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GU Radiology > BRANT: Chapter 48: Pelvocalyceal System, Ureters, Bladder and Urethra > Flashcards

BRANT: Chapter 48: Pelvocalyceal System, Ureters, Bladder and Urethra Flashcards

PBR 1 edition

1
Q

It is now the imaging method of choice for evaluation of hematuria and as a screening examination of the pelvicalyceal system and ureters.

A

CT urogram

CT IVP

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2
Q

In CT urogram, thin-slice MDCT acquisitions are reformatted in longitudinal planes to provide visualization of the collecting system comparable to the traditional intravenous pyelogram (IVP), also called the

A

Excretory urogram

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3
Q

T/F: The CT urogram is limited by lower spatial resolution than the IVP, which is based on traditional radiography

A

True

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4
Q

T/F: Retrograde pyelography, performed by cystoscopic catheterization of the ureteral orifice followed by injection of contrast, is independent of renal function, provides high-quality images of the ureter and the collecting system, and is another alternative commonly utilized by urologists.

A

True

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5
Q

It is the imaging method of choice for screening for hydronephrosis but is limited in its ability to demonstrate small uroepithelial tumors.

A

US

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6
Q

The collecting tubules of a medullary pyramid coalesce into a variable number of papillary ducts that pierce the tip of the papilla and drain into the receptacle of the collecting system called a ____

A

Minor calyx

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7
Q

The sharp-edged portion of the minor calyx projecting around the sides of a papilla is called the ____

A

Fornix of the calyx

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8
Q

Name the entity pointed by the red arrow

A

Extrarenal pelvis

A so-called extrarenal pelvis is predominantly outside the renal sinus and is larger and more distensible than the more common intrarenal pelvis, which is surrounded by renal sinus fat and other structures

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9
Q

The following statements are true, except:
a. Infundibula extend between minor calyces and the renal pelvis.
b. The ureters have an outer fibrous adventitia that is continuous with the renal capsule and with the adventitia of the bladder.
c. The mucosa lining the entire pelvicalyceal system, ureters, and bladder is transitional epithelium or uroepithelium
d. The ureters enter the bladder at a non-oblique angle.

A

d. The ureters enter the bladder at a non-oblique angle.

OBLIQUE

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10
Q

3 main points of ureteral narrowing, where calculi are likely to become impacted, are:

A

a. Ureteropelvic junction (UPJ)
b. Site at which the ureter crosses the pelvic brim
c. Ureterovesical junction (UVJ)

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11
Q

Weigert–Meyer rule states that:
a. Ureter draining the UP moiety insertion, obstructs/refluxes?
b. Ureter draining the LP moiety insertion, obstructs/refluxes?

A

a. UP (ectopic): medial and inferior, obstructs (ureterocele)
b. LP (orthotopic): lateral and superior, refluxes

The Weigert–Meyer rule states that with complete ureteral duplication, the ureter draining the upper pole passes through the bladder wall to insert inferior and medial to the normally placed ureter draining the lower pole.

The upper pole ureter is commonly tortuous and dilated. The ectopic ureterocele and its associated dilated ureter may simulate a multiseptated cystic mass in the pelvis.

The upper pole ureter often ends as an ectopic ureterocele reflecting obstruction because of its ectopic insertion. The lower pole ureter inserts in, or near, the normal location in the bladder trigone and is subject to vesicoureteral reflux because of distortion of its passage through the bladder wall by the ectopic ureterocele. (“Upper pole obstructs; lower pole refluxes.”)

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12
Q

The anomaly in retrocaval ureter is due to faulty embryogenesis of the inferior vena cava, with abnormal persistence of the ____ anterior to the ureter instead of the right supracardinal vein posterior to the ureter

A

Right subcardinal vein

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12
Q

Retrocaval ureter is a developmental variant in which the right ureter passes behind the inferior vena cava at the level of ____ vertebra.

A

L3 or L4

The ureter exits anteriorly between the cava and the aorta to return to its normal position.

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13
Q

Which urinary tract stone will not be detected on conventional radiograph:
a. Calcium oxalate
b. Brushite
c. Uric acid
d. Cystine

A

c. Uric acid

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14
Q

Which urinary tract stone will not be detected on conventional radiograph:
a. Calcium phosphate
b. Cystine
c. Brushite
d. Indinavir calculus

A

d. Indinavir calculus

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15
Q

Most common urinary tract stone is composed of:
a. Brushite
b. Struvite
c. Calcium phosphate
d. Calcium oxalate

A

d. Calcium oxalate

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16
Q

T/F: Nearly all stones are visible on unenhanced CT as high attenuation (>200 H), geometric or oval, opaque objects.

A

True

The single exception is the soft tissue attenuation (15 to 30 H) crystalline calculus associated with treatment of HIV patients with the antiretroviral drug, indinavir.

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17
Q

Ureteral dilatation: ____

A

> 3 mm

Stones less than 6 mm in size are likely to pass spontaneously through the ureter within 6 weeks. Stones larger than 6 mm are more likely to remain lodged in the ureter and require intervention for removal.

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18
Q

Mean attenuation value of phleboliths which can differentiate them from ureteroliths

A

160 HU

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19
Q

T/F: The probability that a calcification represents a phlebolith is less than 3% when the attenuation is >300 H

A

True

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20
Q

Renal collective system thickening, usually seen in pyenophrosis, is defined as ____

A

> 2 mm

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21
Q

Vesicoureteral reflux is a common cause of hydronephrosis in children. The basic defect is an abnormal ureteral tunnel at the ____ and associated urinary tract infection allowing infected urine from the bladder to reflux up the ureter.

A

UVJ

22
Q

Congenital megaureter is due to an aperistaltic segment of the lower ureter ____ in length causing a functional obstruction and resulting in dilation of the proximal ureter. Ureteral dilation exceeds ____

A

5 to 40 mm, 7 mm

The aperistaltic segment of the ureter demonstrates smoothly tapered narrowing without evidence of mechanical obstruction.

23
Q

Stone or Tumor

A

Champagne glass sign in Ureteral TCC. This sign distinguishes tumor from a calculus that impacts in the ureter and causes distal spasm and narrowing

24
Q

T/F: A diagnosis of ureteral stricture should never be made unless dilation of the ureter or pelvis above the point of narrowing is present.

A

True

25
Q

The normal filled urinary bladder is oval, with the floor parallel to, and ____ above, the superior aspect of the symphysis pubis.

A

5 to 10 mm

26
Q

T/F: The inferior surface is extraperitoneal.

A

True

27
Q

T/F: The superior surface is covered by peritoneum, which extends to the side walls of the pelvis.

A

True

28
Q

True of the urinary bladder, except:
a. Anteriorly, the bladder is separated from the symphysis pubis by fat in the extraperitoneal space of Retzius.
b. Posteriorly, the bladder is separated from the uterus by the uterovesical peritoneal recess in females and from the rectum by the rectovesical peritoneal recess in males.
c. The trigone is a triangle at the bladder floor formed by the two ureteral orifices and the internal urethral orifice. With voiding, the trigone descends 1 to 2 cm and transforms from a flat surface into a cone with the urethra at the apex
d. The bladder wall has four layers: an outer connective tissue adventitia, smooth muscle consisting of longitudinal muscle fibers sandwiched between inner and outer layers of circular fibers, submucosal connective tissue (the lamina propria), and the mucosa of transitional epithelium.

A

d. The bladder wall has four layers: an outer connective tissue adventitia, smooth muscle consisting of longitudinal muscle fibers sandwiched between inner and outer layers of circular fibers, submucosal connective tissue (the lamina propria), and the mucosa of transitional epithelium.

The lining mucosa of the bladder is loosely attached to the muscular coat, so when the bladder is contracted, the mucosa appears wrinkled. The bladder wall has four layers: an outer connective tissue adventitia, smooth muscle consisting of CIRCULAR muscle fibers sandwiched between inner and outer layers of LONGITUDINAL fibers, submucosal connective tissue (the lamina propria), and the mucosa of transitional epithelium.

29
Q

T/F: On MR T1WI, the bladder wall is often indistinguishable from low-intensity urine.

A

True

30
Q

The ____ is the vestigial remnant of the urogenital sinus and allantois. It is a tubular structure that extends from the bladder dome to the umbilicus along the anterior abdominal wall. The ____ is its obliterated residual.

A

Urachus
Median umbilical ligament

31
Q

The normal wall of a well-distended bladder should not exceed ____ in thickness.

A

5 to 6 mm

32
Q

Name the structure pointed by the blue arrowhead and the black arrows

A

Blue: Trigone
Black: Bladder wall

33
Q

GU TB primary affects which organ?

A

Kidneys

34
Q

The most common urinary tract neoplasm affects which of part the GUT

A

UB

35
Q

Extraperitoneal bladder rupture (80% of bladder ruptures) results from puncture of the bladder by a spicule of bone from a pelvic fracture. Contrast extravasates into extraperitoneal compartments, most commonly the ____

A

Retropubic space of Retzius

Conventional or CT cystography with distention of the bladder to at least 250 mL is required to exclude bladder rupture.

36
Q

Name the studies done and the pointed structures

A

Photo A: Retrograde urethrogram
Photo B: Voiding cystourethrogram

A. Base of the bladder
B. Penile urethra
C. Bulbar urethra
Straight arrow: Suspensory ligament of the penis at the penoscrotal junction
Curved arrow: Membranous urethra/Urogenital diaphragm
Arrowhead: Veromontanum

The membranous urethra ( curved arrows) is only 1 cm in length and is entirely within the muscle of the urogenital diaphragm.

37
Q

The retrograde urethrogram is a simple study of the male ____ urethra.
a. Anterior
b. Posterior
c. A and B
d. None of the above

A

a. Anterior

Complete filling of the posterior urethra is not possible because contrast runs freely into the bladder.

38
Q

In retrograde urethrogram, contrast medium is injected into the anterior urethra by means of a syringe or catheter that occludes the meatal orifice. Radiographs are exposed in the ____ projection.

A

Right posterior oblique

The anterior urethra normally distends fully because of resistance of the external sphincter at the level of the UROGENITAL DIAPHRAGM

39
Q

Voiding cystourethrography is performed by filling the bladder with contrast via a catheter. The catheter is removed, and radiographs are obtained while the patient urinates into a basin on the fluoroscopy table. The voiding urethrogram demonstrates distention of the ____ urethra.
a. Anterior
b. Posterior
c. A and B
d. None of the above

A

c. A and B

40
Q

The male urethra is divided into posterior and anterior portions by the inferior aspect of the ____

A

Urogenital diaphragm

41
Q

Anterior or posterior urethra
a. Penile urethra
b. Membranous urethra
c. Prostatic urethra
d. Bulbous urethra

A

a. Anterior
b. Posterior
c. Posterior
d. Anterior

The posterior urethra consists of the prostatic urethra within the prostate gland, from the bladder neck to urogenital diaphragm, and the short membranous urethra, which is totally contained within the 1 cm thick urogenital diaphragm.

The anterior urethra extends from the urogenital diaphragm to the external urethral meatus. It consists of the bulbous urethra extending from the urogenital diaphragm to the penoscrotal junction, and the penile urethra extending to the urethral meatus.

42
Q

The anterior urethra is entirely contained within the corpus spongiosum penis except for the proximal 2 cm of the bulbous urethra, called the ____. This unprotected portion of the urethra is particularly susceptible to straddle injury.

A

Pars nuda

43
Q

The prostatic urethra runs vertically through the prostate over a length of ____

A

3-4 cm

44
Q

An oval filling defect in the midportion of the posterior wall is the ____.

A

Verumontanum

45
Q

True of the male urethra, except:
a. An oval filling defect in the midportion of the posterior wall of the posterior urethra is the verumontanum
b. The ejaculatory ducts open into the urethra on either side of the verumontanum, and the prostatic glands empty into the urethra by multiple small openings that surround the verumontanum.
c. The utricle, a mullerian remnant, is a small, saccular depression in the middle of the verumontanum.
d. Cowper glands are pea-sized accessory sex glands within the urogenital diaphragm on either side of the membranous urethra. Their ducts empty into the penile urethra 2 cm distally
e. The voluntary external urethral sphincter within the urogenital diaphragm entirely surrounds the membranous urethra.

A

d. Cowper glands are pea-sized accessory sex glands within the urogenital diaphragm on either side of the membranous urethra. Their ducts empty into the bulbous urethra 2 cm distally

46
Q

Name the structures pointed by the arrows/arrowheads

A

Arrowhead: Veromontanum
Skinny arrow: Cowper glands
Fat arrow: Ducts of the Cowper glands

On retrograde urethrography, the bulbous urethra tapers to a cone shape as the urethra enters the external sphincter. The apex of the cone marks the division between the membranous and bulbous urethra.

47
Q

The penoscrotal junction that divides the bulbous and penile urethra is marked by the ____, which causes a normal bend in the urethra.

A

Suspensory ligament of the penis

48
Q

T/F: The entire anterior urethra is lined by the glands of Littre whose secretions lubricate the urethra.

A

True

49
Q

The female urethra varies in length from ____

A

2.5 to 4 cm

50
Q

Name the pointed structures

A

Arrow: Urethra
Arrowhead: Vagina
A: Rectum

On MR, the urethra is isointense with the vaginal muscle on T1WI. On T2WI, the normal urethra demonstrates a characteristic target appearance with dark inner and outer rings and a middle zone of high signal intensity. The middle zone corresponds to highly vascular submucosa and enhances markedly with gadopentetate administration. The dark inner zone is mucosa, and the dark outer zone is urethral smooth muscle.

51
Q

Traumatic injury to the male posterior urethra occurs in about 10% of pelvic fractures. The junction between the ____ and ____ urethra is the most common site of injury.

A

Prostatic and membranous

52
Q

Which urethra is affected?

A

Membranous urethra at the level of urogenital diaphragm

GU Radiology (4 decks)

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