeper=bad
  • MC loc is actually the thigh
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27
Q

MC 1˚ RP malignancy

A

liposarcoma

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28
Q

MC RP malignancy

A

lymphoma

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29
Q

MCC’s RP hem

A

1) anticoag
2) rupture/leaking aorta
3) bleeding RCC or AML
(A’s)

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30
Q

NHL vs HL RP lymphoma

A

NHL-nodes larger, involve mesentery, non continuous

-HL nodes para-aortic early, more continuous

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31
Q

risk of malignancy based on Bosniak

A

1) 0%
2) 0%
2F) <5%
3) 50%
4) 100% (ie: RCC)

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32
Q

Bosniak 1

A
  • simple anechoic

- hairline thin wall

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33
Q

Bosniak 2

A
  • hyper dense, <3 cm
  • thin Ca, sept
  • no ST
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34
Q

Bosniak 2F

A
  • hyperdense >3cm
  • minimally thickened Ca, wall or septa
  • no ST
  • totally intrarenal
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35
Q

bosniak 3

A
  • measureable enhancement

- thick/irreg or smooth wall/septa

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36
Q

Bosniak 4

A

same as 3 + distinct enhancing ST components

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37
Q

what is always present in ARPKD

A

congenital hepatic fibrosis

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38
Q

Tuberous sclerosis and kidneys

A
  • AML

- RCC (younger pts)

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39
Q

ADPKD findings-where are the cysts, ass?

A
  • cysts: kidneys, liver, seminal vesicle

- berry aneurysms

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40
Q

what happens to dialysis related kidney cysts?

A

regress s/p tx

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41
Q

parapelvis vs peripelvic cyst

A

para (beside)-simple renal cysts that plunge into the renal sinus from the adjacent renal parenchyma. Org from parenchyma, may compress collecting system. look like cortical cyst but bulge in (instead of out)
-peri-from renal sinus, mimic hydro

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42
Q

renal abscess cutoff for drainage

A

3cm

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43
Q

striated nephrogram ddx

A
  • acute ureteral obstruction
  • acute pyelonephritis
  • hypoTN (BL)
  • acute renal v thrombosis
  • renal contusion
  • radiation nephritis
  • medullary sponge kidney
  • infantile polycystic kidney (BL)
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44
Q

findings chronic pyelo

A
  • thinning, atrophy, scarring

- HTr of normal residual tissue!

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45
Q

mx emphysematous pyelonephritis vs pyelitis

A

kid-Abx + nephrectomy

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46
Q

who gets emphysematous pyelonephritis vs pyelitis

A
  • kid-DM

- CS-women, DM, urinary obstruction

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47
Q

img pyonephrosis

A
  • US > CT (has trouble distinguishing pyonephrosis from hydronephrosis
  • F/F level
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48
Q

papillary necrosis causes

A
  • DM (mc)
  • pyelonephritis
  • SCD (50% of SC pts dev PN!)
  • Tb
  • analgesia
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49
Q

img papillary necrosis

A
  • filling defects in calyx

- lobster claw-linear streek in calyx

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50
Q

MC extra pulmonary site Tb

A

-urinary tract

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51
Q

Tb renal disease img/progression

A
  • earliest- pap necrosis/ “moth eaten calyces-deep cups/w-shaped central necrosis (pelvis remains symmetrical)
  • progressed necrosis –> cavity (MOST CHAR)
  • phantom calyx-focal stenosis of infundibulum
  • diffuse infundibulum stenosis–> caliectasis
  • ureteral stenosis –> Kerr kink-scarring of pelvis –> uplifted appearance at renal pelvis
  • putt kidney-Ca autonephrectomized end stage Tb kidney
  • Ca mesenteric nodes
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52
Q

HIV nephropathy

A
  • MCC renal fx in this population

- enlarged, echogenic, loss of fat (edema in fat)

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53
Q

disseminated PCP-renal disease

A

punctate (cortical) Ca

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54
Q

who’s at risk for CIN?

A
  • pre-existing renal dx (+DM w/ renal disease)
  • CHF
  • dehydration
  • myeloma
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55
Q

Stone compositions

A
  • Ca-oxalate-75%
  • struvite-women + UTI
  • uric acid-Unseen on xray
  • cystine-rare, cong disorders of metabolism
  • indinavir-HIV. only stone not seen on CT
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56
Q

Rx nephrolithiasis-size cut off.

A
  • 5mm cut off

- uric acid-change acidic diet/mediacl (Kcitrate, NaBicarb)

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57
Q

appearance of stones on dual E CT

A
  • non-uric acid stones-higher HUat 80kEv

- UA-same at 80 and 140

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58
Q

cortical nephrocalcinosis mimic

A

disseminated PCP

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59
Q

Medullary sponge kidney MOA and ass

A
  • UL cystic dilation of CTs

- Ehlers-Danlos, Caroli’s, BW

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60
Q

in which organs is RI useful?

A

those with a capsule

61
Q

delayed vs persistent nephrogram

A

UL vs BL

62
Q

cortical rim sign

A

perfusion of cortex (8hrs-days later) via dual bs

63
Q

flip flop enh

A

region of hypo density/hypoenh bc hyperdense on delayed

64
Q

renal v thrombosis causes

A
  • nephrotic MC in adults
  • dehydration
  • indwelling umbilical venous catheter
65
Q

RI calculation

A

(peak systolic-ED)/Peak Systolic

66
Q

flavors of kidney tx compl

A

1) urologic-MC
2) vascular-2nd MC
3) cancer-3rd MC
4) AVN-steroids (- now w/ cyclosporine use)
5) trauma (more superficial, less rib protection)

67
Q

urologic compls s/p kidney tx

A
  • fluid collections
  • hyperacute rejection
  • acute rejection
  • ATN
  • cyclosporin toxicity
  • Chronic rejection
68
Q

“delayed graft function” (DGF)

A

-transplant requiring dialysis in 1st wks. Amount of cold ischemia is best predictor

69
Q

img urologic compls kid tx (minus fluid colls)

A
  • hyperacute rejection-immediate, not imaged.
  • acute-swelling, RI+, MAG3 3pt crappy
  • ATN-MAG3 N perfusion w/ retained tracer
  • chronic rejection-same as acute
  • cyclosporin tox-ATN but months later
70
Q

how many kid tx pts wind up with acute rejection?

A

20%

71
Q

how to differentiate acute rejection vs ATN?

A
  • MAG3

* bx (despite Nucs)

72
Q

what cancers are renal tx pts at risk for

A
  • 100x at risk via immunosuppresion
  • nonmelanomatous skin cancer (annual skin exams), lymphoma, colon cancer
  • RCC-native kidney
  • PTLD-EBV, B cell proliferation, 1st yr, mult organs, mass encasing/replasing hilum. rx=(-) imm supp
  • urothelial-BK in donor kidney. cyclophosphamide
73
Q

kidney fx vs shattered

A
  • fx-2+ fragms, lac goes full depth connecting 2 cortical surfs
  • shatter-3+ fragms
74
Q

renal trauma: wedge shaped perfusion abN vs diffuse non perfusion vs persistent nephrogram

A
  • segm a
  • devascularized
  • renal v thrombosis
75
Q

mx renal trauma

A
  • grades 1-3 conservative

- 4, 5-surgery

76
Q

renal trauma grades

A

1) subcap hem
2) <1cm lac
3) >1cm lac, active bleed into perirenal space
4) fractured, blood outside perirenal space, segm infarcts
5) shattered, hilar injury, devasc

77
Q

ureteral wall Ca

A

Tb

schisto

78
Q

ureteritis cystica

A

chronic inflamm (DM, recurr UTI)

  • tiny subep cysts
  • ?(+) risk cancer
79
Q

ureteral pseudodiverticulosis

A

small outpouching
BL 75%
-upper/middle 3rd
-maligancy

80
Q

malakoplakia-pathophys, who, orgm

A

chronic granulomatous condition–> ST nodularity/plaques in bladder and ureters (bladder MC)

  • imm supp F w/ chr UTI
  • E. Coli
81
Q

-BW: Michaelis-Gutmann bodies

A

malakoplakia

82
Q

malakoplakia vs leukoplakia

A

M-not mal

L-mal

83
Q

leukoplakia

A

squamous MP 2/2 chronic irritation

  • bladder > ureter
  • mural filling defects
  • risk SCC
84
Q

RP fibrosis-causes

A
  • iso-75%
  • radiation, mx (methyldopa, ergotamine, methysergide), inflamm (pancreatitis, pyelonephritis, inflamm aneurysm), mal (desmoplastic rxn, Lymphoma)
  • mal=10% (PET to find 1˚?)
85
Q

RP fibrosis-aka

A

Ormond dx

86
Q

RP fibrosis-nukes

A

gallium+

PET HOT in active phase

87
Q

RP fibrosis-MOA, ass

A

fibro-inflamm proliferation

-ass w/ IgG4

88
Q

medial vs lateral deviation of ureters

A
  • Lat-RP LAD, aortic aneurysms, psoas HTr (proximal)

- med (“waisting”)-RPF, retrocaval ureter, pelvic lipomatosis, psoas HTr (distal)

89
Q

sub epithelial renal pelvis hematoma

A
  • long term anticoag
  • hemophilia
  • thickening upper tract wall w/o enh (vs TCC)
90
Q

TCC/urothelial CA RFs

A
  • smoking
  • azo
  • cyclophosph
  • aristolochic acid
  • horseshoe
  • stones
  • ureteral pseudodiverticulosis
  • hereditary non-polyposis colon cancer (II)
91
Q

Balkan nephropathy

A

degenerative nephropathy endemic to Balkan States

  • high rate renal pelvis and upper ureter TCCs
  • 2/2 eating aristolocholic acid (AA) seeds in Aristolochia clematis plant
92
Q

mets to ureters

A

GI, Prostate, renal, breast

93
Q

ureteral fibroepithelial polyp

A

upper tract/pelvis

  • younger pt
  • smooth/oblong and mobile
  • vs tcc
94
Q

bladder diverticula-who

A
  • boys
  • chronic BOO
  • ehler danlos
95
Q

bladder ears-when is it seen, in whom (why), vs diverticulum

A

-transitory extraperitoneal herniation of bladder into ing canal

  • in the infant, lies in a relatively high position in the pelvis and is proportionately large in relation to the abdominal cavity (1, 15). This position places the lateral base closer to the internal inguinal ring than in the adult. With increasing age, the bladder becomes almost completely a true pelvic structure except when distended (5). It is covered by peritoneum in its superior and posterior portions, while laterally and anteriorly it consists of only loose areolar tissue.
  • bladder ears: in young infants, NORMAL (?) protrusion of the lateral aspect of the bladder into the inguinal canal

-vs diverticulum: herniation has smooth wall, wide neck

96
Q

what’s more likely cancer? macro vs micro hematuria

A

macro

97
Q

wall thickening of bl cancer

A

nodular and asymm

98
Q

bl cancer enh

A

“hypovasc” but do enh (often arterial)

99
Q

squamous bladder cancer

A
  • recurr UTIs & stone dx
  • schisto
  • suprapubic cath
100
Q

bladder leiomyoma

A 
benign tumor (mc) at trigone
-BW: unary hesitancy, drippling
101
Q

TCC subtypes

A
  • papillary (frond like, low grade)

- nonpapillary (aggressive)

102
Q

location of bladder tumors

A
  • TCC-base (infest
  • squamous-trigone, lat
  • adeno-midline
  • rhabdo-paratesticular
103
Q

Bladder cancer RFs

A
  • smoking
  • poison-arsenic, aniline, benzidine
  • diverticulu-2-10% via stasis. quick to spread (less m)
104
Q

Ca rate in bladder adeno

A

75%

105
Q

urinary diversion surgeries

A
  • bowel made into conduit or reservoir –> ureters att to it
    1) incontinent
    2) continent
  • compl: early (bowel function, leakage, fistula) & late (inf, stone, herniation, strictures, recurr)
106
Q

early urinary diversion sx compls

A

1) bowel function-dynamic ileus (MC, 25%), SBO (3%, entero-entero)
2) urinary leakage-ureteral-reservoir anastomosis –> urinoma, 5%
3) fistula-mc in pts w/ pelvic radiation

107
Q

late urinary diversion sx compls

A
  • inf
  • stones
  • parastomal herniation-15% w/ ileal conduits. 10% need sx. obesity :(
  • urinary stricture- L>R (L is brought under mesentery)
  • recurr-adv org disease, 3-15%
108
Q

psoas hitch

A
  • aunt minni

- removal of long-segm distal ureter –> stretch IL bladder toward short ureter and sew to psoas m

109
Q

pear shaped bladder

A

1) hematoma

2) pelvic lipomatosis

110
Q

bladder infections

A
  • emphysematous-E coil, DM
  • Tb (from upper)
  • schisto-ENTIRE BLADDER will Ca
111
Q

ddx bladder diverticulum

A
  • colovesicular-diverticular
  • ileovesical-crohns
  • rectovesical-Neo or trauma
112
Q

neurogenic bladder-types

A

1) small contracted (pinecone/christmas tree)-spinal lesions above T12
2) atonic-sacral lesions and peripheral neuropathy
3) suprapontine lesions-spastic bladder w/ normal sphincters

Sensory neurogenic bladder
Inability to sense bladder fullness results in a large rounded and smooth bladder. Voiding is often preserved.

Motor paralytic bladder
Atonic large bladder with the inability of detrusor contraction during voiding.

Uninhibited neurogenic bladder
Rounded bladder with a trabeculated appearance to the mucosa above the trigone from detrusor contractions. On voiding large interureteric ridge is noted

Reflex neurogenic bladder
Results from detrusor hyperreflexia with a dyssynergic sphincter. This leads to contrast extension to the posterior urethra and an elongated pointed urthera with pseudodiverticula.

Autonomous neurogenic bladder
Intermediate between detrusor hyperreflexia (contracted) and dysreflexia (atonic).

113
Q

bladder diverticula-mc loc

A

uvj

114
Q

bladder stones-how

A

1) drop from above
2) form 2/2 stasis
* known RF for TCC and SCC

115
Q

role of cystography (via fluoro or CT)

A

100% sensitive when filled w/ 300-400 mL

116
Q

pseudoazotemia aka pseudo renal failure

A

bladder rupture–> Cr abs by peritoneal lining–> elevation of blood Cr –> pseudo renal fx

117
Q

appearance extraperitoneal vs intraperitoneal bladder rupture

A
  • extra-molar tooth

- intra-bowel loops

118
Q

which type of bladder rupture is MC?

A

extra

119
Q

extraperitoneal bladder rupture ass

A 
pelvic fx (almost 100%
-10% with pelvic fx have bladder rupture
120
Q

male urethra parts

A
  • ant (penile, bulbous)

- pst (membranous, prostatic)

121
Q

vocab: fossa navicularis, verumontanum, prostatic utricle

A
  • FN: most ant portion of urethra
  • V: ovoid mound in pst prostatic urethra.
  • PU: center of V. embryologic mullein remnant
122
Q

how to differentiate bulbous vs membranous urthera

A

1) conus configuration

2) inf margin obturator foramina

123
Q

MOA urethral trauma

A
  • ant: straddle

- pst-car accident

124
Q

urethral trauma types

A

1) stretched, ie: in tact
2) membranous
3) membranous + bulbar- UGS ruptured, perineal/scrotal contrast. MC
4) bladder base –> prostatic urethra
5) bulbous

125
Q

retrograde vs antegrade urethral studies

A

retrograde-ant part fills
antegrade (voiding urethrogrphay)-pst pt fills
-dynamic urethrography=using both

126
Q

MC urethral trauma type

A

3

127
Q

which urethral trauma types are ass w/ incontinence

A

2-4

128
Q

urethral strictures

A
  • bulbous trauma (MC)-short segm

- GN-long/irregular

129
Q

effect of pancreatic tx on urethra

A
  • old form of surgery connecting pancr tx to bladder

- pancreatic enzymes jack up urethra –> extrav

130
Q

condyloma acuminatum

A

small filling defects on RUG

-should not instrumentize (even RUG)-seeding

131
Q

urethrorectal fistula cause

A

radiation (classically brachytherapy, 1%)

132
Q

urethral diverticulum

A

-long term foley

133
Q

urethral cancer-bd of subtypes

A
  • rare
  • 80% SCC
  • prostatic urethra TCC 90%
  • diverticulum-adeno
134
Q

female urethral diverticulum

A
  • way more common than in men!
  • middle 1/3, pstlat wall
  • stress urinary incontinent (60%), UTI
  • BW=saddle bag
  • adeno
135
Q

normal kidney echogenicity

A

Antenatally, fetal kidneys show varying texture depending on gestational age. It is echogenic in the first trimester, with decreasing echogenicity as the pregnancy progresses. Corticomedullary differentiation can be appreciated after 15 weeks of gestation but clear demarcation between cortex and medulla can be seen at 20 weeks. Renal echogenicity decreases compared to liver and spleen after 17 weeks 12.

Normal kidney appearance in adult:

cortex is less echogenic than the liver
medullary pyramids are slightly less echogenic than the cortex
cortex thickness equals/is more than 6 mm 14
if the pyramids are difficult to differentiate, the parenchymal thickness can be measured instead and should be 15-20 mm 11
central renal sinus, consisting of the calyces, renal pelvis and fat, is more echogenic than the cortex
renal pelvis may appear as a central slit of anechoic fluid at the hilum
normal ureters are generally not well seen on ultrasound

136
Q

infiltrative kidney lesions

A
  • lymphoma
  • tcc
  • medullary cystic nephroma/medullary rcc
137
Q

mx multilocular cystic nephroma

A

resection (indist from cystic rcc)

138
Q

low attenuation LAD

A

whipples
testicular neo
tb
atypical mycobacterium

139
Q

upper tcc îs found-likelihood of CL and lower tract?

A

CL 3-5%

Bladder: 30-50%

140
Q

mcc renal scarring

A

reflux nephropathy

141
Q

sign of fat and Ca in a renal mass

A

fat containing rcc

142
Q

scarring with dilated calyces

A

reflex nephropathy

143
Q

what makes upper pole moiety reflux?

A

shorter intramural course

144
Q

significance of sudden disappearing excreted contrast

A

-developing hypotension

145
Q

chance of obstructed labor in setting of UL vs BL pelvic kidneys

A

UL-none

BL-100%

146
Q

christmas tree bladder

A

spastic detrusor against spastic sphincter

147
Q

retraction of urinary bladder wall

A

m invasive bladder cancer (rx=radical cystectomy s/p TURBT)

148
Q

oncocytoma-path, img

A
  • Path: Benign renal tumor composed of eosinophilic epithelial cells arising from intercalated cells of collecting ducts
  • img:
    • Solid renal cortical mass lesion with central stellate scar
    • Encapsulated, well marginated, smooth contour
    • large mass with renal contour abnormality and compression of collecting system
    • lacks mal features
    • Ca/hem/necr rare
    • Degree and timing of enhancement are variable due to variable cellularity

-CT: Isodense or slightly hyperdense relative to kidney

-MR
T1WI
Isointense to low signal
T2WI
Intermediate signal: Highly cellular components
↑ signal: Edematous stroma, central scar, cystic areas
DWI
↑ signal in highly cellular components
↑ ADC values
Not useful to differentiate from RCC
T1WI C+
Dynamic postcontrast findings are similar to CECT

-Grayscale ultrasound
Well-defined, homogeneous, hypo-/isoechoic mass
Central scar: Usually echogenic
Color Doppler
Internal flow ± central radiating vessels

149
Q

bladder hernia types

A

1) extraperitoneal- bladder protrudes through the inguinal ring, remaining entirely outside the peritoneum
2) paraperitoneal- also extraperitoneal protrusion with an adjacent peritoneal hernia
3) intraperitoneal, in which a more superior portion of the bladder carries its peritoneal covering into the inguinal ring

*paraperitoneal type is twice as common as the intraperitoneal and that extraperitoneal hernias are rare

radiology (31 decks)

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