Urologic radiology

Question 1

Test of choice for suspected nephroureterolithiasis

Answer 1

Noncontrast CT abd/pelvis

OR doppler ultrasound if pregnant

Question 2

Signs of nephroureterolithaisis on CT

Answer 2

• Visible stone
• Hydronephrosis
• Hydroureter
• Perinephric stranding

Question 3

Imaging in patients with suspected pyelonephritis

Answer 3

Not necessary when pyelo is empirically suspected.

Only performed after a failure of empiric treatment for pyelonephritis after 72 hours, in which case a contrast CT abd/pelv is usually indicated.

Question 4

Captopril scintigraphy

Answer 4

Tc99 tagged scintigraphic scan which highlights the kidneys. Can be used in the setting of suspected renal artery stenosis.

A delay in excretion indicates poor kidney function. As such, this scan will highlight the poorly functioning kidney.

Poor choice for those with poor renal function, as it may reduce function further.

Question 5

When revascularization is performed in renovascular hypertension

Answer 5

• In patients with significant stenosis bilaterally or in a solitary functioning kidney, especially if captopril-enhanced scintigraphy is positive, regardless of renal function.
• When renal insufficiency is present, in patients with unilateral significant stenosis.

Question 6

Past what point do we qualify “significant” hematuria

Answer 6

>3 RBC/hpf

This is an indication for clinical workup.

Question 7

Glomerular and extraglomerular hematuria

Answer 7

Glomerular: From pathology of the nephron. Accompanied by proteinuria and with acanthocytic microscopic appearance.

Extraglomerular: “Isolated hematuria” without proteinuria. Suggests stone, malignancy, trauma, infection, or medication effect.

Question 8

Workup of isolated painless hematuria without other explanation

Answer 8

CT urography

to evaluate for possible malignancy

Question 9

Bosniak renal cyst classification

Answer 9

Question 10

If a renal cyst is suspicious on ultrasound, what is the next best step to work it up?

Answer 10

CTA or MRA

To evaluate the cyst’s vascularity.

If the cyst enhances, it is likely to be renal cell carcinoma.

Question 11

Bellclapper deformity

Answer 11

Question 12

In testicular torsion, ___

In epididymitis, ___

Answer 12

In testicular torsion, flow in one testicle is gone or basically gone

In epididymitis, flow in one testicle is increased (and the epididymis will be huge!). This is due to associated orchitis.