WEEK 1: Workshop: Imaging Urinary tract Flashcards
State the imaging exams for the urinary tract.
Imaging exams
– X-rays
* KUB (kidney-ureter-bladder)
* Intravenous urogram (IVU, IVP)
* Retrograde ureterogram and
urethrogram
* Voiding cysto-urethrogram
– Ultrasound
– CT
– MRI
State the functions of the kidney.
Function
– Regulation of vascular solutes and water
* Regulated blood pressure
– Filters the blood
State the 3 main parts of the kidney
Parts
– Cortex (glomerulus, proximal and distal convoluted tubule and some loop of Henle)
– Medulla (loop of Henle, collecting ducts)
– Collecting system
Describe how Contrast Imaging works.
- IV contrast
– Foreign substance
– Filtered and excreted by kidney - Intravascular (cortical phase)
- Excreted into collecting ducts (medullary phase)
- Excreted into the collecting system (excretory phase)
Describe how imaging with ultrasound works.
What produces echos?
State the following US characteristics.
– Time to echo return?
– Loudness of return?
Imaging with sound
* Emit sound wave
* Listen for echos
* Emit sound wave
* Listen for echos
* Etc.
– Difference in tissues (tissue planes)
* Different tissue – different acoustic
impedance
* Echo at interface
– Time to echo return
* Measure of depth
– Loudness of return
* Measure of difference in acoustic impedance
What are some causes of renal masses?
Focal Renal Lesions
- Neoplasm Focal Renal Lesions
– Malignant
* RCC
* TCC
* Lymphoma
* Mets
* Wilms tumor
– Benign
* Adenoma (oncocytoma)
* Angiomyolipoma (AML) (fat!)
* Multilocular cystic nephroma - Infection (abscess)
- Trauma
* Hematoma/Laceration/Fracture - Infarction
* Other
What is hydrouteronephrosis?
Hydroureteronephrosis is a medical condition characterized by the dilation of both the ureter and the renal pelvis (part of the kidney) due to an obstruction in the flow of urine. This obstruction can occur anywhere along the urinary tract, leading to a buildup of urine and subsequent swelling.
Hydroureteronephrosis
State the 5 causes.
- Obstruction
– Calculus
– Neoplasm - Primary
– TCC, Squamous cell - Pelvic malignancies
– cervix, uterus, ovary,
colon, prostate
– Strictures - Post op, XRT, TB
– Papillary necrosis
– Hematoma
– Pregnancy (minor, not significant) - Reflux
- Prior obstruction or reflux
Describe the Renal Vascular Supply
- Right and left renal arteries
– Arise from lateral aspect of aorta (occasionally multiple) - Right and left renal veins
– empty into the lateral aspects of the IVC
Renal arteries divide into
– Segmental arteries
* To each region
– Arcuate (interlobar) arteries
* Between medullary pyramids and between the cortex and medulla
– Intralobular arteries
* Enter nephrons
What is renal Arteriogram?
State its uses.
- Inject contrast into aorta or renal artery
Uses
1. Renal artery stenosis
– “Pre-renal” renal disfunction
– Renovascular HTN
* Unilateral stenosis
– Causes
* Atherosclerosis
* Vasculitis (PAN)
- Renal artery laceration
- Aneurysms and AVM’s
- Embolization neoplasms
What is Intravenous or CT Urogram?
Describe how it is done.
What are its uses?
- Imaging evaluation of the collecting system and ureters
- IVU
1. Inject water soluble contrast into a peripheral vein.
2. Kidney filters contrast
3. Excretes it into the collecting systems
4. Passes into the urinary bladder via the ureters - Uses
1. Hematuria
2. Strictures: a restriction
Describe the flow of urine to the bladder.
Urine excreted into
1. Calix
* Cup-shaped
* Surrounding medullary tip
2. Infundibulum
3. Renal pelvis
4. Ureter
* Peristalsing tube
5. Bladder
Ureter is a peristalsing tube. Peristalsing Tube
Cyclic, involuntary contractions propel fluid from proximal to distal.
State causes of its obstruction.
Obstruction
- Proximal dilatation
- Distal collapse
State causes of Ureteral Stricture.
- Prior surgery
- Urologic
* Other pelvic (GYN)
- Urologic malignancy
2. Transitional cell carcinoma (TCC) - Squamous ca.
- Extrinsic malignancy or inflammation
* Infections - TB
* shistosomiasis
* XRT
* Other - Polyureteritis cystica:
Description: Polyureteritis cystica is a rare condition characterized by the presence of small, cystic, fluid-filled lesions (cysts) in the ureter lining.
* Malicoplakia
Description: Malacoplakia is a rare inflammatory condition that can affect various organs, including the urinary tract. It is characterized by the formation of granulomatous lesions containing abnormal accumulations of certain cells.
Most common malignancy of the urothelium
– 95% in bladder
– 5% in upper tracts (kidney, collecting systems
and ureter)
* 10% of all upper tract neoplasms (most are RCC)
* Presentation
– Hematuria
* Imaging
– Filling defect (polypoid)
– Annular stricture with shelf-like margins
State the pathology.
Transitional Cell Carcinoma