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1
Q

TRUE OR FALSE

Glomus tympanicum usually causes erosion of the underlying bone

A

FALSE

If there is erosion of the floor of the middle ear cavity, a glomus jugulotympanicum should be considered.

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2
Q

What is an aberrant ICA?

A

It is a collateral pathway present in cases of an involuted cervical segment of the internal carotid artery. The aberrant ICA courses in the middle ear, lateral to the cochlear promontory. It is composed of the inferior tympanic artery and the caroticotympanic artery, both enlarged.

It rejoins the horizontal segment of the petrous portion of the ICA.

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3
Q

What are the imaging findings of an aberrant ICA?

A

Vessel coursing horizontally from posterior to anterior through the middle ear, lateral to the cochlear promontory
Abscence/hypoplasia of the vertical segment of the petrous ICA

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4
Q

What is the definition of:

1- Dehiscence of the jugular bulb
2- Jugular bulb diverticulum
3- High riding jugular bulb

A

1- The jugular bulb is displaced superolaterally and extends into the middle ear canal through a dehiscent sigmoid plate.

2- Focal polypoid extension of the jugular bulb (usually superiorly) into the deep temporal bone just behind in IAC, with an intact sigmoid plate.

3- Extension of the most cephalad portion of the jugular bulb superior to the floor of the internal auditory canal

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5
Q

What is the jugular bulb?

A

It is the union of inferior petrosal and sigmoid dural venous sinuses in or just distal to the jugular foramen, essentially the origin of the internal jugular vein

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6
Q

What type of otosclerosis presents with conductive hearing loss? Sensorineural?

A

Fenestral otosclerosis presents with conductive hearing loss (fixation of foot plate of stapes)

Retrofenestral (cochlear) otosclerosis presents with sensorineural hearing loss.

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7
Q

Describe the types of otosclerosis

A

Fenestral: There is involvement of the oval window, with lucency of the fissula ante fenestram. There can also be involvement of the foot plate of the stapes, which thickens and becomes immobile. It can also extend to the margins of the oval and round windows.

Retrofenestral/cochlear: Low attenuation around the basal turn of the cochlea. There can also be involvement of the lateral walls of the internal acoustic canal and the cochlear promontory.
It almost always presents with fenestral otosclerosis.

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8
Q

What is the fissula ante fenestram?

A

It is a cleft of fibrocartilaginous tissue located just anterior to the oval window and posterior to the cochlea. Most common location involved in fenestral otosclerosis.

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9
Q

Hypoplasia/abscence of the vestibular aqueduct or decreased distance of the posterior semi-circular canal to the posterior edge of the temporal bone are signs of which pathology?

A

Meniere’s disease (idiopathic endolymphatic hydrops)

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10
Q

What is a persistent stapedial artery?

A

The stapedial artery is transiently present in normal fetal development. When it fails to regress, it is termed a persistent stapedial artery.

This presents on CT as abscence of foramen spinosum and enlargement/soft tissue filling of the tympanic segment of the facial canal.
It is often associated with an aberrant carotid artery.

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11
Q

What is the DDx of masses at the jugular foramen?

A 
Glomus jugulare
Glomus jugulotympanicum
Schwannoma
Meningioma
Metastasis
Pseudomasses (asymmetric jugular bulb prominence)
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12
Q

What is a paraganglioma?

A

It is a tumor arising along the autonomous nervous system (from non-chromaffin paraganglia). AKA extra-adrenal pheochromocytomas.

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13
Q

What anatomic “compartments” should be assessed when evaluating a patient with tinnitus?

A 
Scalp (AVM)
Middle ear
Temporal bone
membranous labyrinth
Internal auditory canal/cerebellopontine angle
skull base foramina and canals
dural venous sinuses
jugular foramen
brainstem/supratentorial brain (intracranial hypertension)
neck
temporo-mandibular joint
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14
Q

What are the two types of muscular tinnitus?

A

Palatal myoclonus

Middle ear myoclonus

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15
Q

What is middle ear myoclonus?

A

Tinnitus secondary to rapid rythmic contractions of the stapedius and tensor tympani muscles. Does not have specific imaging correlates.

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16
Q

What is palatal myoclonus?

A

Tinnitus secondary to myoclonus of the tensor and levator veli palatini, tensor tympani, salpingopharyngeus and superior constrictor muscles.

It is caused by cerebellar and brainstem diseases such as demyelination and infarcts.

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17
Q

TRUE OR FALSE:

Idiopathic Intra-cranial hypertension can present as tinnitus

A

TRUE

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18
Q

What structures are located in the epitympanum?

A

Malleus head

Short process of incus

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19
Q

What structures are located in the mesotympanum?

A

Muscles: tensor tympani, stapedius
Ossicles: malleus and incus, stapes
Ligaments
Nerves: chorda tympani (VII) and Jacobson’s nerve (IX)

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20
Q

What innervates the tensor tympani?

A

V3 of CNV

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21
Q

What innervates the stapedius?

A

CNVII

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22
Q

In the temporal bone, which canal travels through the “hoop” of the superior semi circular canal?

A

Subarcuate artery canal

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23
Q

What is the relationship of the nerves in the internal auditory canal?

A

7up coke down

Anterosuperior: facial nerve

anteroinferior: cochlear nerve
posterosuperior: superior vestibular nerve
posteroinferior: inferior vestibular nerve

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24
Q

Give a basic differential diagnosis for pulsatile tinnitus (8)

A

1- Congenital vascular variants:
Aberrant ICA
Dehiscent Jugular bulb

2- Tumor
Paraganglioma
Hemangioma

3- Vascular
AVM/AVF
Aneurysm
Pial siderosis (CNVIII)

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25
Q

Ddx of conductive hearing loss?

A 
Cholesteatoma
Hemangioma
Glomus tympanicum
Trauma (disruption)
Congenital
Otosclerosis
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26
Q

TRUE OR FALSE

Acquired cholesteatoma enhances on post gadolinium images

A

FALSE

Cholesteatomas do not enhance. If there is enhancement, another pathology should be considered.

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27
Q

What are the complications of acquired cholesteatoma?

A

labyrinthine fistula: lateral semi-circular canal most common
facial nerve canal erosion causing CNVII palsy
intracranial invasion through the tegmen tympani
sigmoid sinus erosion/thrombosis
automastoidectomy into the external auditory canal

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28
Q

In necrotizing external otitis, what are the pathogens typically involved?

A

Diabetic: pseudomonas
HIV: aspergillus

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29
Q

What is the primary risk factor for external auditory canal exostosis?

A

Chronic cold water exposure (divers)

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30
Q

What is the Ddx of an external ear neoplasm?

A 
1- Skin cancers
        SCC - most common
        Basal cell carcinoma
        Melanoma
2- Ceruminoma
3- Parotid tumors
4- Metastasis
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31
Q

What is the most common primary neoplasm of the petrous apex?

A

Chondrosarcoma

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32
Q

What is the difference in location between a base of skull chordoma and a chondrosarcoma?

A

Chordoma: typically midline, mostly at the clivus
Chondrosarcoma: arises from cartilage, therefore from the sutures. These are off midline.

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33
Q

What is the most common cause of post-traumatic conductive healing loss?

A

Incudostapedial disruption

The normal incudostapedial joint space is <1mm

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34
Q

What is the most common primary lesion in the parapharyngeal space?

A

Minor salivary gland tumor (90%)

However primary parapharyngeal space masses are uncommon, always assess if the lesion arises from another space. If the lesion is completely surrounded by fat, then it is a primary parapharyngeal space lesion.

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35
Q

What are the contents of the carotid space?

A

ICA
IJV
CN 9-12

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36
Q

What is the typical location of a glomus vagale (paraganglioma)?

A

In the carotid space, 2cm below the skull base

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37
Q

How to differentiate a hypervascular schwannoma from a paraganglioma on imaging

A

With conventional angiography:

Hypervascular schwannoma has multiple areas of contrast puddling, paraganglioma has areas of arteriovenous shunting.

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38
Q

What anatomic structures are typically displaced by carotid body paraganglioma?

A

It splays the ICA and ECA

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39
Q

What are the contents of the masticator space?

A 
Medial/lateral pterygoid muscles
Masseter muscle
Temporalis muscle
Inferior alveolar nerve (branch of V3)
Inferior alveolar artery and vein
Ramus and posterior body of mandible
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40
Q

What are the contents of the Parotid space?

A 
Parotid gland and stenson's duct
Facial nerve
Retromandibular vein
External carotid artery
Intraparotid lymph nodes
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41
Q

What are the contents of the nasopharynx?

A 
Mucosa
Waldeyer's ring (adenoids)
minor salivary gland
Superior and middle pharyngeal constrictor muscles
Torus tubarius
Levator veli palatini muscle
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42
Q

Where do juvenile angiofibromas originate?

A

Sphenopalatine foramen

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43
Q

What % of transverse temporal bone fractures result in facial nerve injury?

A

50%

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44
Q

What is the name of the canal containing CNVI? Where is it located?

A

Dorello’s canal

It courses along the posterior aspect of the clivus

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45
Q

A pneumatized petrous apex increases the risk of which pathologies?

A

It is present in 10% of patients

It increases the risk of a cholesterol cyst (granuloma) or apical petrositis

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46
Q

What is a cholesterol cyst? (ENT)

A

A cholesterol cyst is a foreign body giant cell reaction to cholesterol crystals. It is thought to be initially instigated as a reaction to an obstructed air cell and therefore occurs more commonly in a pneumatized petrous apex.

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47
Q

ENT

What are the MR charactistics and typical location of a cholesterol cyst?

A

Cholesterol cysts are typically located in the petrous apex, however they can also be found in the mastoid portion of the temporal bone or middle ear cavity.

On MR imaging, it appears as an expansile mass with internal hemorrhage that does not suppress on fatsat images.

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48
Q

What vascular complications are associated with apical petrositis?

A

Internal carotid arteritis

Dural venous thrombosis

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49
Q

What is the Gradenigo triad?

A

Apical petrositis/otomastoiditis
Facial pain due to trigeminal neuropathy at meckel’s cave
Lateral rectus palsy due to CNVI palsy at dorello’s canal

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50
Q

Which cranial nerves can a petrous apex schwannoma originate from?

A

CNV
CNVII
CNVIII

51
Q

Name this triad:

Apical petrositis/otomastoiditis
Facial pain due to trigeminal neuropathy at meckel’s cave
Lateral rectus palsy due to CNVI palsy at dorello’s canal

A

Gradenigo triad

52
Q

What is the typical location of a head and neck chondrosarcoma?

A

Typically arises from the midline clivus, or slightly off midline at the petroclival synchondrosis.

53
Q

True or false:

Cholesterol granulomas are typically typically T1 hyperintense with diffusion restriction.

A

FALSE

Cholesterol granulomas are T1 hyperintense, do not suppress on fat sat and do not show diffusion restriction.
If diffusion restriction is present, consider a cholesteatoma.

54
Q

What percentage of chordomas arise in the sacrum? In the clivus?

A

50% arise in the sacrum

35% arise in the clivus

55
Q

Describe the internal matrix of a chordoma

A

Chordomas do not have an internal matrix. There can be bone fragments within the lesion representing eroded bone.

56
Q

What is the most common primary malignancy of the sublingual gland?

A

Adenoid cystic carcinoma

57
Q

Which cranial nerve is located in the pars nervosa and pars vascularis?

A

Pars nervosa: CNIX

Pars vascularis: CNX and CNXI

58
Q

Which structure is characteristically eroded by a glomus jugularis?

A

Jugular spine (bony process seperating the pars nervosa and the pars vascularis)

59
Q

Which phakomatosis is associated with aplastic ICA?

A

NF1

60
Q

What is Eagle syndrome?

A

Symptomatic elongation of the styloid process or calcified stylohyoid ligament

61
Q

How long after radiation therapy does lymphoma calcify?

A

More than 12 months after radiation therapy

62
Q

Which of the following is uncommon in thyroid cancer lymphadenopathy:

Calcified
Highly enhancing
Hemorrhagic
Cystic

A

Hemorrhagic is very uncommon

63
Q

Which segment of the cranial nerve does not normally enhance on MRI imaging?

A

Preganglionic segment

64
Q

What cyst is associated with an unerupted tooth?

A

Dentigerous cyst

65
Q

What is the most common tumor to arise in the parapharyngeal space?

A

Pleomorphic adenoma

66
Q

What location characteristics allow you to differentiate a warthin’s tumor from a pleomorphic adenoma?

A

Bilateral
Multiple
Located in the tail of the parotid

67
Q

When evaluating a mass near the level of the parapharyngeal space that is displacing the carotid artery, name the most likely origin based on the direction in which the carotid artery is displaced

A

Anteriorly: carotid space
Medially: parotid space
Posteriorly: parapharyngeal space
Laterally: paravertebral space

68
Q

What is a minor salivary gland?

A

Salivary gland tissue outside of the salivary glands (parotid, submandibular, sublingual)

Located throughout the oral cavity

69
Q

What is a ranula?

A

Congenital obstruction of the sublingual gland causing cystic dilatation. Can be simple or diving, which is determined by whether or not it extends inferior to the myelohyoid muscle.

70
Q

TRUE OR FALSE

Juvenile angiofibroma always involves the sphenopalatine foramen and pterygopalatine fossa

A

FALSE

Juvenile angiofibroma can be limited to the nasopharynx

71
Q

Describe Bailey’s classification of 2nd branchial cleft cysts

A

type I: deep to platysma, anterior to sternocleidomastoid
type II: abutting internal carotid artery and adherent to internal jugular vein (most common)
type III: extending between internal and external carotid arteries
type IV: abutting pharyngeal wall and potentially extending superiorly to skull base

72
Q

PED

What MRI feature helps in the differentiation of a proliferative hemangioma from an involuting hemangioma?

A

In the proliferative phase, there are multiple flow voids, whereas during the involuting phase the flow voids are no longer present.

73
Q

What is a Michel’s anomaly?

A

Complete labyrinthine aplasia

74
Q

What are the 3 components of the hypopharynx

A

Pyriform sinus
Posterior wall of the hypopharynx
Post cricoid hypopharynx

75
Q

What is the differential diagnosis of lacrimal gland enlargement (Inflammatory and neoplastic)?

A 
INFLAMMATION
Dacryoadenitis
Spread from adjacent cellulitis
Orbital pseudotumor
Sjogren syndrome/other granulomatous dz
Sarcoidosis
Collagen vascular disease
Wegener granulomatosis
NEOPLASMS
Lymphoma/leukemia
Minor salivary gland tumors
Metastasis
Germ cell tumors: dermoid, epidermoid
Sarcoma
76
Q

What are the contents of the pterygopalatine fossa?

A 
Pterygopalatine plexus
Pterygopalatine ganglia (V2)
77
Q

DDx of a hypoglossal canal mass?

A 
Schwannoma
Meningioma
Mets
Chordoma
Large glomus jugulare
Neurogenic spread of tumor
Myeloma
78
Q

Most likely salivary gland tumor to exhibit perineural spread?

A

Adenoid cystic carcinoma

79
Q

Which landmark can you use to delineate a postseptal from preseptal orbital cellulitis?

A

The posterior lacrimal crest. If the inflammatory changes extend posterior to this point, there is postseptal cellulitis

80
Q

TRUE OR FALSE

A subperiostal abscess necessarily has adjacent bone erosion.

A

FALSE. Bone erosion is not necessary.

81
Q

Which structure seperates the retropharyngeal space from the danger space?

A

Alar fascia

82
Q

When determining whether a patient has retropharyngeal edema vs abscess, the visualization of which normal structure guides you towards the diagnosis of retropharyngeal edema?

A

If you are able to visualize the alar fascia, the most likely diagnosis is retropharyngeal edema.

83
Q

What is a bezold abscess?

A

A Bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid , at the attachment site of the posterior belly of the digastric muscle, and extends into the infratemporal fossa.

84
Q

3 most common malignancies to involve the tongue base?

A

Squamous cell carcinoma, most common
Lymphoma
Minor salivary gland tumors (mucoepithelioid, adenoid cystic)

On imaging, cannot differentiate them.

85
Q

What is the most common tumor to involve the parapharyngeal space (not necessarily arising from it)?

A

Squamous cell carcinoma.

Most common to arise from parapharyngeal space is pleomorphic adenoma

86
Q

Rosenmueller’s fossa is located posterior to which structure?

A

Torus tubarus

The eustachian tube is anterior to the torus tubarus

87
Q

Two most common neoplasms to involve the soft palate?

A

Squamous cell carcinoma

Minor salivary gland tumor

88
Q

Two most common neoplasms involving the buccal area?

A

SCC
Lymphoma

Cannot be differentiated radiologically

89
Q

What is the name of the duct of the submandibular gland? Parotid gland?

A

Submandibular: Warthon’s duct

Parotid gland: stensen’s duct

90
Q

What is the retromolar trigone?

A

The retromolar trigone is an oral cavity subsite that is consists of the mucosa posterior to the last mandibular molar. It is roughly triangular shaped and extends superiorly towards the maxilla along the anterior surface of the mandible.

91
Q

Two most common neoplasms involving the hard palate?

A

SCC

Minor salivary gland tumor

92
Q

Which landmark seperates level 1A from 1B lymph nodes?

A

Medial border of the anterior belly of the digastric muscles.

93
Q

If most of a lymph node is posterior to the internal jugular vein, while still touching it, is it level 2A or 2B?

A

2A

2B lymph nodes are posterior and not in contact with the IJV

94
Q

What are the borders of lymph node level 5?

A

Posterior to the back of the SCM from the skull base to the clavicle
It is anterior to the anterior edge of the trapezius

95
Q

What are the boundaries of level VI lymph node level?

A

They are located medial to the internal carotid arteries

Extends from the base of the hyoid bone to the top of the manubrium

96
Q

What are the boundaries of level VII lymph nodes?

A

From the top of the manubrium down to the innominate vein

Between the carotid arteries

97
Q

If you have isolated level 5 lymphadenopathy, which neoplasm should be considered?

A

Skin cancers (melanoma, BCC)

98
Q

If a patient has isolated supraclavicular lymphadenopathy, which neoplasms should be considered?

A 
Gastric
Lung
Colon
Breast
Nasopharyngeal SCC
Hodgkin's lymphoma
99
Q

Where are the retropharyngeal lymph nodes located?

A

Within 2cm of the skull base

Medial to the internal carotid arteries

100
Q

In head and neck cancer, the presence of a metastatic lymph node has what impact on survival?

A

Reduces survival by 50%

101
Q

How do you measure a lymph node in head and neck imaging?

A

When you are imaging cervical lymph nodes in transverse axial plane, you are cutting the lymph node through its short axis. You need to measure the “long axis” of the lymph node, not short axis like the remainder of the body.

If larger than 10mm (15mm lvl2 and 7-10mm retropharyngeal), then it is enlarged.

102
Q

what is the anatomic landmark seperating the supraglottis from the glottis?

A

laryngeal ventricles, seperating false from true vocal cords.

103
Q

Signal characteristics of adenoid cystic carcinoma of the salivary glands?

A

CT:
If agressive, appears infiltrative
Homogeneous enhancement

MRI:
T1 hypo-iso
T2 mild to marked hyper (agressive is more marked)
C+ homogeneous

104
Q

A Kasai procedure is most successful if performed before which age?

A

8 weeks of age.

Kasai procedure is performed for noncorrectable biliary atresia.

105
Q

What is Alagille syndrome?

A

It is a congenital genetic multi-system disorder.
Involvement includes:

Paucity/stenosis of intrahepatic bile ducts leading to cirrhosis/hepatic failure

Renal disease (cysic disease, small/echogenic kidneys, nephrocalcinosis)

Posterior embryotoxon (ocular pathology)

Butterfly type vertebrae

Facial anomalies

Cardiovascular (coarctation of aorta, peripheral pulm art stenosis)

106
Q

What is the DDx for low inetstinal obstruction in the newborn? (5)

A 
Anorectal malformations
Hirschsprung disease
Meconium ileus
Functional immaturity of the colon
Distal atresias
107
Q

In the evaluation of neonatal low intestinal obstruction with contrast enema, which contrast agent should be used and why.

A

Iodinated water-soluble contrast

Meconium ileus/functional immaturity of the colon can be aided by water-soluble enema
There can be colonic perforation in certain cases of hirschsprung
The density of water-soluble contrast is sufficient in neonates

108
Q

What is hirschsprung disease?

A

Absence of ganglion cells in the myenteric plexus of the distal bowel.

Embryologically, neural crests migrate along the vagal trunks in a cranio-caudal direction. In Hirschsprung, there is arrest of migration during 7th-12th weeks of getation, resulting in distal aganglionosis.

109
Q

Most common area of involvement in Hirschsprung disease?

A

Short segment disease constitutes 75% of cases, involving rectum and portion of the sigmoid colon.

Hirschsprung can vary from ultra-short segment disease (only internal sphincter) to total colonic aganglionosis with small bowel involvement.

110
Q

TRUE OR FALSE

Hirschsprung disease primarily affects term infants.

A

TRUE

It is rare in premature infants.

111
Q

TRUE OR FALSE

Hirschsprung disease is associated with Down syndrome

A

TRUE (5-8%)

112
Q

What percentage of patients with hirschsprung disease present with perforation? Enterocolitis?

A

5% present with perforation of distal SB, colon or appendix.

25-33% present with enterocolitis.

113
Q

What are the contrast enema findings in Hirschsprung disease?

A

Transition zone (the aganglionic bowel is collapsed, with proximal distention)
Irregular contractions and serrations
Mucosal irregularity
Abnormal rectosigmoid index (diameter rectum/sigmoid <1 suggests hirschsprung)
If barium used, 24hr delayed film can show retained barium.

The narrowing is gradual (as opposed to functional immaturity where the transition is abrupt)

114
Q

Meconium ileus is associated with which pathology? What percentage of patients with this disease present with meconium ileus?

A

Cystic fibrosis. It is the presenting feature in 5-20% of cases.

115
Q

What are potential complications of meconium ileus?

A 
Volvulus
Perforation
Atresia
Peritonitis
Pseudocyst formation

Complications occur in up to 50% of cases.

116
Q

What are the abdominal radiograph findings in meconium ileus?

A

Dilated bowel consistent with low intestinal obstruction

Bubbly appearance in RLQ (air mixed /w meconium)

Variation in caliber of distended bowel loops

Paucity of air-fluid levels

Pneumoperitoneum

If associated /w meconium peritonitis (not always 2nd to meconium ileus), scattered abdominal calcifications can be present.

Meconium pseudocyst: mass effect from necrotic bowel with a fibrous wall that may be calcified.

117
Q

What are the contrast enema findings in meconium ileus?

A

Microcolon (<1cm in diameter)
Multiple filling defects in distal ileum from meconium
Distended distal small bowel

118
Q

In the treatment of meconium ileus by contrast enema:

1- which type of contrast agent should be used?
2- What is the success rate?
3- Complications?
4- Can it be performed multiple times?

A

1- Hyperosmolar water-soluble agent (ex: half strength gastrograffin). This draws water into the bowel lumen.

2- 50-60%

3- Perforation (2-11%), necrotizing enterocolitis, shock

4- Can be repeated if hydration/electrolyte balance adequate. If it fails after 2-3 attempts, operative management should be considered.

119
Q

TRUE OR FALSE

Functional immaturity of the colon is associated with cystic fibrosis

A

FALSE

Functional immaturity of the colon, a.k.a. meconium plug syndrome, is not associated with CF.

120
Q

What maternal and infantile factors are associated with functional immaturity of the colon? (6)

A

MATERNAL:
Diabetes
Magnesium sulfate

INFANTILE:
Prematurity
Hypoglycemia
Sepsis
Hypothyroidism
121
Q

What are the contrast enema findings in functional immaturity of the colon?

A

Narrowed rectum, sigmoid and left colon.
Abrupt transition at the level of the splenic flexure to dilated transverse and right colon.
Normal rectosigmoid index (>1)
Multiple filling defects of meconium (non-specific).

Rectum remains distensible (in contrast to hirschsprung where it is almost always narrowed).

122
Q

DDx of microcolon in newborns?

A

Meconium ileus

Distal ileal atresia

123
Q

TRUE OR FALSE

The splenic flexure is the most common location of transition zone on contrast enema in Hirschsprung disease.

A

FALSE

The most common location of involvement in Hirschsprung disease is sigmoid and rectum. A transition zone at the splenic flexure is uncommon in Hirschsprung disease, and is the most common location for a transition zone in functional immaturity of the colon.

124
Q

Describe the following categories of Duplex kidney anomalies:

1- Duplex kidney
2- Duplex collecting system
3- Bifid collecting system
4- Double/duplicated ureters

A

1- Two seperate pelvicalyceal systems draining into a single renal parenchyma

2- Duplex kidney draining into:

  • Single ureter (duplicated pelvicalyceal system uniting at UPJ)
  • Bifid ureter (2 ureters that unite before bladder)
  • Double ureter (complete duplication of ureter)

3- Duplex kidney with 2 seperate pelvicalyceal collecting systems uniting at UPJ or as bifid ureters.

4- 2 ureters that drain seperately into the bladder or genital tract.

ENT (2 decks)

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