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Y4 SA - Urogenital > Diagnostic Imaging of the Urogenital Tract > Flashcards

Diagnostic Imaging of the Urogenital Tract Flashcards

1
Q

What are the 5 main considerations of diagnostic imagine of the urogenital tract?

A

Mass effect
Effacement
When is prostatomegaly suspicious?
Contrast studies - which study when?
Stones are not equal in radiography

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2
Q

What are the common presentations of urogenital disorders/disease?

A

Pollakisuria, stranguria, discoloured urine, polyuria, anuria, incontinence, vulval discharge, etc

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3
Q

What are the 3 commonly available methods for imaging the urogenital tract?

A

Radiography
Contrast radiography
Ultrasound

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4
Q

What is plain radiography useful for?

A

Shape, size, location, but not internal architecture or ureters

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5
Q

List the pros and cons of plain radiography

A

Pros:
- Readily accessible
- Low-operator dependency
- Easy to perform
- Low risk
Cons:
- Limited information
- Ionising radiation

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6
Q

What is contrast radiography useful for?

A

Same as plain radiography + internal architecture or luminal space, ureters

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7
Q

List the pros and cons of contrast radiography

A

Pros:
- Good quality information
- Readily accessible
Cons:
- Ionising radiation
- Slightly increased risk
- Operator dependent

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8
Q

What is ultrasound useful for?

A

Shape, size, internal architecture or luminal space, less good ureters

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9
Q

List the pros and cons of ultrasound

A

Pros:
- High quality information
- No ionising radiation
- Low risk
Cons:
- Slightly less accessible
- Highly operator dependent

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10
Q

Describe the normal appearance of the uterus and ovaries on radiography

A

Not visible on radiographs unless greatly enlarged

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11
Q

Describe the normal appearance of the uterus and ovaries on ultrasound

A

Difficult - the body is located between the urinary bladder ventrally and the descending colon dorsally

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12
Q

How does a pyometra appear on radiography?

A

Dilated, soft tissue opacity loops originating between bladder and colon
Mass effect displacing the intestines cranially and dorsally

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13
Q

How does a pyometra appear on ultrasound?

A

Fluid dilation of the uterine horns and body
Thin or thick, cystic wall

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14
Q

Where is the prostate located on normal radiography?

A

Caudal to the bladder, may be partly within the pelvic canal

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15
Q

Describe the size/shape and opacity of the normal prostate on radiography

A

Size: dependent on neutering status
Rule-of thumb (entire): ≤70% height of the pelvic inlet
Shape: Symmetrical, ovoid to round, urethra centrally
Opacity: homogeneous soft tissue opacity

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16
Q

What are the 3 causes of prostatomegaly?

A

Benign prostatic hyperplasia
Prostatitis
Prostatic neoplasia

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17
Q

Describe the main features of Benign prostatic hyperplasia

A

Entire dogs
Symmetrical enlargement
Soft tissue opacity

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18
Q

Describe the main features of prostatitis

A

Entire dogs!
Most marked enlargement
Regular or irregular shape
May see mineralisation
± Loss of serosal detail

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19
Q

Describe the main features of prostatic neoplasia

A

Especially in castrated dogs!!
Mineralisation
Asymmetrical
Irregular shape
± Loss of serosal detail

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20
Q

In neutered dog mineralisation very specific for …?

A

Prostatic neoplasia

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21
Q

Where does prostatic neoplasia metastasize to?

A

Medial iliac lymph nodes and lumbar vertebrae (periosteal reaction, lysis) and lung

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22
Q

Name 3 contrast studies

A

Cystography
Retrograde urethrography
Intravenous urography

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23
Q

Which contrast media can be used in cystography?

A

Positive
- Iodine containing
- NOT barium
Negative
- Air
- CO2 or N2O

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24
Q

Which contrast studies can only use positive iodine containing contrast?

A

Retrograde urethrography
Intravenous urography

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25
Q

What are the principles of cystography

A

Catheterise and empty bladder
instill/insufflate with contrast medium (air/gas or iodine-based contrast) until reasonably distended

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26
Q

Describe the uses of a Pneumocystogram

A

Great for assessment of position and to identify “radiolucent” calculi (urate/cysteine), masses, clots

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27
Q

Describe the uses of a double contrast cystogram

A

Uses only a small amount of positive contrast and is great for mucosal detail and “radiolucent” stones, masses, clots

28
Q

Describe the uses of a positive contrast cystogram

A

Great for position, shape, and most importantly integrity (bladder tears/rupture)

29
Q

How do the following appear on double contrast cystography:
Calculi
Blood clots
Air bubbles

A

Calculi = central defects in the contrast pool
Blood clots = may adhere to the bladder wall, often irregular, can appear everywhere
Air bubbles = iatrogenic, at the pool margins

30
Q

Describe the principles of retrograde urethrogram/vaginourethrogram

A
  • Catheterise, empty bladder, inflate bladder moderately with air/gas (creating back pressure)
  • Place catheter tip in tip of penis/just within vulva and clamp
  • Inject iodine-based contrast and expose at end of injection
  • Needs to be done under GA as it is painful
31
Q

Describe the principles of intravenous urography

A

Intravenous injection of iodine-based contrast medium and documentation of its transition through the kidneys, ureters and into the bladder with multiple radiographs

32
Q

For a diagnostic study of intravenous urography what features are needed?

A
  • Adequate renal function and hydration
  • Good patient preparation (fasting, enema)
  • GA/heavy sedation
  • Multiple VD and lateral radiographs at short intervals
  • Time! - Can take up to 2 hours to carry this out
33
Q

Which contrast is best for visualisation of the bladder?

A

Cystography

34
Q

Which contrast is best for visualisation of the urethra (bladder)

A

Retrograde urethrogram

35
Q

Which contrast is best for visualisation of the ureters and kidenys

A

Intravenous urogram

36
Q

What are the indications for cystography?

A

Radiolucent calculi, bladder masses, bladder rupture/integrity, chronic cystitis

37
Q

What are the indications for retrograde urethrography?

A

Stranguria (urethrolith, stenosis, inflammation, neoplasia), integrity, ectopic ureter

38
Q

What are the indications for an intravenous urogram?

A

Suspected ectopic ureter, ureteroliths, ureteral stenosis; renomegaly; integrity

39
Q

What are the potential problems of intravenous urography?

A

Inadequate renal function, dehydration, iodine hypersensitivity

40
Q

Describe the normal radiographic appearance of the bladder

A

Pear-shaped, smoothly marginated, soft tissue opacity in caudoventral abdomen

41
Q

Describe the normal appearance of the bladder on ultrasound

A

Pear-shaped organ in the caudal abdomen with anechoic contents

42
Q

Describe chronic cystitis on diagnostic imaging

A

Not visible on plain radiographs
Ultrasound - Irregularly thickened wall, Blood clots

43
Q

Which contrast is used for cystitis

A

Double contrast cystography
- Thickened (cranioventral) wall
- Irregular mucosa
- Blood clots

44
Q

Describe the appearance of different bladder calculi on radiography

A

Accumulate in the most dependent part of the bladder (centrally)
Visibility depended on radiopacity and size:
- Struvite, oxalate, calcium phosphate: moderate to marked
- Silicate: moderate
- Cystine and urate: non-opaque to faint

45
Q

Describe the appearance of bladder masses on radiography

A

Not visible on plain radiographs (effacement).
Defect in the contrast pool or soft tissue opacity on pneumocystogram.
Predilection site: trigonum, dorsal bladder wall

46
Q

Describe the appearance of bladder masses on ultrasound

A

Most commonly urothelial cell carcinoma (previously TCC)
Sessile, polypoid echoic mass

47
Q

What is the most common cause of a bladder rupture

A

Trauma induced

48
Q

How can bladder ruptures be diagnosed using diagnostic imaging?

A
  • Plain radiographs: may see loss of serosal detail and small bladder.
  • If suspected, do positive contrast cystography.
  • Leakage of contrast.
  • Ultrasound rarely able to show defect, but will see free fluid
49
Q

What is the only way to accurately assess the urethra

A

Through retrograde (vagino)urethrogram - Smoothly marginated, slightly varying diameter

50
Q

Describe the normal appearance of the kidneys on radiography - location, opacity, shape, margination

A

Location: retroperitoneal space, left kidney usually more caudally
Opacity: homogeneous soft tissue opacity ± fat at the hilus
Shape: bean-shaped in dog, slightly more rounded in cats
Margination: sharp and smooth

51
Q

How can you assess if the kidneys are of normal size?

A

Best assessed on VD radiographs
Dog: length of normal kidneys should be between 2.5 and 3.5x length L2 vertebral body
Cat: normal renal length ~ 1.9-2.6x length L2

52
Q

Describe the normal appearance of kidneys on ultrasound

A

Cortex: Echoic, similar or hypoechoic to liver
Medulla: Near anechoic, least echogenicity of all organs
Renal pelvis and diverticula (renal sinus):
- Hyperechoic (bright)
- Should not contain any urine (anechoic)

53
Q

Renomegaly will cause a mass effect where?

A

Ventrally displaced colon

54
Q

List the causes of a unilateral irregular/focal Renomegaly

A

Neoplasia
Cysts
Abscess, haematoma

55
Q

List the causes of a bilateral irregular/focal Renomegaly

A

Neoplasia/metastasis
PKD = polycystic kidney disease
FIP

56
Q

List the causes of a unilateral smooth (generalised) Renomegaly

A

Neoplasia
Hydronephrosis
Perinephric pseudocyst

57
Q

List the causes of a bilateral smooth (generalised) Renomegaly

A

AKI
Pyelonephritis
Lymphoma
FIP

58
Q

Pyelectasia and hydronephrosis both show?

A

Dilation of the renal pelvis

59
Q

What is pyelectasia?

A

Mild to moderate dilation secondary to diuresis or inflammation (pyelonephritis)

60
Q

What is hydronephrosis?

A

Moderate to severe often secondary to obstruction (ureteral calculi, masses), overall enlargement of the kidney

61
Q

What are the causes of small kidneys (microrenale)

A

CKD
Atrophy
Dysplasia (congenital)

62
Q

Describe the changes seen on diagnostic imaging with CKD

A

Non-specific and poor correlation with function
Changes with CKD are variable and kidney may appear normal in early stages
‘Classic endstage’: small and irregular, but maybe smooth
Ultrasound: poor corticomedullary definition, small, irregular

63
Q

Describe the appearance of renal cysts on ultrasound

A

Renal cysts maybe solitary, develop as part of CKD or if multiple indicate polycystic kidney disease (PKD)
Thin walled
Mostly unicameral
Distal acoustic enhancement
May distort surface

64
Q

Describe the normal position of ureters on diagnostic imaging

A

Usually not visible on plain radiographs or ultrasound, but IVU very useful!

65
Q

Where are the ureters located?

A

Retroperitoneum, lateral to the spine on VD
Size: 1-2 mm, peristalsis

Y4 SA - Urogenital (12 decks)

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