Recognizing What to Order - Genitourinary Imaging

Question 1

Recurrent stone symptoms?

Answer 1

Either CT abdomen + pelvis WITHOUT contrast or US kidneys and bladder.

Question 2

Acute scrotal pain without trauma?

Answer 2

US scrotum with Doppler.

Question 3

Acute pyelonephritis with complications (diabetes, immunocompromised, prior stones)?

Answer 3

Either CT abdomen + pelvis WITHOUT and WITH contrast or US kidneys and bladder.

Question 4

Hematuria?

Answer 4

CT abdomen + pelvis WITHOUT + WITH contrast - Study is known as CT urogram.

Question 5

Hematuria with known parenchymal disease?

Answer 5

US kidneys + bladder.

Question 6

Renal trauma, blunt with hematuria?

Answer 6

CT abdomen + pelvis WITH contrast.

Question 7

Renal trauma, penetrating, with or without hematuria?

Answer 7

CT abdomen + pelvis WITH contrast.

Question 8

Pelvic trauma, blunt?

Answer 8

Abdominal radiographs - Then retrograde cystography or CT pelvis with bladder contrast (CT cystography).

Question 9

Pelvic trauma, penetrating?

Answer 9

Either retrograde cystogram or CT pelvis with bladder contrast (CT cystography) - Equivalent studies, if already doing CT, then do CT cystogram.

Question 10

Renovascular HTN?

Answer 10

MRA abdomen WITH contrast or CTA abdomen.

–> If diminished renal function, also can use US kidney with Doppler.

Question 11

Obstructive voiding symptoms from enlarged prostate?

Answer 11

US pelvis (bladder + prostate) transabdominal.
--> If BUN is elevated, then US of kidneys to evaluate for hydronephrosis.

Question 12

Renal mass of indeterminate benignancy?

Answer 12

Either CT abdomen WITHOUT and WITH contrast or MRI abdomen WITHOUT and WITH contrast.
–> Either CT or MRI is appropriate.

Question 13

Acute flank pain, suspicion of stone?

Answer 13

CT abdomen + pelvis WITHOUT contrast - Stone search study.