Renal imaging

Question 1

First line image in suspected renal colic

Answer 1

X-ray

Question 2

Which other conditions can simulate renal colic?

Answer 2

Pyelonephritis

Gynaecological disease

Question 3

Imaging used in pregnancy

Answer 3

US and/or MRI

Question 4

Which muscles do normal ureter pass inferiorly over?

Answer 4

Psoas muscle

Question 5

Which sites are calculi prone to getting stuck in?

Answer 5

Pelviureeric junction
Pelvic brim
Vesicoureteric junction

Question 6

Causes of calcification on x-ray (other than renal calculi)

Answer 6

Phleboliths
Lymph nodes
Uterine fibroids
Arterial calcification

Question 7

What is the most definitive test to confirm ureteric calculus?

Answer 7

CT

Question 8

Downsides to CT scanning for calculi

Answer 8

Ocassionally struggles to distinguish between claculi & phleboliths in the absence of secondary symptoms
Radiation

Question 9

How is renal colic followed up?

Answer 9

Check progress using simplest test that showed the calculus at presentation

Question 10

Causes of macroscopic haematuria

Answer 10

Calculi 
Infection 
Tumour 
Urethritis/prostatitis 
Trauma 
Clotting disorders

Question 11

First line investigation of macroscopic haematuria in over 50’s

Answer 11

CT urography

Question 12

Uses of cystoscopy

Answer 12

To confirm tumour

To ablate tumour in patients unfit for nephrourectomy

Question 13

What is CT contrast urography best for detecting?

Answer 13

Renal parenchymal tumours

Urothelial tumours of thew collecting system or ureters

Question 14

Why is the first line investigation of macroscopic haematuria in the under 50’s not CT urogram?

Answer 14

Incidence of urothelial tumours is very low so it’s unjustified radiation

Question 15

First line investigations of macroscopic haematuria in the under 50’s?

Answer 15

US

Cystoscopy

Question 16

When is an MR urography indicated?

Answer 16

Contrast allergy
Renal impairment
Pregnancy

Question 17

What is a fat mass found on CT most likely to be?

Answer 17

Angiomyolipoma

Question 18

Solid masses of what size tend to be malignant?

Answer 18

> 3cm

Question 19

Imaging for pre-renal disease

Answer 19

MR angiography to detect RAS

Question 20

Imaging in renal disease

Answer 20

US to guide biopsy

Question 21

What, other than obstruction, can cause hydronephrosis?

Answer 21

Ureteric reflux

Question 22

Why is renal size on US helpful in renal impairment?

Answer 22

Distinguish between acute & chronic

Question 23

Findings of epididymo-orchitis on US

Answer 23

Testis and/or epididymis is hypervascular

Question 24

Findings of testicular torsion on US

Answer 24

Testis are avascular

Question 25

Findings of varicoele on US

Answer 25

Dilated scrotal venous plexus Typically on left side Tortuous veins >2mm in diameter

Question 26

Finding of hydrocoele on US

Answer 26

Black anechoic fluid surrounds the testicle

Question 27

Findings of epididymal cyst on US

Answer 27

Typically rise within epididymal head

Question 28

Findings of testicular tumour on US

Answer 28

Soft tissue mass | May have demonstratable vascularity

Question 29

How is renal trauma best assessed?

Answer 29

CT

Question 30

How is bladder rupture best imaged?

Answer 30

Cystography or CT cystography (contrast leaks through rupture)

Question 31

What is urethral druption associated with?

Answer 31

Anterior pelvic fracture/dislocation | Straddle injury

Question 32

What should you do clinically if you have suspiscion of urethral disruption (meatal bleeding, unable to pee)?

Answer 32

Call urology (don't attempt catheterisation)

Question 33

What imaging is used to define long term stricture formation?

Answer 33

Urethrography

Question 34

What non-vascular procedures can be done by interventional radiology?

Answer 34

Relief of ureteric obstruction Drainage of abscess or renal cyst Biopsy of renal masses Guided ablation of tumours

Question 35

What vascular procedures can be done by an intervention radiologist?

Answer 35

Correction of renal artery stenosis Control of arterial bleeding sites (embolzation) Varicocoele embolization