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GU and breast Flashcards

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1
Q

Actinomycosis (pelvic)

A

Opportunistic infection resulting mucosal breach following IUCD, trauma or recent surgery.

Imaging features:

  • Fat stranding
  • Intraperitoneal free fluid
  • Tubo-ovarian abscess
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2
Q

Adenomyosis

A

MRI:

  • Increased thickness (>12mm) of junctional zone with high T2 foci.
  • Enlargement or globular shape of uterus.

US:

  • Heterogenously increased echotexture with JZ and myometrila cysts

HSG:

  • Outpouchings of contrast in to wall
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3
Q

Adult polycystic kidney disease

A
  • 30-50 yo
  • AD
  • No increased risk of malignancy
  • Assoc. w/ Hepatic cysts, intracranial berry aneurysms, pancreatic and splenic cysts.
  • IVP - Swiss chees appearance
  • Cysts have variable MR characteristics.
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4
Q

Asherman’s disease

A

Intra-uterine adhesions formed as a result of previous trauma, D&C and infection. Can affect fertility.

HSG - irregular linear filling defects.

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5
Q

Birt-Hogg-Dube

A

Lung:

  • Multiple cysts and spontaneous pneumothorax

Skin:

  • angiofibromas,
  • perifollicular fibromas
  • acrochordons
  • fibrofolliculomas

Renal:

  • Chromophobe RCC
  • Oncocytoma
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6
Q

Bladder rupture classification

A
  1. Bladder contusion
  2. Intraperitoneal rupture
  3. Interstitial bladder injury
  4. a) Simple extraperitoneal rupture b) Complex EPR
  5. Combined bladder injury
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7
Q

Bosniak

A

I:

  • low attenuation, hairline wall with nor septations or calcifications.

II:

  • Paper-thin septations
  • May contain thin or short segement thick calcification in the wall or septa.
  • Hyperattenuating cysts

IIF:

  • Multiple hairline septa that do not enhance
  • Can contain thick irregular calcification
  • hyperattenuating cysts that are larger than 3cm
  • CT or MR follow-up at 6 montsh and then yearly for 5 years.

III

  • Multiloculated cyctic nephroma
  • Complex septated cysts with heavy calcification
  • Radiologicially indisiguishable from cystic RCC therefore surgerically removed.

IV:

  • Large ehnacing soft tissue component with irregular margins and enhancement.
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8
Q

Breast implants.

A

Foramation of a fibrous capsule occurs. ruptures can be intracapular or extracupsular.

Intracapsular:

  • Linguini sign on MR

Extracapsular & Intracapsular:

  • Snow storm node
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9
Q

Breast papilloma

A

Most common cause of bloody nipple discharge

Early menopausal women

Solitary dilated duct in the subareolar region

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10
Q

Brenner Tumour

A

AKA transitional cell tumour

Rare and usually benign

Solid fibrous tumour assoc. w/ ipsilateral cystadenoma or cytic teratoma

Low T2 and T1

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11
Q

Clear cell carcinoma

A

Over 45

Mailgnant transformation of endometriomas

BIG >6cm

Enhancing mural nodules

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12
Q

Contraindications to HSG

A

Active uterine bleeding/menses

Active infection

Pregnancy

Uterine surgery on the past 3 days

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13
Q

Contraindications to UAE

A
  • Pelvic infection
  • History of pelvic radiation
  • Connective tissue disease
  • Asymptomatic fibroids
  • Pregnancy
  • Pedunculated fibroids
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14
Q

Corpus Luteum Cyst (CLC)

A

Residual follicle following ovulation.

CLC results from failed resorption of bleeding in to the cyst.

If fertilised the CLC becomes CLC of pregancy and can continue to grow til 8-10 weeks - shoudl resolve by 16 weeks.

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15
Q

DCIS

A

Early form of breast Ca

Hitology: camedo type is more aggressive than non-comedo.

Pagets disease = high-grade DCIS

US: microlobulated mildly hypoechoic mass with ductal extension and normal acoustic transmisson.

Mammo: Fine linear branching or fine pleomorphic calc.

MRI: non-mass-like enhancement

Galactography: multiple intraductal masses.

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16
Q

Diethylstibestrol (DES) expesure

A

T-shaped uterus

Uterine hypoplasia

Increased risk of clear cell cancer of the vagina

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17
Q

Dygerminoma

A

30 yo

Similar to seminoma of the testes and pineal germinomas

Radiosensitive and good survival outcome.

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18
Q

Ectopic ureter

A

Female with UTI, hydromephrosis and incontinence.

Majority of ectopic ureters emby into the post sphincteric urethra > vagina > tubes > perineum.

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19
Q

Endometrioma

A

Rounded homogenous mass with low level echoes and increased through transmission.

T1 bright - will not fat sat - T2 dark - ‘shading sign’

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20
Q

Endometroid ovarian cancer

A

Second most common ovarian cancer

Assoc w/ concomitant endometrial cancer (25%)

Malignant transformation of endometriomas

15% bilateral

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21
Q

Fibroadenoma

A

Well defined lobulated mass.

Popcorn calcification

US - well defined and hypoechoic

MRI - T1 hypo - T2 hyper - enhances

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22
Q

Fibrothecoma

A

PM women

Ovarian stomal tumour

Assoc w/ endometrial hyperplasia and Meigs syndrome if larger than 5cm

Assoc w/ fibromatosis - causing omental fibrosis and sclerosis peritonitis (Dark T1 and T2 ‘ black garland sign’)

Iso T1 and Low T2

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23
Q

Germ cell tumour

A

Teratoma = Any tissue (dermoid plug or Rokintansky nodule can be premalignant)

Dermoid = Hair, teeth, sebaceous gland

Epidermoid = Only epidermis and secretes watery fluid.

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24
Q

Granulosa cell tumour

A

Oestrogen active tumour

assoc. w/endrometrial hyperplasia/polyp/carcinoma

Adult form more common - Px w irregular bleeding

Juvenile form (rare) - Px w pseudoprecocious puberty

MR: Solid-cystic with haemorrhagic components

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25
Indications for breast MRI
1. High risk screening 2. Preoperative assessment 3. Evaluation of recurrence or residual tumour post surgery 4. Response to therapy 5. Evaluation of post-op scar vs recurrence 6. Implant integrity.
26
Invasive Ductal Ca
Most common breast Ca Hard, non-mobile, painless lump. Inx - irregular high density mass with spiculate/indistinct margines and pleomorphic calc. Mass with **echogenic halo** on US Subtypes: * NOS - most common (65%) * Tubular * Mucinous - Uncommon round/lobulated and circumscribed mass with good outcomes. * Medullary * Papillary
27
Invasive Lobular Carcinoma
* Second most common breast Ca after IDC-NOS (5-10%) * Presents later than IDC in and Older population. * Uncommon to met to axilla - prefers stuff like peritoneal surfaces * Mammo: * architectural distortion withouth a central mass "dark star" * "shrinking breast" - non compressible breast * US - Shadowing without a mass
28
Krukenberg's
Ovarian mets from stomach or colon Ca. Typically bilateral complex masses.
29
Leukoplakia
Haematuria, white plaques - premalignant for SCC
30
Malakoplakia
Rare inflammatory comdition affecting the bladder Yellow-Brown subeithelial plaques Cobblestone appearance on IVP. Occur in immunocomprimised, DM etc. NOT premalignant.
31
Malignant types of calcification in breast.
* Amorphous * Coarse, heterogenous and irregular * Fine pleomorphic * Fine linear/branching (ductal)
32
Mallerian duct cyst vs. Prostatic utricle cyst
**Mullerian duct cyst** **Prostatic utricle cyst** *Age* 20-40 0-20 *Shape* Teardrop Pear *Extends above prostate* Yes No *Communicates with prostatic urethra* No Yes
33
Mayer-Rokitanksy-Kuster-Hauser syndrome
* Dysgenesis of the mullerian ducts * Vaginal or uterine agenesis * Normal sex characteristics and karyoptype * Renal abnormalities * Normal ovaries in typical type. Ov and FT can be abnormal in atypical type.
34
Medullary Breast Carcinoma
* Sub-type of IDC * 40-50yo * 25% have BRCA1 * Very large at time of discovery. * Round circumscribed mass w/ no calc - just soft tissue mass on mamm * US - Posterior acoustic enhancement
35
Meigs Syndrome
Classically ovarian fiboma related ascites and pleural effusion. But can be seen with other ovarian tumours.
36
MEN I
* Pituitary adenoma * Parathyroid adenoma * Pancreatic islet cell tumour
37
MEN 2b
* Marfanoid habitus with course facial features * Medullary thyroid carcinoma * Pheochromocytoma * Oral ganglioneuroma
38
MEN IIa
* Medullary thyroid carcinoma * Pheochromocytoma * Parathyroid adenoma
39
Mets to breast (in order)
1. melanoma 2. sarcoma 3. lymphoma 4. lung ca 5. gastric
40
Myelolipoma
Rare benign tumour composed of adipose and haematopoietic tissue. Inx: * Obvioud fat mass * May enhance * 20% have calcification
41
Ovarian cancer
Premenopausal ovarian volume \>18cm^3 and PM \>8cm^3. Large cyst (\>5cm) Doppler RI \<0.4 with pleak velocity \>25cm/s Mucinous or cyst adenocarcinoma (most common) Complex cystic mass. * Stage 1 Limited to ovary * Stage 2 Both ovaries +/- Ascites * Stage 3 Intraperitoneal mets * Stage 4 Extra peritioneal mets Endrometroid carcinoma Germ cell tumour * Dysgerminoma * Embyonal cell * Choriocarcinoma * Teratoma * Yolk sac tumour Sex chord-stromal tumour * Granulosa cell * Sertoli-Leydig tumour * Thecoma and fibroma Mets * Uterine * Stomach/colon * Lymphoma
42
Dermoid (ovarian)
20-30yo 'tip of the iceberg sign' - absorption of most of the US beam at the top of the lesion. cystic mass with a hyperechoic soild mural nodule. (Rokitansky nodule) MRI: T1 bright - Will fatsat out - T2 bright 1% malignant - become squamous cell Ca. (RF = BIG and \>50yo)
43
Ovarian vein syndrome
Ureteral notching as result of thrombus in the gonadal veins. Usually assoc w/ pregnancy. Right gonadal vein - crosses ureter - IVC Left gonadal vein - crosses ureter - left renal vein
44
Papillary breast carcinoma.
* Rare subtype of IDC * Complex cystic solid mass * Elderly
45
Papillary necrosis
Ischaemic damage to the medulla and does not tend to involve the cortex. Appearance: * clubbed calyces * Calcification * sloughing of necrotic papilla. * altered renal contour * lobster claw and signet ring sign Causes: * analgesia * diabetes * pyelonephritis * renal vein thrombosis * sickle cell.
46
Paraovarian cysts
Embryological remnant of the broad ligament. Can have cyclical changes, tort or rupture. **Can only be diagnosed if ipsilateral ovary is shown to be separate.**
47
PCOS
Px: Stein-Leventhal syndrome - Oligomenorrhea, hirsutism & obesity. Increase LH, LH/FSH ratio and androgens. Imaging: * Bilaterally enlarged kidneys (similar size) * \>12 follicles not bigger than 1cm * Peripheral location of cysts with central hyperechoic fibrous tissue
48
PET in the menstural cycle
1st week to avoid false positive. Should not be positive post menaupause.
49
Peyronie Disease
Calcified plaques in both corpora cavernosa Ix: US * calcified peripheral plaques * thickened septum between corpora cavenosa MR - above pluse DWI to demonstrate inflammation (place saline bags over dick to prevent susceptibility artefact)
50
Pheochromocytoma
Paraganglioma arising from the adrenal medulla. Functional tumours secrete catecholamines (adrenaline/noradrenaline/dopamine) 10% extradrenal (most commonly at organ of zuckerland near the aortic bifurcation) 10% bilateral 10% are malignant. Assoc w/ MEN 2, NF1 and VHL. Inx: * MR: T2 lightbulb * MIBG scintigraphy * Octeotride scintigraphy
51
Phyllodes Tumour
* Rare encapsulated fibroepithelial tumour. Resembles fibroadenoma. * Rapidly growing * 40-50yo * Can met to pleura.
52
Radial scar
High-risk lesion and needs to come out - Assoc. w/ DCIS, IDC and tubular carcinoma Not an actual scar - just fibrous tissue around ducts which gives the impression of architectural distortion.
53
Renal SCC
* 5% of renal pelvis tumours * Assoc w/ Leukoplakia, chronic irritation from schistosomiasis or nephrolithiasis
54
Renal-retinal dyplasia
Recessive disease of mudullary custic disease and retinitis pigmentosa.
55
Reninoma
Small hypvascular mass Px: HTN, Hypernatraemia and hypokalaemia.
56
Risk factors for breat cancer
1. Age 2. Fhx 3. Early menarche 4. Late meopause 5. Late first pregnancy 6. Nulliparity
57
Salpingitis Isthmica Nodosa (SIN)
Diverticula-like invaginations into the myosalpinx. Associated with previous PID Increased risk of ectopic pregnancy.
58
Schistosomiasis
S. Japonicum eggs in the urinary tract cause sever granulomatous reaction. Inflammatory polyposis (bilharziomas) Extensive Calcification ___ Can lead to SCC
59
Serous Ovarian / cystadenocarcinoma
Most common ovaria malignancy (75% benign or borderline - 25% malignant) Women of child bearing age. Unilocular cystic with septations. Pappilary projections
60
Sertoli-Leydig
\<30 yo Androgen secreting tumours associated with virilisation Unilateral - 15% malignant
61
Stages of RCC
62
TB GU
Renal\>Ureteral\>Bladder\>Seminal vesicles. Commonly unilateral. * Variable paranchymal calcification. * Pappillary necrosis * Tyberuloma * Parenchymal scarring. * Infundibular stenosis leading to amplutated calyx * Corckscrew ureter * Renal pelvis stenosis * Narrow, rigid and aperistaltic segments of the ureter.
63
Testicular tumours
Germinoma (95%) * seminoma (40%) - radio sensitive with a good prognosis - age 40-60 assoc. w/ crypotorchidism * embyonal carcinoma (10%) - aggressive seminoma with bad prognosis * choriocarcinoma (1%) - very aggressive * teratoma (10%) - 10-20yo with good prognosis * mixed Sex-cord stromal tumours * Leydig cell - endochronogically active and benign Mets * prostate * kidney * lymphoma * leukaemia Epidermoid - benign with classical onion skin on US
64
Theca Lutein Cysts
Develop in conditions with elevated b-HCG. * Molar pregnancy * Choriocarcinoma * Rh incompatibility * Twins * Ovarian hyperstimulation syndrome MRI: * Can be MASSIVE (20cm) * Usually bilateral and multi-locular * Solid components show intense enhancement * Intermediate T2; High DWI.
65
Transplant kidney
Functional assessment = Resistive index should be \<0.7 (Psys - Pdia/Psys) ATN: most common reversible renal failure - 24 hours post transplant. Seen as a persistent dense nephrogram on CT. -Normal flow but reduced extretion. Rejection: * RI \>0.7 * Increased renal size * Thickened hypo-echoic cortex * Large pyramids * Loss of CMJ
66
Traumatic kidney injury grades
67
Tubular Breast Carcinoma
* Subt-type of IDC * Rare and slow growing * Small/slow growing * Assoc. w/ radial scar * Contralateral breact Ca 10-15% * Mammographically indistinguishable from other cancers with spiculated margins
68
Unterine MR signal intensities
* Endometrium, high SI * Junctional zone (inner layer of compact myometrium), low SI * Myometrium, intermediate SI * Cervical stroma, low SI * Serosal covering, low SI
69
Urachal adenocarcinoma
Antero-superior dome of the bladder in the midline 70% calcify 90% are adenocarcinoma
70
Uraemic cystic disease
End stage renal disease and dialysis patients. Increased incidence of RCC and haemorrhagic cysts
71
Waterhouse-Friderichsen syndrome
Adrenal haemorrhage secondary sepsis (DIC)
72
Yolk sac tumour
\<20 yo Raised AFP Rare and highly malignant
73
Struma Ovarii
Subtype of ovarain teratoma Multilocular cystic mass - T2 dark 'cystic' areas due to colloid - intense enhancement. Actually contain thyroid tissue and can present as a thyroid storm.

Radiology (6 decks)

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