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Flashcards in Radiology Deck (115)
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1

What is one of the most useful imaging modalities for assessment of the kidneys and collecting systems?

Intravenous urogram (IVP)

2

What is the most common current indication for IVP?

Evaluation of obstruction

3

What are 3 things that might cause obstruction?

1. Stone
2. Blood clot
3. Tumor

4

What can IVP/IVU identify with regards to obstruction?

It's level and the nature of the obstruction

5

What can distortion of the collecting systems be?

A secondary indication of a renal mass

6

Is a IVP good to identify a renal mass?

No, it is more effectively evaluated with other imaging modalities: CT and US

7

What is the initial screening exam for a patient with suspected renal pathology?

Abdominal plain film (KUB)

8

What are renal contours relatively well defined by in a KUB?

Adjacent fatty tissue in the perinephric space

9

True or False: KUB can help identify the contour of the urinary bladder?

FALSE

10

What is the prime utility of plain film radiography?

To identify calcifications or stones

11

What % of urinary tract calculi are calcified and generally visualized with plain film radiograph?

85%

12

What are calcification in pelvis typically?

They are frequently of vascular origin (phleboliths)

13

When is a retrograde pyelogram performed and who does it?

This is usually done in conjunction with cystoscopy and this is performed by a urologic surgeon

14

What is done in a retrograde pyelogram?

The distal portion of the ureter is catheterized and contrast is administered in a retrograde manner

15

When is a retrograde pyelogram particularly useful?

In the evaluation of kidneys which are non-functional or completely obstructed

16

What is a useful non-inasive imaging modality that uses high frequency sound waves to produce images of internal structures of the body?

Sonography

17

True or False: Kidneys are typically well demonstrated by US?

True

18

What part of the kidneys is US the most useful in evaluating?

The collecting systems

19

What is US helpful for screening?

Obstruction (hydronephrosis)

20

What is US an excellent assessment for?

Evaluation of renal mass (cyst v. solid)

21

What is the single most helpful examination of the kidney?

CT

22

When you do CT for a kidney, do you give IV contrast?

You usually do the scan before and after the administration of IV contrast

23

What is quite useful in the acute setting for evaluating the patient with suspected urinary obstruction secondary to a stone or calculi?

An unenhanced CT with helical aquisition

24

What is enhanced CT critical for?

The evaluation of renal masses, trauma, or infection

25

What can be utilized for guidance for subsequent interventional procedures such as drainage and biopsy?

US and CT

26

What is the exam that utilizes radioactive agents injected into the blood stream and subsequently accumulated by the kidney?

Nuclear Medicine (Scintigraphy)

27

What kind of exam is nuclear medicine?

It is primarily a functional exam

28

What is an invasive exam that is most useful for the evaluation of the renal arteries (and less commonly the veins)?

Renal angiography

29

Why are applications of MRI limited?

Cost

30

True or False: MRI is no more specific than CT in regards to evaluating a renal mass?

True

31

What does MRI have some potentially broader applications in?

Staging a renal mass with potential vascular involvement

32

What are the major components of the urinary system?

1. Kidneys
2. Intrarenal collecting structures
3. Renal pelvis
4. Ureters
5. Urinary bladder
6. Urethra

33

What are the kidneys located within?

A cone of renal fascia (Gerota's fascia) surrounded by the fat in the perirenal space

34

What makes up the kidney?

Lobes that consist of pyramidal shaped medulla surrounded by cortex

35

What does the cortex consist of?

Proximal and distal convoluted tubules and the accompanying blood vessels

36

Where are the peripheral and septal cortex located?

1. The peripheral cortex is immediately beneath the renal capsule
2. The septal cortex extends down between the pyramids as the columns of Bertin

37

What can occasionally simulate a renal mass?

The columns of Bertin

38

What do the medullary pyramids consist of?

Collecting tubules and the long, straight portions of the loops of Henle as well as the accompanying blood vessels

39

What is the apex of the pyramids directed at?

The renal sinus (ant is projects into the calyces)

40

Are renal arteries single or multiple?

Either

41

What vertebral level to the renal pedicles lie at?

L1-L2 (adjacent to spine)

42

What is the typical sagittal diameter of an adult kidney?

9-12 cm

43

What does the collecting system in each kidney consist of?

Calyces and renal pelvis

44

How many calyces per kidney?

Usually 8-12

45

What shape are the calyces?

Cup-shaped

46

What do the ureters do?

Conduct urine from the renal pelvis to the urinary bladder

47

Where do the ureters lie?

In the retroperitoneal space medially, anterior to the psoas muscle

48

How many ureters per kidney?

Usually 1, but duplications can occur

49

What can result in a dilation or ureterocele?

Abnormal insertion of the distal ureter into the urinary bladder
(These can occur in aberrant locations and lead to obstruction or reflux

50

What do the kidneys derive from?

Metanephros and the ureteric bud

51

What kind of abnormalities are the kidneys subject to?

Migration, rotation, fusion

52

What is the most common renal anomaly?

Horseshoe kidney (occurs in less than 1% of the population)

53

What does horseshoe kidney result in?

Abnormal orientation with fusion of the lower poles across the midline

54

What is it called when both kidneys lie on one side of the abdomen with one ureter typically coursing across the midline?

Cross-fused ectopia

55

What is it called when a kidney is located in the upper pelvis, typically in iliac fossa?

Pelvic kidney

56

What are 2 other anomalies mentioned with the kidney?

Agenesis and hypoplasia

57

What % of renal stones contain calcium?

85%

58

How are a vast majority of stones detected?

On plain film or CT

59

What is the favored imaging modality for stones?

Helical CT

60

What does helical CT do?

It serves to identify the stones as well as associated obstruction

61

What testing needs to be done for uric acid stones?

CT, they are radiolucent on plain film

62

What is a deposit of precipitated calcium which fills all or part of the collecting system of the kidney?

Stag-horn calculus

63

What do stag-horn calculi result from?

Chronic infection or low grade to moderate obstruction

64

What is a disorder where there is dilatation of the renal tubules (ectasia) and tiny calculi form in these tubules and can be discharged into the collecting system causing intermittent obstruction or pain

Medullary sponge kidney

65

In medullary sponge kidney, whit size stones may not pass through the UV junction without intervention?

Stones larger than 4-5mm

66

What do stones need to pass spontaneously?

Good hydration and analegesia

67

What is a method of fragmenting calculi nonsurgically?

Extracorporal Shock Wave Lithotripsy

68

How does ESWL work?

A shock wave is created outside of the body and focused onto the stone using parabolic reflectors and targeting device...this may disrupt the stone into smaller pieces that can pass spontaneously

69

What can cause increased pressure within the collecting system and ultimately result in impaired renal function?

Obstruction of the ureter

70

What needs to be done to preserve renal function with obstruction?

Relieve it ASAP!

71

How is an obstruction typically relieved?

By the urologist using a retrograde approach from the urinary bladder

72

How are percutaneous approaches for relieving obstruction done?

-By a radiologist with US or CT guidance
-Catheter is placed into the collecting system and ultimately can be directed through the obstructed segment of the ureter into the urinary bladder to provide for contained internal drainage

73

What are the most common causes of obstruction?

Stones and neoplasm

74

What can occur as a result of prior surgical intervention?

Iatrogenic obstruction

75

What occurs typically as the result of atherosclerosis?

Stenosis or obstruction of the renal arteries

76

What is an alternative cause of stenosis or obstruction of the renal arteries?

Fibromuscular dysplasia

77

What is the most sensitive modality for evaluation of renal artery stenosis?

Angiography

78

What is angiography typically performed with?

MR and CT (MRA or CTA)

79

What happens if a functional stenosis is identified on angiography?

Interventionally is can be relieved with either a balloon catheter or metallic stent

80

What happens of a renal artery stenosis cannot be relieved?

It will ultimately lead to continued, impaired renal function and atrophy

81

Why are the kidneys prone to infection?

Because of their filtering function

82

What can be involved in infection in the renal system?

They kidney itself or the perinephric space

83

What can be done if a focal collection occurs (abscess)

It can be drained percutaneously

84

How are renal infections normally treated?

With medical (antibiotic treatment)

85

What can chronic, long standing infections lead to?

Impaired renal function...it can spread to other spaces in the abdomen

86

What are the 2 types of renal trauma?

Blunt or pentrating

87

Where can damage from trauma occur?

To the kidney itself, as well as the collecting system or vessels

88

What is the most useful imaging modality in the acute setting for the kidney?

CT

89

What is of less use in kidney trauma?

Angiography

90

What is really common in the kidney, occurring in 50% of the adult population over 50?

Renal masses (especially cysts)
-The cysts can become quite large

91

When is intervention indicated in renal masses?

Only if there are symptoms such as pain or clinical findings

92

What can renal masses occasionally lead to?

HTN

93

What is the most useful imaging modality in the initial setting for renal masses?

US

94

What else can be helpful in discriminating renal masses?

CT

95

What is an AD inherited condition in which many of the DCT end blindly and aren't connected to the collecting system?

Adult polycystic kidney disease

96

What is the result of adult polycystic kidney disease?

Gradual formation of multiple cysts of variable size throughout the kidney

97

What other organs can be involved in adult polycystic kidney disease?

Liver and pancreas

98

What occurs later in life in adult polycystic kidney disease?

Renal failure

99

What do adult polycystic kidney disease patients have an increased incidence of?

Other conditions like intacranial aneurysm

100

What is problematical in the kidney?

Solid and complex cystic masses

101

What is the most malignant lesion?

Renal cell carcinoma

102

What can kidney tumors present with?

Pain and hematuria

103

When do you ideally want to identify renal tumors?

When they are small and resectable

104

What kind of lesion is renal cell carcinoma?

An aggressive lesion

105

What can renal cell carcinoma spread to?

Other organs, the renal vein, and IVC

106

What is a relatively benign neoplasm which typically has fatty elements within it and can bleed spontaneously?

Angiomyolipoma

107

If metastatic disease to the kidney common?

No

108

What kind of infiltrative tumors can occur in the kidney?

Lymphoma or leukemia

109

What is a benign renal neoplasm which may demonstrate a central scar?

Oncocytoma

110

What must be excluded in acute renal failure and how is this best done?

Obstruction, sonographically

111

What is another test that can prove useful in evaluating the level of renal function?

Scintigraphy (nuclear medicine)

112

With renal failure, what does imaging have to offer?

Little other than excluding readily treatable causes (it can be a mechanism to direct renal biopsy)

113

What is renal imaging done in conjunction with?

Clinical findings and laboratory data

114

What is renal imaging a tool in?

The armamentarium of diagnosis

115

What is the primary goal of imaging and intervention?

To prevent renal function and direct patient care