Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

URI 2 > Urinary Imaging > Flashcards

Urinary Imaging Flashcards

1
Q

What are the different imaging modalities we could use for the urinary system and what could we use them for? (4)

A

•Radiography

–Still an important tool, particularly presence/absence, size/shape, mineralisation, ruptures, complex spatial relationships

•Ultrasonography

–Extremely helpful, particularly kidneys and bladder

–Complementary to radiography

•CT (and MRI)

–CT being used increasingly, particularly ureters and urethra

–Contrast CT – gold standard

•Endoscopy

  • Useful for direct visualisation of the bladder and urethra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do we image in a urinary case?

A

•Concentrate on those cases where clinical signs are severe, or recurrent or persistent in the face of treatment as these are the cases which are more likely to have a physical changes which we can detect

clinical signs and other work-up must suggest changes within the urinary tract that will be detected by the chosen method

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

•What do we call this imaging plane of kidney? Where renal pelvis is asymmetrical at far edge of image?

A

•Frontal (dorsal) we are going from greater curvature of kidney in near field all the way through to reach the pelvis on other side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

•What is NOT routinely visible on plain abdo radiograph? (2)

A

–Urethra

–Ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

•On a VD of a dog abdo, what is the normal range for max renal length?

A

•2.5-3.5 x length L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

•Which radiograph contrast is used for kidneys?

A

•IV urogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

•Which radiographic contrast study will give the best mucosal detail in the bladder?

A
  • Double contrast cystogream
  • Positive – coat mucosa
  • Air – see detail
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

•How many layers are visible in an U/S image of a normal bladder wall? What are they?

A
  • 3
  • Mucosal surface
  • Muscle
  • Serosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does this show?

A

Left – large soft tissue structure. Non contrast; non filtering enlarged L kidney

R – some contrast in ureter and leaving renal pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can we use IVU for in regards to kidnye function?

A

IVU provides only very crude assessment of renal function (excretion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do we do if one or both kidneys are not visible?

A

Investigate further

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the effect of an enlared left kidney?

A
  • Ventral displacement of colon
  • Medial displacement of colon and small intestine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the effect of an enlarged right kidney?

A
  • Ventral displacement of duodenum
  • Medial displacement of ascending colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What may a reduced renal size be associated with?

A

Change in shape +/- opacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes reduced renal size? (2)

A

•Generally chronic renal disease (older) or dysplasia (young)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is this?

A

Small kidney and abnormal ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Was ist Das?

A

IVU

Mis-shapen – fibrotic

Small

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2 ultrasound changes of the internal renal architecture?

A

Generalised increase in cortical echogenicity

Medullar rim sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes generalised increase in cortical echogencitity? (3)

A

-non-specific change in many renal diseases, e.g. early nephritis or lymphoma, or incidental fat accumulation in cats.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the medullar rim sign?

A

-Hyperechoic band in outer medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes medullary rim sign? (4)

A

-Causes include hypercalcaemia, acute tubular necrosis, chronic renal disease, FIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are these and what is the significance?

A

Renal coritcal cysts

Fluid filed cavities.
You will see one or two cysts in the cortex! Often incidental. If you have many cysts e.g. polycystic kidney dx – reduce the amount of functional tissue = problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is this?

A

Dilation of renal pelvis

Chunky ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is going on?

A

Hydronephrosis/ dilated ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What can be seen here?

A

Renal Cyst

Distorting normal renal pelvis anatomy!

Radiography useful but cant tell if ST mass or fluid filled (then use U/S in combo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is this?

A
  • Beware superimposition shadows
  • Especially in fat animals!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is shown here?

A
  • Renal medulla can appear very hypoechoic on U/S/
  • Can look anechoic in some on some machines! Don’t just jump to renal pelvis dilation
  • Can do an IVU if you aren’t 100%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is going on?

A

Location
Have we got ectopic ureters? Contrast – very specific to find location
IVU
Retrograde
Pneumocystogram
Can see contrast in v (vagina)
Contrast in UA (urethra)
Contrast in UA we get a thin line which splits out into bladder (we have positive and air)
Dorsal have a wider band joining with ureter. Have proved ureter terminates in urethera!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is this?

A

Dilated ureter (megaloureter/hydroureter)
Degree of hydronephrosis
Ectopic ureter
Closer to the kidney easier to see ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is going on here?

A

Opacity
Ensure you take x ray of WHOLE abdo not just bladder
Thin arrow – ureteric calculi
Thick arrows – renal calculi!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can be seen?

A

Only see one normal renal shadow

Arrow heads – increase ST opacity in an enlarged retropeeitonal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is this?

A

Ureteric rupture

Contrast leaking out!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can be seen on this CT?

A

frontal image (normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is this?

A

transverse of kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is this?

A 
Computed Tomography (CT) with contrast – go to for ureters
Left – transverse through pelvis, bottom is bladder, 2 circular structures with contrast – ureters
RHS normal and LHS is dilated.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is this?

A

normal ureteric opening. Have a bladder, mid grey in dorsal part of bladder is urine. Ventral part is contrast. Contrast media is more dense and drops to the bottom. Can see a dribble of contrast dorsal through urine. It is urine coming out… tells u the ureters are normally terminating in the bladder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is this highlighting?

A
  • Beware deep circumflex iliac arteries in retroperitoneal space
  • Around L5 come out perpendicular to aorta! Get an opaque area.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Whats going on here?

A

Bladder neck in pelvis – abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are you thinking about this? What do you do?

A

Where’s the bladder?!
No sign of bladder in caudal
so did contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is going on?

A

Caudally displaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What can cause a reduced bladder size? (4)

A

–Very small bladder

  • Animal has just urinated
  • Bilateral ectopic ureters with bladder hypoplasia
  • Ureteral rupture

–Bladder rupture

–Bladder displacement

–Peritoneal disease obscures shadow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What can cause bladder enlargement? (2)

A

•Bladder is highly distensible, so may appear very large in normal animals! Storage organ.

–e.g. if left in kennel for several hours with no opportunity to urinate before radiography!

•Neurological or mechanical causes of pathological enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is this? Describe the appearance

A
  • Cystic calculi
  • Echogenic, often with acoustic shadowing
  • Reflect back U/S – echogenic with deep shadows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What can be seen?

A

Solitary radiopaque calculus

Contain heavy elements e.g. Ca or Mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is this?

A

Radiolucent calculi

They are soft tissue fluid opacity (wont show up against urine. Will need contrast or U/S

46
Q

What is this?

A

Radiopaque calculi

47
Q

What is the appearance of stuvite and calcium oxalate of radigraph?

A

Radiopaque

48
Q

What is the appearance of cystine urate on radiograph?

A

Radiolucent

49
Q

What is the appearance of acute cystitis on x ray?

A
  • Changes are minimal
  • There hasn’t been time for a physical change
50
Q

What is this? Describe appearance

A

–Chronic cystitis

  • Thickening may be localised(cranioventral)
  • Thickening may be generalised
  • Irregularity of wall
  • Contrast adheres to the mucosa
51
Q

Complete this table

A
52
Q

What can be seen?

A

Polypod cystitis

Polyps (thick arrow) – finger like lucent projections attached to wall

Calculi (thin arrow) – rounded (irritated wall and led to polyp)

Air bubbles (arrow head) – polygon shape around catheter!

53
Q

What is this?

A

Cystitis

Note: the change particulary CrV

54
Q

Describe and diagnose

A

Polypoid cystitis

Marked irregularity

Double contrast

55
Q

Diagnose

A

Mucosal neoplasia

56
Q

what is the most common bladder neoplasia?

A

•Most common neoplasm = urothelial (ex-transitional) cell carcinoma

57
Q

Where do bladder tumours often effect?

A

Dorsal wall/trigone

58
Q

What is the appearance of bladder mucosal tumours?

A
  • Irregular surface
  • Protrude into lumen
  • Positive contrast adherence
59
Q

What is this?

A

Cranioventral bladder wall thickening and associated mass

60
Q

Describe what you see

A

Bladder neck mass (blue arrow) and blood clots (yellow arrow)

61
Q

What has been used to take this image?

Describe what is seen?

A

Double contrast

Concave with thickening

62
Q

What is the appearance of bladder mucosal tumours?

A
  • Fixed wall become rigid and distort shape
  • May be no mucosal irregularity or mass and no contrast adherence
  • If the tumour erodes through epithelium – get similar signs as the epithelial tumours
63
Q

When filing the bladder for contrast imaging how full do you fill it?

A

Fill the bladder well, but do not apply too much pressure …….. “two day old party balloon”

64
Q

Describe what you see!

A

Leakage of positive contrast medium through the bladder wall in a case of FLUTD.

The bladder wall was grossly intact.

Urothelium is so leaky – leaks through bladder wall!!! Leakage between urothelial cells

65
Q

These are the same dog… Why the difference in appearance?

A

Take care interpreting wall thickness with small bladders

2 images from same dog! Just urinated.

Wall relatively thick on left.

66
Q

What has caused this appearnce?

A

“Slice thickness” artefact

•Change probe direction

Increase in echogenicity in far side of bladder

67
Q

What has caused this appearance?

A

Side/grating lobes artefact

  • Reduce gain
  • Knock the gain down in the near field to see this
68
Q

What imaging is this?

A

Retrograde urethrogram

69
Q

What imaging is this?

A

Retrograde vaginourethrogram

70
Q

Describe what you see

A

Enlarged prostate

in perineal rupture

Urethra caudally displaced – as is bladder neck.

71
Q

Describe what you see

A

Urethral compression – arrows

Problems urinating due to compression

72
Q

What is this?

A

Urethral neoplasia

–Radiographic appearance NOT distinguishable from urethritis!!

–Marked irregularity of urethra – widened. Some erosion into bladder neck.

73
Q

Describe what you see

A

Urethral rupture – positive contrast are the best way to look

Avulsed urethra off the bladder

74
Q

What is this?

A

Urate calculi

75
Q

What is this?

A

Urethrolithiasis - dog

76
Q

What is this?

A

Urolithiasis

77
Q

•Which calculi will not be seen on plain radiographs?

A
  • Urate – contains no heavy elements
  • (Struvite have Mg and ca in calcium oxalates)
78
Q

•Which radiograph contrast study should be used to detect rupture of the bladder?

A
  • Positive contrast
  • Air will just move through the abdo and cant distinguish from bowel gas!
79
Q

•Which abnormalities are indistinguishable from urethral neoplasia of positive contrast urethrogram?

A

•Urethritis

80
Q

Accidentally added this FC..

A

CBA to delete it..

81
Q

What is the normal shape and size of canine kidneys?

A
  • 2.5-3.5 x length of L2 (VD)
  • Right kidney
    • Located approx T13-L1/2
    • Cranially in contact with the caudate love of the liver (may not see this margin)
  • Left kidney:
    • Usually slighlt further cauda and ventral
    • Seperation of kidneys more obvsious on a RLR view
82
Q

What is the normal shape and size of feline kidneys?

A
  • Tend to be more oval in shape
  • More frequently super imposed
  • More caudally positioned
  • Cranial pole of kidney more often seperated from the liver by fat
  • Normal size
    • 2-3 x L2
83
Q

What is IVU?

A

Positive contrast media

Provides anatomical and functional info

Specific informattion can be obtained at each stage of the IVU, and the actual technique may need to be varied according to the findings at each stage

84
Q

What are the contraindications of IVU?

A

Dehydration/hypovolaemia

Severe renal failure/anuria

85
Q

How do you prepare for IVU?

A

Starve 24

Thorough cleansing enema

GA

86
Q

What is the technique of IVU?

A

High concentration/low volume = inject bolus into peripheral vein

Low concentration/high volume - contrast given in IV drip

Several radiographs taken to track the flow of contrast through urinary tract

87
Q

What do you do for IVU high concentration low volume.

A

•Immediate VD view (0 mins) = angiogram

  • Opacification of renal vessels
  • Rapid phase, easy to miss

•0-1 minutes VD view = nephrogram

–Uniform opacification of renal parenchyma in both kidneys

  • (Negative contrast has been placed into bladder - pneumocystogram)
  • 5 minutes VD view = pyelogram

–contrast within renal pelvises and ureters

  • Normal pelvic width no more than 2-3mm
  • Ureteral width approx 2-3mm

–Interrupted ureteral filling is a normal finding due to peristalsis

•10-15 minutes

–Both ureters should run caudally in the retroperitoneal space to terminate at the bladder trigone

88
Q

How is the bladder often seen on radiographs?

A
89
Q

Where is the normal urethra on plain radiograph?

A

Not visible!!

90
Q

What is this?

A

Stifle fabellae may be super imposed on poorly positioned mages and cofused with calculi

91
Q

What are the contrast radiography of the bladder? (3)

A
  • Pneumocystogram
  • Positive contrast cystogram
  • Double contrast cystogram
92
Q

What is bladder contrast readiographs useful for?

A

–Identification of bladder location

–Investigation of possible rupture

–Detection of radiolucent calculi

–Evaluation of the bladder wall

  • Wall thickening
  • Masses
  • Mucosal surface
93
Q

What is this?

A

Double contrast cystogram – chronic cystitis in a cat

94
Q

What do we do for retrograde cystogram?

A

Survery films

Cathertise/empty/bladder

Inject contrast medium

95
Q

What are the retrograde cystogram contrast medias? What are the advantages? (3)

A
96
Q

What is this?

A

Incomplete filling - pneumocystogram

  • Inadequate distention of the bladder or urethra is a major cause of poor diagnostic quality with retrograde contrast studies
  • Here, the bladder is not fully distended resulting in an irregular shape
  • There are also air bubbles in the residual urine in bladder resulting in a honeycomb appearance. This can be avoided by less enthusiastic injection of air through the catheter
97
Q

What is this?

A

Artefactual indentation of the bladder wall – positive contrast urethrocystogram

•Again, this bladder is not fully distended with contrast medium

As a result, faeces pressing on the bladder are resulting in an indentation of the dorsal bladder wall

98
Q

What is this?

A
  • The urinary catheter has been inserted too far into the bladder and is twisting around the wall
  • This should be avoided by measuring the catheter against the body before inserting
  • Inserting it too far into the bladder may cause iatrogenic damage to the mucosa, and in extreme circumstances it can form a knot when attempting to pull it out, making it impossible to remove (a cystotomy will be necessary!)
99
Q

How do you do a retrograde vaginourethrogram?

A

Foley catheter or urinary catheter plus clamp

Injecte diluted iodine contrast media

  • Test injection for leaks
  • CAREFUL injection - vaginal rupture

Lateral views are suually most helpful, VD view may be helpful for some abnormalities

100
Q

How do you do a retrograde urethrogram?

A

Catheterise urethra

Position tip distal to area under investigation

Clamp sheath tightly around catheter

Inject diluted water soluble contrast medium (can mix1:1 with sterile aq gel)

Exposure immediately after end of injection - observe all radiation safety rules

Lateral views are usually most helpful

101
Q

What are the ultrasound views of the kidneys?

A
102
Q

What is the renal anatomy of the ultrasound of the kidney?

A
103
Q

What can you see on the mid sagittal section view of renal anatomy?

A

–The hypoechoic medulla reappears central to the more echogenic cortex

–The pelvic diverticulae are prominent and can be seen as short, evenly-spaced echogenic “islands” traversing the medulla to the cortex (= the fingers of your hands being ’cut’ in transverse section - arrows)

–The renal crest is seen as a hyperechoic line running transversely across the kidney (= the paper)

104
Q

What can you see on mid transvere section of the renal antomy U/S?

A

–The medial renal pelvis and peri-pelvic fat can be identified as an echogenic area positioned medially (= the touching palms of your hands)

–The dorsal and ventral parts of the renal pelvis appear as diverging hyperechoic lines (= the separated palms of your hands)

–The renal crest is seen as a hyperechoic line between the pelvic lines (= the paper)

–Cortex and medulla can be identified by their normal appearance

105
Q

What can be seen in the frontal (dorsal) plane of the renal anatomy?

A

•Frontal plane – similar appearance to sagittal plane except:

–Eccentric position of the renal pelvis – seen medially in the far field (= palms of hand)

–Diverticulae appear to be longer because they are ‘cut’ through their long axis (= fingers)

–Cortex and medulla appear as usual

106
Q

What is there a correlation in size of the kidney with in the dog?

A

•In dogs, there is a correlation between renal size and weight of dog or use kidney:aorta ratio

107
Q

What is the normal cat kidney length?

A

3-4.5cm

108
Q

What is a small and large kidney size in relation to kidney:aorta?

A

Small if kidney:aorta < 5.5

Large if kidney:aorta > 9.1

109
Q

What is the normal ultrasound appearance of the bladder?

A
  • Pear-shaped appearance on sagittal section
  • Rounded appearance on transverse section
  • Degree of distension affects shape, size and wall thickness
110
Q

What are the 3 bladder layers?

A
  • Inner mucosal interface (hyperechoic)
  • Muscle layer (hypoechoic)
  • Outer serosal layer (hyperechoic)
111
Q

What is the normal dog bladder thickness?

A

•+/- 2.3 mm (minimally distended) – +/- 1.4mm (mod. Distended)

112
Q

What is the normal cat bladder thickness?

A

•1.3-1.7mm

URI 2 (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions