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Imaging and revision Flashcards

1
Q

what level does the renal arteries come off the aorta

A

L2 (above gonadal)

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2
Q

what level do the gonadal arteries come off the aorta

A

L2 (below renal)

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3
Q

what level does the coeliac trunk and SMA come off the aorta

A

L1

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4
Q

what level does the IMA come off the aorta

A

L3

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5
Q

what level does the abdominal aorta bifurcate

A

L4

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6
Q

what level are the renal hilums at

A

left L1

right L1/2

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7
Q

what are the contents of the renal hilum

A

posterior- renal pelvis
middle- renal artery
anterior- renal vein

lymphatic
nerves
renal sinus fat

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8
Q

which renal vein is longer

A

the left- passes across the aorta anteriorly to join the right sided IVC

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9
Q

what is USS good at detecting in the kidneys

A 
renal size 
cortical scarring 
distention 
calculi 
abnormalities
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10
Q

what is CT good at showing in the kidneys

A

vascular assessment

most pathologies

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11
Q

what are the negatives of CT

A

high dose radiation

contrast induced nephropathy (rise is serum creatinine and urea 3 days after exposure)

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12
Q

is CT with/ without contrast best to detect calculi

A

without

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13
Q

are the kidneys bound by mesentery

A

no are retoperitoneum

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14
Q

how can you reduce the risk of CT induced nephropathy

A

hydration

eGFR<60

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15
Q

what is MRI good at showing in the kidneys

A

renal lesions
vascular assessment
most pathologies

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16
Q

what are the negatives of MRI

A

nephrogenic systemic fibrosis (initial skin erythema, pruritis, pain, later involves other organs, with time skin thickens)

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17
Q

what are the subdivision of the ureter

A

abdominal, plevic and intravesicle

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18
Q

where do the ureters narrow

A 
pelviureteric junction (renal pelvis and ureter)
pelvic brim(crosses over the common iliac artery bifurcation0 anterior and medial to SI joint) 
vesicoureteric junction (enters bladder)
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19
Q

what muscle does the abdominal ureter follow

A

medial aspect of the psoas

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20
Q

where does the pelvic ureter turn medially

A

the level of the ischial spines

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21
Q

what part of the bladder does the ureters enter

A

the posterolateral angles

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22
Q

what ureter abnormalities can you get

A

bidif
duplex (two into bladder)
ectopic ureter
retrocaval ureter (behind IVC)

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23
Q

what is the workhorse for assessing the collecting system, ureter and bladder

A

CT urogram

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24
Q

what is the posterior wall of the bladder loosely attached to in females

A

anterior vagina and cervix

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25
do you need a full/empty bladder to assess outline w/ USS
full
26
what can USS of the bladder detect
diverticula, wall irregularities, internal calculi, outline and volumetric measurement
27
what is cystography good for
``` (been replaced by CT urogram) leak through bladder tear internal calculi wall irregularities diverticula ```
28
what is the gold standard for local bladder tumour staging
MRI
29
where in bladder does the urethra originate
antero-inferior wall of bladder
30
what are the subdivisions of the male urethera
prostatic membranous bulbous penile
31
what is a urethrogram and what is it used for
retrograde filling of urethra strictures trauma diverticula
32
what is the primary imaging choice for testes, scrotum, uterus, ovaries and prostate
USS
33
what is a hysterosalpingogram used for
infertility- tubal patency | uterine anomalies
34
what is an MRI used to image in the genitalia
``` prostate cancer (local staging) abnormalities not characterisable by USS ```
35
what usually causes renal colic
ureteric calculus
36
what else can stimulate renal colic
pyelonephritis (do USS to exclude ureteric obstruction) or gynaecological disease (do USS to visualise pathology)
37
what investigations into colic if the patient is pregnant
USS/ MRI
38
what tests can detect real calculi
KUB x ray (only shows dense minority- not sensitive or specific as other causes of calcification), CT and MRI (calculi are usually calcium dense)
39
what is the definitive test to confirm a symptomatic ureteric calculus
non contrast enhanced CT (shows nearly all regardless of size or calcium content) also shows signs of obstruction (perinephric stranding, hydroureteronephrosis)
40
what happens to most calculi
are passed spontaneously
41
what can cause macroscopic haematuria
``` calculi infection tumour (renal cell carcinoma, transitional cell carcinoma) urethritis/ prostatitis trauma clotting disorders ```
42
what investigation into haematuria in over 50s
``` ct urography (kidneys, collecting systems and ureters) cytoscopy (bladder and urethra) ``` ureteroscopy (tumours)
43
what is the most sensitive way of detecting renal parenchymal tumours, urothelial tumours of the collecting systems or ureters
second CTU following contrast
44
what investigations for haematuria in under 50s
incidence low so not CTU USS of kidneys for calculi and renal parenchymal tumours cystoscopy for bladder TCC, caclui or tumours/ evidence of urethritis or prostatitis CTU only when US and cytoscopy normal and haematuria persists
45
when is MR urography used
when CTU contraindication (contrast allergy, renal impairment, pregnancy)
46
why are renal masses <3cm followed up not operated on
as very rarely metastasise
47
what are renal masses containing fat
benign angiomyolipomas
48
what are fluid dense renal masses
cysts | uniform cysts are benign
49
what renal cysts are malignant
complex cysts containing solid areas/ thick septa
50
are solid renal masses >3cm often benign/malignant
malignant
51
what features of a renal mass can MR detect
size, presence of fat/fluid, internal architecture
52
what is used for renal tumour staging
CT - local extent - modal disease - metastatic disease
53
what mets do you get in the lung form renal tumours
cannonball mets
54
what are the types of renal impairement
``` pre renal (dehydration, hypotension, renal artery stenosis) renal (parenchymal disease, drugs, toxins) post- renal (obstruction) ```
55
what is used to detect renal artery stenosis
MR
56
what is used to detect renal disease
USS to guide biopsy
57
what often accompanies obstruction
hydronephrosis
58
what is epididymo-orchitis
inflammation of the epididymis and/or testes caused by virus/ bacteria can be complicated by abscess formation/ ischaemia
59
what test for epididymo-orchitis
usually hypervascular on US
60
who gets testicular torsion
young males
61
what test for torsion
usually avascular or US
62
what are causes of a painless scrotum swelling
``` hernia, variocoele, hydrocoele, epididymal cyst testicular tumour (rare) ```
63
what is a variocoele
dilated scrotal venous plexus
64
what is a hydrocoele
when (black anechoic on USS) fluid surround the testes
65
what is a testicular seminoma
intra testicular soft tissue mass
66
what is the best imaging for ureteric/ renal injury
CT
67
what type of bladder rupture needs surgery
intraperitoneal (extra peritoneal more common and treated conservatively)
68
how is bladder rupture diagnosed
cystography/ CT cystography (contrast leaks through tear)
69
when do you not catheterise
in urethral injury (meatal blleding, cant pass urine) (call urologists)
70
what relieve ureteric obstruction
nephrostomy
71
what is the definitive test for scrotal disease
USS

Renal (27 decks)

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