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Urogenital imaging Flashcards

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1
Q

Where do the kidneys lie?

A

Retroperitoneal: paravertebral gutters of the posterior abdominal wall

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2
Q

What is the level of the left kidney hilum?

A

L1

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3
Q

What is the level of the right kidney hilum?

A

L1/2

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4
Q

What are the contents of the renal hilum?

A 
Renal vein
Renal artery
Renal pelvis (ureter) 
Lymph
Nerves
Renal sinus fat
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5
Q

What conditions can be detected using USS of the kidneys?

A 
Renal size
Cortical scarring
Doppler
Distention of pelvicalyceal system
Calculi
Detection of renal abnormalities
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6
Q

When it a CT kidney indicated?

A

Vascular assessment
Characterizes most pathologies
Multiplanar

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7
Q

What type of CT is best to detect calculi?

A

No contrast

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8
Q

What part of the kidney is best seen with contrast?

A

Corticomedullary

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9
Q

What part of the renal tract is best seen when the contrast is being excreted?

A

Opacification of the renal collecting system and ureters

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10
Q

What is contrast induced nephropathy?

A

Condition in which an impairment in renal function occurs within 3 days following an IV administration of contrast medium in the absence of alternative aetiology

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11
Q

What are risk factors for contrast induced nephropathy?

A 
Renal impairment +/- DM 
Dehydration 
Congestive heart failure 
LV ejection fracture
Acute MI
Nephrotoxic drugs
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12
Q

How can the risk of contrast induced nephropathy be reduced?

A

eGFR <60 pre contrast

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13
Q

What will an MRA renal angiogram show?

A 
Abdominal aorta
Right renal artery 
Left renal artery
Aortic bifurcation
Splenic artery 
Lumbar arteries
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14
Q

What is nephrogenic systemic sclerosis?

A

Severe systemic fibrosing disorder assoc with the exposure of gadolinium containing contrast media

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15
Q

Where does the ureter empty into the bladder?

A

Vesicoureteric junction

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16
Q

What are the 3 anatomical constrictions of the ureters?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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17
Q

Where does the abdominal ureter run?

A

Medial aspect of psoas

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18
Q

Where does the pelvic ureter run?

A

Enters pelvis at bifurcation of common iliacs
Anterior and medial to SI joint
Turns medially at ischial spines to enter the posterolateral bladder

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19
Q

What is a CT urogram used for?

A

Assessing the collecting system, ureters and bladder

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20
Q

What is the structure of the bladder?

A 
Pyramidal shaped organ when empty:
Posteriorly is the base
Anteriorly is the apex (behind pubic symphysis) 
Superior wall
2 inferolateral walls
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21
Q

Where do the ureters enter the bladder?

A

Posterolateral angles

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22
Q

What is the trigone?

A

Triangular smooth area of bladder between ureters and urethra

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23
Q

What covers the superior surface of the bladder?

A

Peritoneum

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24
Q

What lies inferolaterally to the bladder?

A

Obturator internus and levator muscles

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25
What lies anterior to the bladder?
Pubic symphysis
26
What lies posterior to the bladder in females?
Anterior vagina and cervix
27
What lies posterior to the bladder in males?
Inferior prostate
28
What is required in a bladder ultrasound?
Full bladder
29
What can a bladder USS detect?
Volumetric measurement Internal calculi Wall irregularities Diverticula
30
What is the gold standard to see a leak through a bladder wall tear?
Cystography
31
What is the gold standard for local staging of bladder wall tumours?
MRI
32
What is the gold standard for nodal and metastatic disease staging of the bladder?
CT
33
Describe the urethra in males
``` Bladder neck Prostatic urethra Membranous urethra Bulbous urethra Penile urethra ```
34
When is a urethrogram used?
Strictures Trauma Diverticula
35
What is the lymph drainage of the bladder?
Superolaterally to the external iliacs | Neck and fundus to the internal iliac, sacral and common iliiacs
36
What is the imaging of choice for the genitals?
USS for testes/scrotum, uterus, ovaries and prostate
37
When is a hysterosalpingogram used?
Infertility - tubal patency | Uterine anomalies
38
When is an MRI used?
Prostate cancer - local staging | Troubleshooting for adnexal/ uterine/ ovarian abnormalities not characterisable by USS
39
What can be seen on a scrotal USS?
``` Testicular parenchyma Head of epididymis Mediastinum testis Rete testis Appendix testis ```
40
What is the lymph drainage of the scrotum?
Superficial inguinal nodes
41
What is the lymph drainage of the testis?
Lumbar and para-aortic nodes
42
What causes renal colic?
Ureteric calculus
43
What can mimic renal colic?
Pyelonephriti (do USS to exclude ureteric obstruction) | Gynaecological (do USS to visualise uterine, ovarian and uterine tubal pathology)
44
Why is imaging done in renal colic?
Identify the calculus Assess size and morphology of calculus Detect associated ureteric obstruction Identify additional asymptomatic calculi
45
What are the components of most calculi?
Calcium rich and are dense
46
What is the 1st line test done in suspected renal colic?
KUB x-ray - easy and may show a dense ureteric calculus | Only a minority of renal tract calculi are visible on KUB
47
How many x-rays will you get in a KUB x-ray?
Upper/ mid abdomen for kidneys and proximal ureters | Pelvis for distal ureters and bladder
48
What is the normal ureteric course?
Pass inferiorly over the psoas Descend anterior to the tips of the lumbar transverse processes Cross iliac bifurcation to enter pelvis Pass posteromedially and enter the posterior aspect of the bladder
49
Where do ureteric calculi often get stuck?
Pelviureteric junction Pelvic brim Vesicoureteric junction
50
What can mimic ureteric calculi?
Phleboliths (calcification within a vein) Lymph nodes Uterine fibroids Arterial calcification
51
What is the definitive test to diagnose a ureteric calculi?
Non-contrast CT
52
What is the follow up for renal colic?
KUB to check progress
53
What can cause macroscopic haematuria?
``` Calculi Infection Tumour (renal cell carcinoma) Urethritis/prostatitis Trauma Clotting disorders ```
54
How should macroscopic haematuria be investigated in those over 50?
``` CT urography (kidneys, collecting systems and ureters) Cystoscopy (bladder and urethra) ```
55
How should macroscopic haematuria be investigated in those under 50 be investigated?
Malignancy of bladder or ureters unlikely so: US kidneys to detect calculi and renal parenchymal tumours Cystoscopy for bladder TCC, calculi CTU ONLY when Us or cystoscopy are normal
56
When is MR urography helpful?
Contrast allergy Renal impairment Pregnancy
57
What is the role of imaging in renal masses?
Confirm presence Characterise as benign, indeterminate or malignant Stage malignant masses
58
Is the risk of malignancy of a renal mass smaller than 3 cm high or low?
Low - managed conservatively
59
What are renal masses containing fat?
Angiomyolipomas
60
What are renal fluid density masses?
Cysts - uniform cysts are benign
61
What are complex cysts of the kidneys?
If contain solid areas or thick septa, often malignant
62
What are solid (non-cystic) tumours of the kidneys?
If over 3cm, malignant
63
What is used to stage a malignant renal tumour?
CT: extracapsular spread, involvement of adjacent organs, involvement of renal vein or IV Nodal Mets: lungs, bone
64
What can cause renal impairment?
Pre-renal: dehydration, hypotension, renal artery stenosis Renal: parenchymal disease, drugs, toxins Post-renal: obstruction
65
What is used to detect renal artery stenosis?
MR angiography
66
What is used to diagnose renal disease?
US to guide biopsy
67
What is used to diagnose post-renal disease?
US for hydronephrosis (often accompanies obstruction) | CT
68
What can cause a painful scrotum?
Epididymo-orchitis Testicular torsion Trauma
69
What can cause epididymo-orchitis?
Viral or bacteria May be complicated by abscess formation or rarely ischaemia The testis and/or epididymis is typically hypervascular on US
70
What can be seen on USS of testicular torsion?
Avascular - surgical emergency to prevent infarction
71
What can cause a painless scrotal swelling?
``` Hernia Varicocele Hydrocele Epididymal cyst Testicular tumour ```
72
What imaging modality is used in a painless scrotal swelling?
USS for spacial resolution of superficial soft tissue structures
73
What can be seen on USS of varicocele of the scrotum?
Dilated scrotal venous plexus on left side | Tortuous veins more than 2mm in diameter
74
What can be seen on USS of a hydrocoele?
Black anechoic fluid surrounding the testicle
75
What can be see on USS of an epididymal cyst?
Anechoic uni or multilocular cyst - typically arises within the epididymal head
76
What is used to assess renal injury due to trauma?
CT
77
What can be used to diagnose bladder trauma?
Cystography or CT
78
When is interventional radiology used for non-vascular issues?
Ureteric obstruction Drainage of abscess or cyst Biopsy of renal masses Guided ablation of renal tumours
79
What vascular problems is interventional radiology used for?
RAS Control of arterial bleeding sites Varicocele embolisation

Renal (22 decks)

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