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Year 2 - Renal (DP) > Radiology > Flashcards

Flashcards in Radiology Deck (72):
1

Where do the kidneys lie in the retroperitoneum?

Paravertebral gutters

2

What is the level of the hila for each kidney?

Left -> L1
Right -> L1/L2

3

Why is the left renal vein longer than the right?

Passes across the aorta anteriorly to join to the right sided IVC

4

What CT phase is best to depict calculi?

Pre-contrast

5

After the injection of contrast, how long should be waited for the corticomedullary phase of CT?

25-70 seconds

6

After the injection of contrast, how long should be waited for the Nephrographic phase of CT?

80-180 seconds

7

After the injection of contrast, how long should be waited for the excretory phase of CT?

5-15 minutes

8

Which of the following is not a risk factor for contrast nephropathy:
- Renal impairment - +/- diabetes mellitus
- Dehydration
- Congestive heart failure
- LV ejection fraction > 40%
- Acute MI (within 24 hours)
- Nephrotoxic drugs

LV ejection fraction > 40%
If it is

9

What are the hydration protocols to prevent contrast nephropathy?

1-1.5 ml/kg/h 0.9% normal saline 6-12hrs before and after contrast administration
Sodium bicarbonate instead of sodium chloride – urine alkalinization – prevention of oxygen free radicals
Bicarbonate administered from 1 hour pre-procedure to 6 hrs post

10

How do cysts appear on MRI in the following phases:
- T1
- T2

T1 -> Low/no signal
T2 -> High signal

11

What causes nephrogenic systemic sclerosis?

Exposure to gadolinium containing contrast medium used in MRI

12

What is a CT urogram used to image?

Collecting system
Ureters
Bladder

13

What is the commonest imaging modality for viewing the bladder?

USS

14

What does a bladder USS allow us to see?

Internal calculi (if Calcium)
Bladder wall irregularities
Diverticula

15

What condition needs met for a bladder USS to be most useful?

Bladder must be full

16

What is cystography the gold standard investigation for?

Bladder wall tears

17

What tumour staging is CT best for?

Nodal mets
Distant mets

18

What tumour staging is MRI best for?

Local staging of bladder wall tumours

19

What is a retrograde urethrogram used for?

Urethral:
- Strictures
- Trauma
- Diverticula

20

What is the modality of choice for imaging the testes, uterus, ovaries and prostate?

USS

21

What is the modality of choice for imaging infertility (tubal patency) and uterine abnormalities?

Hysterosalpingogram

22

What is the mediastinum testis?

Infolding of tunic albuginea

23

What is the first line investigation is pyelonephritis or a gynaecological condition is thought to be the source of renal colic?

USS

24

If a patient with renal colic is pregnant, what investigations should be done?

USS and/or MRI

25

Which calculi can be seen on x-ray?

Calcium (dense)

26

What is the first line investigation for suspected renal colic?

KUB X-ray

27

Where do the ureters pass in relation to the psoas muscles?

Anteriorly over them

28

Where do the ureters descend in relation to the tips of the lumbar transverse processes?

Anteriorly

29

How can we visualise the collecting systems, ureters and bladder on x-ray?

IV urogram (contrast)

30

Where do ureteric calculi often get stuck?

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

31

Where do renal calculi mimics tend to lie?

More lateral in the pelvis

32

How can you tell the difference between a renal stone and a phlebolith?

Phlebolith:
- Lie more laterally
- Calcified but have a slightly radiolucent centre
-> Calculi are completely radio-opaque

33

What are phleboliths?

Dislodged clots

34

How does USS help diagnose renal stones?

Can't see stone itself due to bowel obscuring image, but it will show associated hydronephrosis

35

What is the definitive test to confirm a symptomatic ureteric calculus?

Non-contrast enhanced CT

36

What will a CT alo show in renal calculi?

Signs of obstruction:
- Perinephric stranding
- Hydroureteronephrosis

37

What are some potential differentials for renal calculi that will be seen on CT?

Appendicitis
Hernia

38

Where does macroscopic haematuria tend to arise from?

Kidney
Ureter
Bladder
Urethra

39

If the source of haematuria is suspected to be from the kidneys, collecting system or ureters, what modality is the first line if the patient is older than 50?

CT urography

40

If the source of haematuria is suspected to be from the bladder or urethra, what modality is the first line if the patient is older than 50?

Cystoscopy

41

What is the most sensitive way to detect renal parenchymal tumours or urothelial tumours of the collecting systems or ureters?

CT urogram

42

In patients younger than 50 with macroscopic haematuria, why are USS and cystoscopy preferred?

Incidence of urothelial tumours is low, so routine CTU which gives a double dose of radiation is unjustified

43

When is a CTU used in patients younger than 50 with macroscopic haematuria?

If USS and cystoscopy are normal and haematuria persists

44

In what patients is an MR urography useful?

COntrast allergy
Renal impairment
Pregnancy

45

How would an angiomyolipoma appear on CT?

Dark grey:
- High fat content
-> Less dense than surrounding parenchyma

46

When would a CT scan be taken if there is a suspected renal cortex tumour?

100 seconds after contrast

47

What is the 'density' or normal fluid on CT?

48

If the 'density' of a substance inside a cyst on CT is >20 what might you suspect?

Malignancy

49

What are features of complex cysts on CT?

Solid areas
Thick septa

50

Fluid density filled cysts and uniform cysts are usually what?

Benign

51

Solid (non-cystic) masses >3cm are usually what?

Malignant

52

'Cannon ball' mets

Renal tumours mets in the lungs

53

What investigation can be used to diagnose renal artery stenosis?

MRI

54

If the kidney appears small on imaging, what process is occurring?

A chronic cause

55

What will a USS of hydronephrosis show?

Dilated renal pelvis and calyces

56

If the kidney appears normal/large on imaging, what process is occurring?

Acute injury

57

On an US doppler of epididymo-orchitis, how will the testis appear?

Hypervascular (lots of colour)

58

On an US doppler of testicular torsion, how will the testis appear?

Hypovascular (no/very little colour)

59

Which of the following is not a common cause of painless testicular swelling:
- Hernia
- Tumour
- Varicocoele
- Hydrocoele
- Epididymal cyst

Tumour

60

What is a varicocoele?

Dilated scrotal venous plexus with tortuous veins usually >2mm in diameter

61

Why do varicocoeles typically occur on the left?

Renal tumour may extend into left renal vein, which can result into the left gonadal vein being occluded

62

What else must also be scanned in a varicocoele?

Kidneys

63

How does a hydrocoele appear on USS?

Black anechoic fluid surrounding the testicle

64

How does an epididymal cyst appear on USS?

Anechoic uni/multilocular lesion typically arising within the epididymal head

65

A testicular mass with vessels inside is probably what?

Malignant

66

How is renal trauma best assessed?

CT

67

What type of bladder rupture is most common and how is it treated?

Extraperitoneal
Treated conservatively

68

What type of bladder rupture is rarer and how is it treated?

Intraperitoneal:
- Due to compression of full bladder
Requires surgery

69

How is bladder trauma diagnosed?

Cystography
or CT cystography:
- Contrast leaks into intra- or extraperitoneal space

70

If you have clinical suspicion of urethral trauma (meatal bleeding, anuria) what must NOT be done?

Catheterisation

71

How can a urethral stricture be imaged?

Retrograde urethrogram

72

How can a post-biopsy haemorrhage be treated?

US-guided arterial embolisation