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Flashcards in Pediatric imaging Deck (31)
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1

____ is considered more harmful in children than in adults because of the greater radiosensitivity of developing tissues and potential for higher cumulative doses over the child’s lifetime

Ionizing radiation is considered more harmful in children than in adults because of the greater radiosensitivity of developing tissues and potential for higher cumulative doses over the child’s lifetime

2

Amniotic fluid is primarily a ___ of fetal blood across the permeable fetal skin before 8 to 10 weeks. Early fetal urine production begins around ____, such that by 20 weeks, sonography can detect the majority of urologic abnormalities

Amniotic fluid is primarily a dialysate of fetal blood across the permeable fetal skin before 8 to 10 weeks. Early fetal urine production begins around 10 to 12 weeks, such that by 20 weeks, sonography can detect the majority of urologic abnormalities

3

The features of a normal urinary tract include two kidneys, one on each side located in the renal fossa, with a renal cortex that is ____ to the liver, the presence of discrete interfaces between the cortex and the medulla, the absence/presence of cortical cysts, and the absence of masses or dilation of the collecting system or bladder

The features of a normal urinary tract include two kidneys, one on each side located in the renal fossa, with a renal cortex that is isoechoic or slightly hypoechoic to the liver, the presence of discrete interfaces between the cortex and the medulla, the absence of cortical cysts, and the absence of masses or dilation of the collecting system or bladder

4

 In the setting of bilateral hydroureteronephrosis, a thickened bladder, and poor emptying, voiding cystourethrography (VCUG) should be performed to rule out a _____

posterior urethral valve

5

A   normal   infant   renal   sonogram   can   be   confused   with   mature hydronephrosis because of __ with a ___.

A   normal   infant   renal   sonogram   can   be   confused   with   mature hydronephrosis because of hypoechoic renal pyramids with a distinct corticomedullary junction.

6

BILATERAL CYSTIC LESIONS should raise concern for ___ disease of which two types are seen: ___ and ___.

polycystic kidney disease

autosomal dominant polycystic kidney disease (ADPKD).and autosomal recessive polycystic kidney disease (ARPKD)

 

7

On sonography, calculi appear ___, not to be confused with peripelvic fat, which is ____. A ____ can also be seen when using color Doppler to distinguish calculi from other hyperechoic signals

On sonography, calculi appear echogenic with shadowing, not to be confused with peripelvic fat, which is echogenic without shadowing. A “twinkling” artifact can also be seen when using color Doppler to distinguish calculi from other hyperechoic signals

8

Grade 3 dilatation on SFU criteria

The Society for Fetal Urology (SFU) criteria as demonstrated in postnatal sonograms. Grade 0 shows no central renal dilation. In grade 1, the renal pelvis only is visible; in grade 2, major calices can be identified; in grade 3, major and minor calices can be identified; and grade 4 has features of grade 3 but with parenchymal thinning as well

9

___ is the initial means to evaluate any congenital anomaly of the upper urinary tract

Sonography is the initial means to evaluate any congenital anomaly of the upper urinary tract

10

UTZ FINDING of a thickened bladder and dilated posterior urethra known as the ___

 

this is is highly suggestive of a:

KEYHOLE SIGN

posterior urethral valve

11

Midline Pelvic Cysts. A differential diagnosis list that considers most possibilities would include: hydrometrocolpos (urogenital sinus anomalies), ovarian cyst, distended bladder, and urinary ascites. Hydrometrocolpos is distension of the uterus and vagina with ___, and results from ___ secondary to imperforate hymen, vaginal atresia, transverse vaginal septum, or from retrograde flow of urine in urogenital sinus and cloacal malformations

Midline Pelvic Cysts. A differential diagnosis list that considers most possibilities would include: hydrometrocolpos (urogenital sinus anomalies), ovarian cyst, distended bladder, and urinary ascites. Hydrometrocolpos is distension of the uterus and vagina with mucus or blood, and results from vaginal obstruction secondary to imperforate hymen, vaginal atresia, transverse vaginal septum, or from retrograde flow of urine in urogenital sinus and cloacal malformations

12

Classic bladder exstrophy can be identified prenatally when the ___, the lower abdominal wall is ___, and the umbilicus is ___ placed

Classic bladder exstrophy can be identified prenatally when the bladder is not visualized, the lower abdominal wall is irregular, and the umbilicus is inferiorly placed

13

Prune belly syndrome is suggested by observing hydronephrosis/hydroureter, a distended bladder, and the absence of ___ in a male fetus either prenatally or after birth

Prune belly syndrome is suggested by observing hydronephrosis/hydroureter, a distended bladder, and the absence of testes in the scrotum in a male fetus either prenatally or after birth

14

Surgical exploration should/should not be delayed if torsion is suspected and the delay to image will compromise salvageability. Because of reported falsenegative results using color Doppler sonography, investigators have used high-resolution sonography to image torsion of the spermatic cord itself known as the ____.

Surgical exploration should not be delayed if torsion is suspected and the delay to image will compromise salvageability. Because of reported falsenegative results using color Doppler sonography, investigators have used high-resolution sonography to image torsion of the spermatic cord itself known as the “whirlpool sign.

15

The most common prepubertal primary testicular tumor is ___ characterized by a heterogeneous mass with areas of solid, cystic, and ___ components

The most common prepubertal primary testicular tumor is benign teratoma characterized by a heterogeneous mass with areas of solid, cystic, and calcified components

16

UTZ FINDING : An epidermoid cyst has the unique appearance of hyperechoic and hypoechoic rings or ___ with no internal blood flow

An epidermoid cyst has the unique appearance of hyperechoic and hypoechoic rings or “onion rings” with no internal blood flow

17

Sonography in the evaluation of routine cryptorchidism should/should not be pursued

Sonography in the evaluation of routine cryptorchidism should not be pursued. Multiple studies have confirmed its poor sensitivity of detecting and localizing the undescended testicle, and it does not alter the necessary treatment plan
A reasonable exception would be cryptorchidism in a difficult-to-examine obese child where the presence of an inguinal testis on sonography would simplify the surgical approach.

18

VCUG findings: identify A- E

(A) A highly trabeculated bladder. (B)
A ureterocele within the bladder (left) and then everting (right). (C) A large bladder diverticulum and elongated posterior urethra in a child with posterior urethral valve. (D) An elongated posterior urethra secondary to a posterior urethral valve and bilateral grade 5 vesicoureteral reflux. (E) A short distal bulbar urethral stricture.

19

Although MRI plays no role in the evaluation of cysts and masses of the scrotum and testes, one might consider its use for __ in patients with what kind of cancer

Although MRI plays no role in the evaluation of cysts and masses of the scrotum and testes, one might consider its use for tumor staging in patients with testicular cancer

20

VCUG: When obtained to evaluate urinary tract infection, it is regarded as routine to defer VCUG at least until after the patient has received __ and is___

When obtained to evaluate urinary tract infection, it is regarded as routine to defer VCUG at least until after the patient has received several days of antibiotics and is clinically improving.

21

VCUG has been obtained routinely as part of the evaluation of children with hydronephrosis; however, the need to do so has been challenged. Instead, most algorithms reserve VCUG when hydronephrosis is seen along with ___

VCUG has been obtained routinely as part of the evaluation of children with hydronephrosis; however, the need to do so has been challenged (Kim et al., 2001; Yerkes et al., 1999). Instead, most algorithms reserve VCUG when hydronephrosis is seen along with dilated ureter(s)

22

T/F :

CT has little role in the evaluation of pediatric hydronephrosis

true, CT has little role in the evaluation of pediatric hydronephrosis as it offers little advantage over sonography with unwanted ionizing radiation

23

Renal cortical scintigraphy using DMSA relies on uptake by ___, a process that is dependent on renal blood flow

Renal cortical scintigraphy using DMSA relies on uptake by proximal tubular cells, a process that is dependent on renal blood flow

24

The timing of DMSA scintigraphy is determined by whether one is
seeking to document the ___, or instead,____. Because inflammation is a transient process, acute changes are reliably seen when the DMSA scan is obtained within days of the acute episode that gradually resolves over the next 5 months such that by 6 months any lesion demonstrated on scintigraphy is likely a fixed scar

The timing of DMSA scintigraphy is determined by whether one is
seeking to document the acute inflammatory changes of pyelonephritis, or instead, irreversible renal cortical scarring. Because inflammation is a transient process, acute changes are reliably seen when the DMSA scan is obtained within days of the acute episode that gradually resolves over the next 5 months such that by 6 months any lesion demonstrated on scintigraphy is likely a fixed scar

25

The gold standard for differentiation of obstructive and nonobstructive hydronephrosis/hydroureter is___. This can be accomplished with either ____ or ___
 

The gold standard for differentiation of obstructive and nonobstructive hydronephrosis/hydroureter is diuretic renography. This can be accomplished with either 99m (DTPA) or more commonly, 99m
Tc-diethylenetriamine pentaacetic acid Tc-mercaptoacetyltriglycine.

26

There are four key elements to a successful diuretic renogram:

(1) ___

(2) ___

(3) ___

(4) ___

There are four key elements to a successful diuretic renogram:

(1) hydration

(2) selection of the appropriate region of interest (ROI) and background subtraction

(3) bladder drainage,

(4) timing of diuretic administration.

27

1. All of the following statements regarding prenatal sonography are true EXCEPT: a. amniotic fluid contains fetal urine before 10 weeks of age. b. amniotic fluid contains fetal urine by 10 to 12 weeks of age. c. urine fills the fetal bladder by 20 weeks of age. d. the fetal bladder never completely empties despite normal bladder cycling. e. in the fetal kidney, prominent corticomedullary differentiation can be confused for hydronephrosis.

a. Amniotic fluid contains fetal urine before 10 weeks of age. Amniotic fluid does not contain fetal urine before 10 weeks of age

28

. All of the following statements about postnatal ultrasound findings of hydronephrosis are true EXCEPT: a. hydronephrosis may be obstructive or nonobstructive b. hydronephrosis is always an indication of obstruction. c. hydronephrosis can be more fully evaluated by functional imaging to identify obstruction.

b. Hydronephrosis is always an indication of obstruction. Hydronephrosis is not always an indication of obstruction.

29

A normal sonogram is___ to risk-stratify a child with a febrile urinary tract infection (UTI) and is good/not a good predictor for vesicoureteral reflux (VUR).

A normal sonogram is insufficient to risk-stratify a child with a febrile urinary tract infection (UTI) and is not a good predictor for vesicoureteral reflux (VUR).

30

The ____ approach relies on VCUG—following US—to identify all cases of VUR that may result in overtreatment of low- grade VUR

The “bottom-up” approach relies on VCUG—following US—to identify all cases of VUR that may result in overtreatment of low- grade VUR