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Renal > Urogenital imaging > Flashcards

Urogenital imaging Flashcards

1
Q

Where do the kidneys lie?

A

Retroperitoneal: paravertebral gutters of the posterior abdominal wall

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2
Q

What is the level of the left kidney hilum?

A

L1

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3
Q

What is the level of the right kidney hilum?

A

L1/2

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4
Q

What are the contents of the renal hilum?

A 
Renal vein
Renal artery
Renal pelvis (ureter) 
Lymph
Nerves
Renal sinus fat
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5
Q

What conditions can be detected using USS of the kidneys?

A 
Renal size
Cortical scarring
Doppler
Distention of pelvicalyceal system
Calculi
Detection of renal abnormalities
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6
Q

When it a CT kidney indicated?

A

Vascular assessment
Characterizes most pathologies
Multiplanar

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7
Q

What type of CT is best to detect calculi?

A

No contrast

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8
Q

What part of the kidney is best seen with contrast?

A

Corticomedullary

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9
Q

What part of the renal tract is best seen when the contrast is being excreted?

A

Opacification of the renal collecting system and ureters

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10
Q

What is contrast induced nephropathy?

A

Condition in which an impairment in renal function occurs within 3 days following an IV administration of contrast medium in the absence of alternative aetiology

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11
Q

What are risk factors for contrast induced nephropathy?

A 
Renal impairment +/- DM 
Dehydration 
Congestive heart failure 
LV ejection fracture
Acute MI
Nephrotoxic drugs
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12
Q

How can the risk of contrast induced nephropathy be reduced?

A

eGFR <60 pre contrast

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13
Q

What will an MRA renal angiogram show?

A 
Abdominal aorta
Right renal artery 
Left renal artery
Aortic bifurcation
Splenic artery 
Lumbar arteries
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14
Q

What is nephrogenic systemic sclerosis?

A

Severe systemic fibrosing disorder assoc with the exposure of gadolinium containing contrast media

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15
Q

Where does the ureter empty into the bladder?

A

Vesicoureteric junction

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16
Q

What are the 3 anatomical constrictions of the ureters?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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17
Q

Where does the abdominal ureter run?

A

Medial aspect of psoas

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18
Q

Where does the pelvic ureter run?

A

Enters pelvis at bifurcation of common iliacs
Anterior and medial to SI joint
Turns medially at ischial spines to enter the posterolateral bladder

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19
Q

What is a CT urogram used for?

A

Assessing the collecting system, ureters and bladder

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20
Q

What is the structure of the bladder?

A 
Pyramidal shaped organ when empty:
Posteriorly is the base
Anteriorly is the apex (behind pubic symphysis) 
Superior wall
2 inferolateral walls
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21
Q

Where do the ureters enter the bladder?

A

Posterolateral angles

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22
Q

What is the trigone?

A

Triangular smooth area of bladder between ureters and urethra

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23
Q

What covers the superior surface of the bladder?

A

Peritoneum

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24
Q

What lies inferolaterally to the bladder?

A

Obturator internus and levator muscles

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25
Q

What lies anterior to the bladder?

A

Pubic symphysis

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26
Q

What lies posterior to the bladder in females?

A

Anterior vagina and cervix

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27
Q

What lies posterior to the bladder in males?

A

Inferior prostate

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28
Q

What is required in a bladder ultrasound?

A

Full bladder

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29
Q

What can a bladder USS detect?

A

Volumetric measurement
Internal calculi
Wall irregularities
Diverticula

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30
Q

What is the gold standard to see a leak through a bladder wall tear?

A

Cystography

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31
Q

What is the gold standard for local staging of bladder wall tumours?

A

MRI

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32
Q

What is the gold standard for nodal and metastatic disease staging of the bladder?

A

CT

33
Q

Describe the urethra in males

A 
Bladder neck 
Prostatic urethra
Membranous urethra
Bulbous urethra
Penile urethra
34
Q

When is a urethrogram used?

A

Strictures
Trauma
Diverticula

35
Q

What is the lymph drainage of the bladder?

A

Superolaterally to the external iliacs

Neck and fundus to the internal iliac, sacral and common iliiacs

36
Q

What is the imaging of choice for the genitals?

A

USS for testes/scrotum, uterus, ovaries and prostate

37
Q

When is a hysterosalpingogram used?

A

Infertility - tubal patency

Uterine anomalies

38
Q

When is an MRI used?

A

Prostate cancer - local staging

Troubleshooting for adnexal/ uterine/ ovarian abnormalities not characterisable by USS

39
Q

What can be seen on a scrotal USS?

A 
Testicular parenchyma
Head of epididymis
Mediastinum testis
Rete testis
Appendix testis
40
Q

What is the lymph drainage of the scrotum?

A

Superficial inguinal nodes

41
Q

What is the lymph drainage of the testis?

A

Lumbar and para-aortic nodes

42
Q

What causes renal colic?

A

Ureteric calculus

43
Q

What can mimic renal colic?

A

Pyelonephriti (do USS to exclude ureteric obstruction)

Gynaecological (do USS to visualise uterine, ovarian and uterine tubal pathology)

44
Q

Why is imaging done in renal colic?

A

Identify the calculus
Assess size and morphology of calculus
Detect associated ureteric obstruction
Identify additional asymptomatic calculi

45
Q

What are the components of most calculi?

A

Calcium rich and are dense

46
Q

What is the 1st line test done in suspected renal colic?

A

KUB x-ray - easy and may show a dense ureteric calculus

Only a minority of renal tract calculi are visible on KUB

47
Q

How many x-rays will you get in a KUB x-ray?

A

Upper/ mid abdomen for kidneys and proximal ureters

Pelvis for distal ureters and bladder

48
Q

What is the normal ureteric course?

A

Pass inferiorly over the psoas
Descend anterior to the tips of the lumbar transverse processes
Cross iliac bifurcation to enter pelvis
Pass posteromedially and enter the posterior aspect of the bladder

49
Q

Where do ureteric calculi often get stuck?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

50
Q

What can mimic ureteric calculi?

A

Phleboliths (calcification within a vein)
Lymph nodes
Uterine fibroids
Arterial calcification

51
Q

What is the definitive test to diagnose a ureteric calculi?

A

Non-contrast CT

52
Q

What is the follow up for renal colic?

A

KUB to check progress

53
Q

What can cause macroscopic haematuria?

A 
Calculi
Infection
Tumour (renal cell carcinoma) 
Urethritis/prostatitis
Trauma
Clotting disorders
54
Q

How should macroscopic haematuria be investigated in those over 50?

A 
CT urography (kidneys, collecting systems and ureters)
Cystoscopy (bladder and urethra)
55
Q

How should macroscopic haematuria be investigated in those under 50 be investigated?

A

Malignancy of bladder or ureters unlikely so:
US kidneys to detect calculi and renal parenchymal tumours
Cystoscopy for bladder TCC, calculi
CTU ONLY when Us or cystoscopy are normal

56
Q

When is MR urography helpful?

A

Contrast allergy
Renal impairment
Pregnancy

57
Q

What is the role of imaging in renal masses?

A

Confirm presence
Characterise as benign, indeterminate or malignant
Stage malignant masses

58
Q

Is the risk of malignancy of a renal mass smaller than 3 cm high or low?

A

Low - managed conservatively

59
Q

What are renal masses containing fat?

A

Angiomyolipomas

60
Q

What are renal fluid density masses?

A

Cysts - uniform cysts are benign

61
Q

What are complex cysts of the kidneys?

A

If contain solid areas or thick septa, often malignant

62
Q

What are solid (non-cystic) tumours of the kidneys?

A

If over 3cm, malignant

63
Q

What is used to stage a malignant renal tumour?

A

CT: extracapsular spread, involvement of adjacent organs, involvement of renal vein or IV
Nodal
Mets: lungs, bone

64
Q

What can cause renal impairment?

A

Pre-renal: dehydration, hypotension, renal artery stenosis
Renal: parenchymal disease, drugs, toxins
Post-renal: obstruction

65
Q

What is used to detect renal artery stenosis?

A

MR angiography

66
Q

What is used to diagnose renal disease?

A

US to guide biopsy

67
Q

What is used to diagnose post-renal disease?

A

US for hydronephrosis (often accompanies obstruction)

CT

68
Q

What can cause a painful scrotum?

A

Epididymo-orchitis
Testicular torsion
Trauma

69
Q

What can cause epididymo-orchitis?

A

Viral or bacteria
May be complicated by abscess formation or rarely ischaemia
The testis and/or epididymis is typically hypervascular on US

70
Q

What can be seen on USS of testicular torsion?

A

Avascular - surgical emergency to prevent infarction

71
Q

What can cause a painless scrotal swelling?

A 
Hernia
Varicocele
Hydrocele
Epididymal cyst
Testicular tumour
72
Q

What imaging modality is used in a painless scrotal swelling?

A

USS for spacial resolution of superficial soft tissue structures

73
Q

What can be seen on USS of varicocele of the scrotum?

A

Dilated scrotal venous plexus on left side

Tortuous veins more than 2mm in diameter

74
Q

What can be seen on USS of a hydrocoele?

A

Black anechoic fluid surrounding the testicle

75
Q

What can be see on USS of an epididymal cyst?

A

Anechoic uni or multilocular cyst - typically arises within the epididymal head

76
Q

What is used to assess renal injury due to trauma?

A

CT

77
Q

What can be used to diagnose bladder trauma?

A

Cystography or CT

78
Q

When is interventional radiology used for non-vascular issues?

A

Ureteric obstruction
Drainage of abscess or cyst
Biopsy of renal masses
Guided ablation of renal tumours

79
Q

What vascular problems is interventional radiology used for?

A

RAS
Control of arterial bleeding sites
Varicocele embolisation

Renal (22 decks)

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