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RENAL > Radiology > Flashcards

Radiology Flashcards

1
Q

What causes renal colic?

A

ureteric calculus

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2
Q

Why must you ensure the history and exam are consistent with renal colic, before requesting imaging?

A

Tests used to detect calculi give a high radiation dose

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3
Q

What diseases mimic renal colic?

A

pyelonephritis or gynaecological disease

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4
Q

What imaging modality should be used to visualise pyelonephritis or gynaecological disease?

A

Ultrasound

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5
Q

What imaging modalities should be used to minimise radiation exposure to a foetus during pregnancy?

A

US and/or MRI

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6
Q

What substance is found in high density vs low density calculi?

A

Dense calculi = calcium

lower density = urate

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7
Q

What forms of imaging can be used to visualise renal calculi?

A

KUB X-ray
CT
MRI

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8
Q

What is involved in a KUB X-Ray?

A

Kidney, Ureter, Bladder

Photo taken of Upper Urinary tract and separate photo of Lower Urinary tract

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9
Q

Describe the course of the ureters?

A
  • Pass inferiorly over the psoas muscles
  • Descend anterior to the lumbar transverse processes
  • Cross the iliac bifurcation and enter the pelvis
  • Pass posteromedially and enter the posterior aspect of the bladder
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10
Q

What are the predictable sites where ureteric calculi will get stuck?

A

pelviureteric junction
pelvic brim
vesicoureteric junction

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11
Q

Why is contrast not usually used to visualise renal calculi?

A

The contrast is dense, as are most calculi

=> the contrast would obscure visualisation of calculi

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12
Q

What other causes of calcification may simulate renal calculi?

A

Phleboliths
Lymph nodes
Uterine fibroids
Arterial calcification

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13
Q

Aside from the calculus itself, what other signs of obstruction can be seen on CT?

A

perinephric stranding (oedema in perinephric fat)

hydroureteronephrosis (widening of ureter above blockage)

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14
Q

Most calculi pass spontaneously. TRUE/FALSE?

A

TRUE

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15
Q

What are the potential causes of macroscopic haematuria?

A 
Calculi
Infection
Tumour
Urethritis/prostatitis
Trauma
Clotting disorders
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16
Q

At what age does Renal cell carcinoma present vs transitional cell carcinoma?

A

RCC - any age

TCC - over 50

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17
Q

What is the difference between Cystoscopy and ureteroscopy?

A 
Cystoscopy = camera inserted to visualise the bladder and urethra
Ureteroscopy = passed further up to visualise ureters also
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18
Q

Describe how CT urography is carried out?

A
  • First CT scan before contrast
  • Administration of IV contrast
  • This is excreted by kidneys over 15 minutes
  • Top up dose given 60 seconds before 2nd CT (to enhance renal parenchyma)
  • Second CT scan following contrast
19
Q

What is CT urography particularly sensitive in detecting?

A
  • renal parenchymal tumours

- urothelial tumours of the collecting systems or ureters

20
Q

What is meant by a multifocal TCC?

A

Present in multiple parts of urinary tract

e.g. in kidney and in bladder

21
Q

Why is CT urography less commonly carried out in patients under 50 who develop macroscopic haematuria?

A

urothelial tumours of kidney or ureter = very low at this age

CTU imparts a double radiation dose which is unjustified

22
Q

How are patients <50 investigated for macroscopic haematuria?

A

US of kidneys
Cystoscopy

CTU only when US and cystoscopy are normal and macroscopic haematuria persists

23
Q

Over what size are kidney tumours more likely to be malignant?

A

3cm

24
Q

How are renal masses characterised?

A

size
density (fat, fluid, soft tissue, calcified)
uniformity (varying density?)
internal morphology (nodules, septa)

25
Q

What mass in the kidney contains fat?

A

benign angiomyolipomas

26
Q

Masses in the kidney filled with fluid are what?

A

cysts (of which the uniform ones are benign)

27
Q

What type of cysts would you worry about being malignant?

A

if they contain solid areas or thick septa

28
Q

What is CT used to asses when staging a cancer?

A

local spread:

  • extracapsular
  • adjacent organs
  • involvement of renal vein or IVC

Lymph node Involvement

Metastatic disease
lung, bone

29
Q

In pre-renal disease, what imaging modality is used to visualise renal artery stenosis?

A

MR angiography

30
Q

Fluid is dark on US. TRUE/FALSE?

A

TRUE

31
Q

A hypervascular testis on Doppler US with colour may indicate what disease?

A

epididymo-orchitis

32
Q

An avascular testis on Doppler US with colour may indicate what?

A

Testicular torsion

33
Q

What are common causes of painless scrotal swellings?

A

hernia
varicocoele (distended vein)
hydrocoele
epididymal cyst

34
Q

What is a rare but serious differential in a painless scrotal swelling?

A

testicular tumour

35
Q

Epididymal cysts are usually benign. TRUE/FALSE?

A

TRUE

Testicular lump = malignant
Epididymal lump = Benign

36
Q

What imaging modality is the most useful in kidney trauma?

A

CT

37
Q

What investigation is most useful in bladder trauma?

A

cystography or CT cystography

After filling bladder, contrast leaks through into the intra or extraperitoneal space

38
Q

What are the two possible types of bladder rupture?

A

Intraperitoneal (due to compression)

Extraperitoneal (more common)

39
Q

Urethral disruption is associated with what injuries?

A

anterior pelvic fracture/dislocation

OR straddle injury

40
Q

What are the 2 main types of urethral disruption?

A

complete or incomplete

41
Q

Should you attempt catheterisation in urethral disruption?

A

No - call urologist if concerned that urethra has been damaged

42
Q

What is a long term complication of urethral trauma?

A

Stricture formation

43
Q

What non-vascular interventions can radiology perform in the urinary system?

A
  • relief of ureteric obstruction (nephrostomy, ureteric stent)
  • drainage of abscess/cyst
  • biopsy of renal masses
  • guided ablation of renal tumours (e.g. cryoablation)
44
Q

What vascular interventions can radiology perform in the urinary system?

A
  • correction of renal artery stenosis
  • control of arterial bleeding sites (embolisation)
  • varicocoele embolisation

RENAL (24 decks)

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