Flashcards in genitourinaryradiologyflash Deck (92):
Mural bladder wall calcification?
Bladder stone.. TCC.. Cystitis.. Foreign body encrustation.. Amyloidosis.
Extrinsic displacement of bladder?
Pelvic hematoma and urinoma. Pelvic mass. Bladder diverticulum. Lymphadenopathy. Pelvic lipomatosis. Iliopsoas hypertrophy.
Intraperitoneal bladder rupture, CT characteristics?
Lateral pelivic recess (lateral paravesical recesses superior to bladder). Midline pouch of Douglas (posterior to bladder and anterior to rectosigmoid)
Extraperitoneal bladder rupture, CT characteristics?
Perivesical space (extends anterior and superior to bladder to level of umbilicus). Retrorectal or presacral space.
Ileal loop complications?
Early (obstruction or extravasation at ureteroileal anastomosis). Late (chronic pyelonephritis, nephrolithiasis, obstruction).
Filling defects in urethra?
Calculus. Polyp. Carcinoma. Condylomata acuminata. Polypoid urethritis. Malacoplakia. Urethritis cystica. Metastases. Amyloidosis.
Paraurethral outpouchings or tracts?
(Pseudo)diverticulum. Fistula. Cowper's duct or gland. Glands of Littre. Mullerian remnants (utricle or Mullerian cyst).
Ovarian neoplasms, types and frequency?
Epithelial 65%. Germ cell 25%. Sex cord-stroma 5%. Secondary or metastatic 5%. Gonadoblastoma rare.
Epithelial ovarian tumors?
Serous. Mucinous. Endometrioid. Clear-cell. Brenn (rare).
Serous or Papillary epithelial ovarian tumors?
75% benign (large unilocular cyst). Malignant (solid masses, nodular walls, contrast enhancement).
Mucinous epithelial ovarian tumors?
95% benign (large multilocular cystic mass). Pseudomyxoma peritonei.
Ovarian dermoid cyst (mature cystic teratoma)
Primordial germ cell. Common in girls less than 15 yo. 15% bilateral. Torsion, trauma, infection, rupture. Sebaceous plug or tooth.
Metastases to ovary
Krukenberg tumors: Signet ring cells, mucinous ADCA from stomach or colon. Breast cancer. Lymphoma
Nonseminomatous germ cell tumors?
Embryonal cancer. Yolk sac cancer. Choriocarcinoma. Teratoma.
Bilateral, Entire ureteral dilatation without ureteral obstruction?
Bladder outlet obstruction. Prune-belly. Diabetes insipidus. Polydypsia. Primary megaureter.
Unilateral, entire ureteral dilatation without ureteral obstruction?
Vesicoureteral reflex (grades II-IV). Ectopic ureter inserting below bladder. Bacterial infection.
Ureteral dilatation of distal segment only without ureteral obstruction?
Primary megaureter. Vesicoureteral reflux (grade I).
Ureteral dilatation of proximal segment only without ureteral obstruction?
Retrocaval or retroiliac ureter. Enlarged urterus. Postpartum ectasia.
Malignant causes of ureteral narrowing?
Urothelial neoplasm. Local extension of extrinsic tumor. Distant metastasis. Lymphoma.
Infectious causes of ureteral narrowing?
Inflammatory bowel disease causes of ureteral narrowing?
Regional enteritis. Diverticulitis. Appendicitis.
Gynecologic causes of ureteral narrowing?
Traumatic causes of ureteral narrowing?
Stone passage. Iatrogenic. Mechanical stone extraction. Ureterolithotomy. Radiation therapy.
2/3 papillary. 85% of urothelial neoplasms. 20% multifocal. Associations: aniline dyes, tobacco, analgesics, Balkan nephropathy.
Uncommon associations with retroperitoneal fibrosis?
Aortic aneurysm. Aortic graft. Retroperitoneal hemorrhage. Urinoma. Abscess. Metastases. Drugs. Bowel Disease.
CT signs of ureteral stone?
Homogeneous density in ureter lumen. Unilateral hydronephrosis. Hydroureter. Perirenal stranding. Nephromegaly. Loss of white renal pyramids. Kidney stones.
Intraluminal ureteral filling defects
Calculi. Blood clots. Sloughed papilla. Fungus ball. Mucopus. Air bubbles.
Mucosal ureteral filling defects?
Neoplasm. Edema. Leukoplakia.
Mural ureteral filling defect?
Ureteritis cystica. Hemorrhage. Malacoplakia. Endometreiosis. Schistosomiasis.
Common causes of focal filling defects of the bladder wall?
Neoplasm. Stone. Blood clot. Enlarged prostate.
Malignant bladder neoplasms?
TCC. SCC. Adenocarcinoma.
Benign bladder neoplasms?
Leiomyoma. Fibroepithelial polyp. Hemangioma. Pheochromocytoma. Adenoma.
Outpouchings of bladder wall?
Diverticulum and saccule (
Bladder diverticula features?
Result from bladder neck or urethral obstruction. Congenital (Hutch diverticulum). Can cause ureteral obstruction or reflux. Urinary stasis may lead to stones or cystitis. 2% have carcinomas.
Features of xanthogranulomatous pyelonephritis?
Female predominance. History of UTIs. Nephrolithiasis. Renal enlargement. Renal hypofunction. Fractured calculus. Renal cysts. Extrarenal extension common.
Features of renal infarcts?
Wedge-shaped. Cortical rim sign. Usually multifocal. Progressive atrophy over time.
CT findings of pyelonephritis?
Renal enlargement. Multifocal wedge-shaped hetergeneous areas. Parenchymal striations.
Differential of small scarred kidneys?
Unilateral: Reflux nephropathy. Previous renal surgery. Bilateral: Normal calyces (renal infarcts). Abnormal calyces (bilateral reflux nephropathy or analgesic nephropathy).
In reflux nephropathy scarring first develops?
At renal poles.
Differential of unilateral small smooth kidney?
Normal calyces: Renal artery stenosis. Chronic renal vein thrombosis. Renal hypoplasia. Subcapsular hematoma. Radiation therapy. Abnormal calyces: Postobstructive atrophy.
Urographic signs of renal artery stenosis
Small smooth kidney. Delayed nephrogram. Delayed pyelogram. Hyperdense pyelogram. Ureteral notching.
Causes of unilateral reniform enlargement?
Ureteral obstruction. Duplication anomalies and hypertophy. Parenchymal infiltration (pyelonephritis, XGP, contusion, infiltrating neoplasm). Edema (acute renal vein occlusion, acute arterial occlusion/arteritis).
Causes of striated nephrogram?
Common: Acute ureteral obstruction. Pyelonephritis. Uncommon: ARPKD. Acute renal vein thrombosis. Renal contusion. Rare: Radiation nephritis.
Common and uncommon causes of bilateral renal enlargement with masses?
Common: ADPCKD. Uncommon: Acquired renal cystic disease. Simple cysts. Lymphoma. Metastases. Wilm's tumor.
Causes of medullary nephrocalcinosis?
Common: Medullary sponge kidney. Hypercalcemia. RTA. Uncommon: Papillary necrosis. TB. Hyperoxaluria. Chronic furosemide use.
Causes of cortical nephrocalcinosis?
Common: Chronic glumerulonephritis. Acute cortical necrosis. Uncommon: Hyperoxaluria. Rare: Alport's syndrome. Chronic transplant rejection.
General causes of renal failure?
Prerenal: Underperfusion. Renal: Diffuse parenchymal disease. Postrenal: Bladder outlet obstruction, Bilateral ureteral obstruction.
Enlarged hyperechoic kidneys?
2 types of renal sinus fat proliferation?
Renal sinus lipomatosis: increased fat with little mass effect. Replacement lipomatosis: renal atrophy, massive fat.
Renal sinus cysts?
Peripelvic: multiple, small, insinuating. Parapelvic: typical simple renal cyst. Uriniferous: urine extravasation.
Renal sinus neoplasms
Renal: RCC, AML, MLCN. Sinus: AML, teratoma, Lipoma/sarcoma, fibroma/sarcoma, neuroma/sarcoma, leiomyoma/sarcoma, malignant histiocytoma.
Normal ureter course measurements and landmarks?
less than 1 cm lateral to transverse process.. Not medial to vertebral pedicle. Ureters separated by > 5 cm.
Right adrenal gland is located posterior to the
Inferior vena cava (IVC) at the level where the IVC enters the liver.
Radiographic abnormalities of Horseshoe kidney?
Renal nonrotation. Lower pole fusion. Low retroperitoneal position. Renal vascular anomalies
Other urinary tract abnormalities associated with horseshoe kidney?
UPJ obstruction. Duplication anomalies. Stone formation. Pyeloureteritis cystica. Infection-based stone formation.
Crossed fused ectopia?
One kidney crosses midline and fuses with the other. Ureters insert in the bladder in their normal position (crossed kidney's ureter crosses midline).
Radiographic findings of pelvoinfundibular MDK (Multicystic dysplastic kidney)?
Randomly distributed cysts. Noncommunicating cysts. Absent renal function. Atretic ureter.
Radiographic findings of hydronephrotic MDK (multicystic dysplastic kidney)?
Dominant cyst in region of renal pelvis. Radially arrayed cysts may communicate. Minimal renal function possible. Ureter occluded at UPJ (ureteropelvic junction).
Abnormalities with ARPKD (autosomal recessive polycystic kidney disease)?
Oligohydramnios. Nephromegaly. Hyperechoic kidneys. Renal failure inversely proportional to hepatic failure.
MSK (Medullary sponge kidney associations?
Renal tubular ectasia. Nephrolithiasis. Medullary nephrocalcinosis. Caroli's disease. Ehler's-Danlos syndrome.
Multilocular cystic nephroma associations?
Benign cystic neoplasm. Young boys (1st decade). Adult women (3rd and 4th decades). Herniation of parenchymal mass into renal pelvis
Bosniak CT classification of cystic renal masses?
Class I: simple cysts, nonoperative. Class II: septated, minimal calcium, nonenhancing high-density cyst, infected cyst, nonoperative. Class III: multiloculated, hemorrhagic, dense calcium, non-enhancing solid component, renal-sparing surgery. Class IV: marginal irregularity, enhancing solid component, radical nephrectomy.
RCC: IVU features?
Expansile mass. calyceal displacement, compression. Ureteral notching. Diminished function, if renal vein occluded.
RCC: CT, MR features?
Approximately spherical shape. Fails criteria for simple cyst. Lacks internal fat (AML). Enhances.
Other abnormalities that present with renal agenesis?
Absent ipsilateral ureter. Absent ipsilateral hemitrigone. Absent ipsilateral vas deferens. Ipsilateral seminal vesicle cyst. Unicornuate uterus. Abnormal bowel gas pattern.
Nonrotated verus malrotated kidney?
Nonrotated: anterior positioned UPJ (Ureteropelvic junction). Malrotated (over-rotated): posterior positioned UPJ.
Calyceal diverticulum, details?
Intraparenchymal cavity lined with transitional epithelium that communicates with collecting system. Type 1 communicates with minor calyx. Type 2 communicates with infundibulum. Type 3 communicates with renal pelvis.
Mesoblastic nephroma, details?
Benign neoplasm. Hamartoma of the kidney. Diagnosed in children under 2. Mimic malignant neoplasms (Wilm's).
Increased risk of Wilm's tumor (multiple and bilateral). Young patients with renal enlargement and multiple subcapsular masses.. Primitive renal tissue that persists beyond 36 wks gestation.
Organs within anterior pararenal space of retroperitoneum?
Pancreas. Retroperitoneal colon (right and left). Duodenum.
Organs within posterior pararenal space of retroperitoneum?
Organs within perirenal space of retroperitoneum?
Kidney. Adrenal gland. Collecting system. Renal and perirenal vasculature. Renal and perirenal lymphatics.
Solitary expansile renal masses?
Common: Cyst, RCC. Uncommon: AML, abscess, mets. Rare: Oncocytoma, MLCN, Localized renal cystic dz, Focal xanthogranumomatous pyelonephritis.
Other areas of interest in abdominal imaging in RCC?
Contralateral kidney. Renal vein. Vena cava. Regional lymph nodes. Ipsilateral adrenal gland. Adjacent organs. Liver. Skeleton.
Features of oncocytoma?
Males 6th or 7th decade. Solid expansile mass. Iso-heteroechoic at US. Homogeneous enhancement CT. Pseudocapsule. Central scar in larger lesions. Spoke wheel angiographic pattern.
Features of multilocular cystic nephroma?
50% males less than 3 yo. 50% females > 40 yo. Expansile, multiloculated cystic renal mass. Herniation into collecting system. Enhancing septa at CT. Absent hemorrhage. Hypo-or avascular at angiography.
Features of renal abscess?
Evidence of infection. Hypoechoic with less through transmission than cyst. Thick wall, rim enhancement CT. Perinephrich inflammatory changes. Neovascularity in wall on angiogram.
Features of xanthogranulomatous pyelonephritis?
Middle-aged females with UTIs. Focal hypofunctioning renal mass. Infection-based stones.
Features of renal lymphoma?
Usually with systemic lymphoma. Usually bilateral. Multifocal, diffuse, or focal. Hypoechoic without through-transmission. Often with massive lymphadenopathy.
Features of angiomyolipoma?
80% in adults (females). 4th-5th decade. 20% in tuberous sclerosis. Well-defined hyperechoic mass. Fat, even small amounts, diagnostic with CT. Neovascularity with aneurysm on angiography. Unlikely to bleed if less than 4 cm.
von Hippel-Lindau disease?
40% RCC. 75% simple renal cysts. Hemangioblastomas CNS. Retinal angiomas. Pancreatic cysts. Pancreatic neoplasms. 50-80% Pheochromocytomas (multiple, bilateral, extraadrenal).
Tuberous sclerosis features?
Renal cystic disease. 80% AMLs. Cerebral hamartomas. Cardiac rhabdomyomas(sarcomas). Skeletel osteomas. Pulmonary lymphangioleiomyomatosis.
Infiltrative renal neoplasms?
TCC. SCC. Infiltrative RCC. Renal medullary carcinoma. Renal lymphoma.
Distinctions of GU SCC versus TCC?
SCC more aggressive. Fast-growing. 50% SCC have coexistent renal calculus.
Renal medullary carcinoma
Patients less than 40 yo. Sickle cell trait > disease. Poor prognosis,
Duplication anomaly. Upper moiety ureter inserts inferior and medial to normal (lower moiety) bladder insertion.
Medial deviation of upper ureter?
Lower-pole renal mass. Lateral retroperitoneal mass. Psoas hypertrophy. Retroperitoneal fibrosis. Retrocaval ureter.
Medial deviation of lower ureter?
Lymphadenopathy. Pelvic lipomatosis. Iliopsoas hypertrophy. Pelvis mass/fluid collection. Iliac vessel ectasia. Abdominopelvic resection. Cystocele.
Lateral deviation of upper ureter?
Malrotated or horseshoe kidney. Lymphadenopathy. Psoas hypertrophy. AAA. Retroperitoneal mass/fluid. Ureter mobilization surgery.
Lower ureter lateral deviation?
Central pelvic mass/fluid collection. Sciatic ureteral hernia.
Retrocaval ureter: urography findings?
Right ureter. Abrupt medial deviation. Course medial to pedicle. Fish-hook shape. Hydronephrosis.