INvestigations Flashcards
If pyelonephritis is likely, what investigation should you order?
USS
Definitive test for ureteric calculus?
Non-contrast CT stone search
Note: Avoid CT if pregnancy, do USS or MRI instead.
What is the first line imaging in renal colic?
A KUB x-ray.
Be aware though, only a minority of renal tract calculus are visible on a KUB x ray.
Where do calculus often get stuck?
At the PUJ, pelvic brim, and vesico-ureteric junction.
Non contrast CT is the same as what?
The same as CT stone search.
Does CT show all calculus?
Yeah it does, irrespective of size or calcium content.
What are some causes of macroscopic haematuria?
Calculus, infection, tumour (RCC, or TCC over 50)
Urethritis / prostattiis
Trauma
Clotting disorders
Investigation of macroscopic haematuria if > 50?
CT Urography (CTU) - examines the kidneys, collecting systems and ureters
and Cystoscopy (examinse bladder and urethra)
Investigation of under 50s with macroscopic haematuria?
CTU not justified as the incidence of cancer is low.
Therefore do an USS of the kidneys and do a cystoscopy to look for occasional bladder TCC etc.
CTU only when USS and cystoscopy are normal.
When is an MR Urography useful
Useful in patients who have a contrast allergy, renal impairment or pregnant.
NO CONTRAST
NO RADIATION.
When is MR urography used?
Only when a CTU is contraindicated.
A word on renal masses:
Some renal masses present with haematuria however most are detected incidentally.
The role of imaging is to confirm that mass is present, characterise the mass as benign, indeterminate or malignanct and stage malignant masses.
What is used to assess renal mass?
What size uncommonly metastasise?
Masses containing fat are called what?
CT is used to assess mass.
Mass <3cm very rarely metastasise.
They are benign angiomyolipomas.
Complex cysts containing solid areas or thick septa are often malignant
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Solid (non-cystic) masses larger than 3cm are often malignant.
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