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58 Cards in this Set

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Adrenal Calcification

Child
cystic disease (usually the result of hemmorrhage that may be secondary to trauma, infection, birth trauma) arterial or venous thrombosis.

Neuroblastoma 90% CT (node and mets may also calcify)

Ganglioneuroma
Adrenal Calcification

Adult
Cystic disease
carcinoma
Addisons dx
Ganglioneuroma
Inflammatory (TB histoplasmosis)

Pheochromocytoma calcification rare but present in an 'eggshell' pattern
CT of Adrenal Masses
Functioning Tumors
Conn's Adenoma
Pheochromocytoma (associations with Men II, von Hippel Lindau, neurofibromatosis MIBG isotope)

Malignant Tumors
Mets
Carcinoma
Lymphoma
Neuroblastoma

Benign Tumors
Non-functioning Adenoma
Angiomyolipoma
Cyst
Post traumatic hemorrhage
MIBG imaging

Methyl-iodo-benzyl-guanine
Normal
Myocardium
Liver and Spleen
Bladder
Adrenal Galnds
Salivary Glands
Nasopharynx
Thyroid
Colon

Abnormal
Pheochromocytoma
Neuroblastoma
Carcinoid
Paraganglioma
Medullary Thyroid Carcinoma
Ganglioneuroma
Loss Of Renal Outline on Plain Film
Technical Factors
Congenital absence
Displaced ectopic kidney
Perinephric hematoma
Perinephric abscess
tumor (when perinephric fat is displaced)
Post-nephrectomy
Renal Calcification
Calculi

Dystrophic Calcification due to Localized Disease
Infection (TB, Hydatid, xanthogranulomatous pyelonephrtis, abscess)
Carcinoma
Aneurysm
Renal Calcification

Nephrocalcinosis
May be medullary or cortical
Parenchymal calcification Associated with Diffuse Renal Lesion (ie dystrophic calcification) or metabolic abnormality (ie hypercalcemia)
Renal Calcification

Nephrocalcinosis

Medullary (pyramidal)
First 3 70% of cases
HPT
Renal Tubular Acidosis (rickets, osteomalacia Distal tubular defect)
Medullary Sponge Kidney
Renal Papillary necrosis (calcification of necrotic papillae)
Renal Calcification

Nephrocalcinosis

Cortical
Acute cortical necrosis
Chronic glomerulonephritis
Chronic transplant rejection
Renal Calculi
OPAQUE
calcium phosphate/calcium oxalate

POORLY OPAQUE
Cystine

NON OPAQUE
With normocalcemia (obstruction, UTI renal tubular acidosis, medullary sponge kidney)
With Hypercalcemia (HPT, excess Vit D, milk-alkali synd. sarcoid)

PURE CALCIUM OXALATE due to HYPEROXALURIA
Primary Oxaluria rare AR
Enteric Oxaluria

URIC ACID
With hyperuricemia (gout, myeloproliferative disease, antimitotic chemotherapy
With normouricemia idiopathic)

XANTHINE
Due to failure of normal oxidation of purines
Gas in the Urinary Tract

Gas in the Bladder
vesiculointestinal fistula

cystitis (gas forming organisms)
following instumentation
penetrating wounds
Gas in the Urinary Tract

Gas in the Bladder Wall
emphsematous cystitis (usually in DM)
Gas in the Urinary Tract

Gas in the Ureters and Pelvicalyceal Systems
Any cause of gas in the bladder
Ureteric diversion
Fistula
Infection
Non Visualization of One Kidney During Excretion Nephrogram
Absent kidney
Ectopic Kidney
Chronic Obstructive Uropathy
Infection
Tumor
Renal Artery Occlusion
Renal Vein Occlusion
Multicystic Kidney
Unilateral Scarred Kidney
Reflux Nephropathy
TB
Lobar Infarction
Renal Dysplasia

DDx persistent fetal lobulation
Unilateral Small Smooth Kidney
With a Dilated Collection System
post obstructive atrophy

With a Small-Volume Collecting System
Ischemia

Ischemia due to Renal artery Stenosis

Radiation Nephritis

End result of renal Infarction

With 5 or Less Calyces
Congenital hypoplasia
Bilateral Small Smooth Kidneys
generalized arteriosclerosis
chronic glomerulonephritis
chronic papillary necrosis
arterial hypotension

Causes of unilateral small smooth kidneys happening bilaterally
Unilateral Large Smooth Kidney
Compensatory hypertrophy
Obstructed kidney
pyonephrosis
duplex kidney
Tumor
crossed fused ectopia
multicystic kidney
acute pyonephritis
trauma (hematoma/urinoma)
renal vein thrombosis
acute arterial infarction
adult polycystic kidney disease
Bilateral Large Smooth Kidneys
PROLIFERATIVE AND NECROTIZING DISORDERS
acute glomerulonephritis
polyarteritis nodosa
Wegener's granulomatosis
Goodpasture's
SLE

DEPOSITION of ABNORMAL PROTEINS
amyloid
multiple myeloma

ABNORMAL FLUID ACCUMULATION
acute tubulat necrosis
acute cortical necrosis

NEOPLASTIC INFILTRATION
leukemia and lymphoma

INFLAMMATORY CELL INFILTRATION
acute interstitial nephritis

MISC
Polycystic Kidney disaese
Sickle Cell Anemia
Acromegaly
Localized Bulge of the Renal Outline
cyst
tumor
fetal lobulation
dromedary hump
enlarged septum of Bertin
localized hypertrophy
acute focal nephritis (lobar nephronia)
abscess
non-functioning moiety of a duplex
Cortical defects in Radionuclide Imaging
scars
hydronephrosis
trauma (subcapsular or or itrarenal)
renal cysts
carcinoma
infarct or ischemia
abscesses
Mets
Wilm's Tumor
Renal Neoplasms in an Adult
Malignant
RCC
TCC
SCC
Leukemia/lymphoma
Mets

Benign
Hamartoma
Adenoma
Other (myoma, lipoma, hemangioma, firoma-all rare)
Primary Renal Neoplasms in a Child
Wilm's tumor
nephroblastomitosis
congenital mesoblastic nephroma
clear cell sarcoma
rhabdoid tumor of the kidney
multilocular cystic neoroma
RCC
angiomyolipoma
CT Kidney

Focal Hypodense Lesions
Tumors Malignant
RCC
Mets
Lymphoma
TCC
Wilm's

Benign Tumors
oncocytoma (adenoma arising from proximal tubular cells, sometimes has centarl scar if > 3cm)
Angiomyolipoma

Inflammation
Ascess
Xanthogranulomatous pyelonephritis
acute focal bacterial nephritis

Vascular
infarcts
Classification of Renal cysts
Renal Dysplasia
multicystic kidneys
focal anf segnental cystic dysplasia
posterior urethral valves in males

Polycystic Disease
ARPKD
ADPKD

Cortical Cysts
simple cyst
multilocular nephroma
syndromes associated with cysts
Zellweger's
TS
Turner's
von Hippel-Lindau
trisomy 13 18

Meduallary Cysts
calyceal cyst (diverticulum)
medullary spong kidney
papillary necrosis
juvenile nephronopthisis (medullary cystic disease)

Miscellaneous Intrarenal Cysts
Inflammatory (TB, calculus, hytatid)
Neoplastic (cystic degeneration of a carcinoma
Traumatic

Extraparenchymal renal Cysts
Parapelvic cysts (does not communicate with the renal pelvis)
perinephric cyst ( beneath the capsule or between the capsule anf the perinephric fat
CT Renal Cysts
Simple
malignant (5%of RCC are cystic)
Polcystic
Hemodialysis related
von Hippel Lindau (associted pancreatic, hepatic cysts RCC anf pheochromocytoma
Hydatid
Multicystic
cystic hamartoma
Reanal Mass in Newborn and young Infant
hydronephrosis
multicystic kidney
polycystic kidney
renal vein thrombosis
nephroblastomatosis or mesoblastic nephroma
renal ectopia
Hydronephrosis in a Child
pelviureteric obstruction (more common on the left)
bladder otflow obstruction
uretervesical obstruction
associated with UTI
Neurogenic
Nephrographic Patterns
Immediate Faint Persistent Nephrogram
proliferative necrotizing disorders
renal vein thrombosis
chronic severe ischemia

Imeddiate Distinct Persitent Nephrogram
acute tubular necrosis
other causes of acute renal failure
acute on chronic renal failure
acute hypotension

Increaingly Dense Nephrogram
acute obstruction
acute hypotension
acute tubular necrosis
acute pyelonephritis
multiple myeloma
renal vein thrombosis
acute glomerulonephritis
amyloid
acute papillary necrosis

Rim Nephrogram
severe hydronephrosis
acute complete arterial occlusion

Striated Nephrogram
Acute ureteric obstruction
infantile polycystic kidney disease
medullary sponge kidney
acute pyelonephritis
Renal papillary Necrosis

ADIPOSE
analgesics
diabetes
infants in shock
pyelonephritis
obstruction
sickle cell disease
ethanol
Renal Induced Hypertension

Renal Artery
Athrosclerosis 66%(stenosis of the proximal 2cm)
FMD 33% (string of beads appearance, mainly females< 40 bilateral 40%)
Thromboosis
Embolism
Arteritis
Neurofibromatosis
Trauma
Aneurysm
arteriovenous fistula
extrinsic compression
Renal Induced Hypertension

Chronic Bilateral Parenchymal Disease
Chronic Glomerulinephtitis
Reflux nephropathy
Adult polycystic Disease
Diabetic glomerulosclerosis
Connective Tissue disorders (sle scleroderma PAN)
Rx
Analgesic nephropathy
Renal vein thrombosis
Renal Induced Hypertension

Unilateral Parenchymal Disease
less common cause of hypertension

Reflux nephropathy
Tumors (rare juxtaglomerular tumor secretes renin)
Xanthogranulomatous pyelonephritis
Rx
renal vein thrombosis
Renal Vein Thrombosis

Children
Dehydration and Shock
Nephrotic Syndrome
Cyanotic Heart Disease
Renal Vein Thrombosis

Adults
Extension of renal cell carcinoma into renal veins
Local compression by tumor or retroperitoneal nodes
Extension of thrombus from IVC
Trauma
Secondary to Renal Disease
Non Visualization of Calyx
Tumor (RCC adult/Wilms child)
Obstructed Infundibulum (tumor, calculus or TB)
Duplex Kidney
Infection (abscess or TB)
Partial Nephrectomy
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Extrinsic with a smooth margin
cyst
vascular inpression
renal sinus lipamatosis
collateral vessels
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Seperate from the wall and with a smooth margin
blood clot
papilloma
pyeloureteritis cystica
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Arising from the wall with an irregular margin
TCC
SCC
RCC
Squamous metaplasia (cholesteatoma (occurs rarely in association with acute inflammation)
Radiolucent filling Defect in the Renal Pelvis or a Calyx
In the lumen
Blood clot
lucent calculus
sloughed papilla
air
Dilated calyx with a narrow infundibulum
stricture
extrinsic impression by an artery
hydrocalycosis May be a congenital disorder, can only be safely diagnosed in kids when calculus tuberculosis are uncommon)
Dilated calyx with a wide4 infundibulum
post obstructive atrophy
megacalyces
polycalycosis
Dilated Ureter
Obstruction
within the lumen
calculus
blood clot
sloughed papilla
Dilated Ureter
Obstruction
in the wall
edema or stricture secondary to calculus
tumor
TB stricture
schistosomiasis (especially distal ureter)
post surgical trauma
ureterocele
megaureter
Dilated Ureter
Obstruction
outside the wall
retroperitoneal fibrosis
carcinoma cervix, bladder, prostate
retrocaval ureter (right side only)
Dilated Ureter

Vesicoureteric Reflux
No obstruction or reflux
post partum
foloewing relief of an obstruction
UTI
Primary non obstructive megaureter
Retroperitoneal reflux
Idiopathic >50%
Retroperitoneal malignancy (lymphoma mets from testicular ca)
Aortic aneurysm (secondary to blood)
trauma (")
surgery (")
Inflammatory conditions
connective tissue diseases (ank spond, sle, wegeners, Pan
Drugs (methysergide)
Differential Diagnosis of Medially Placed Kidneys
Normal variant 15%
pelvic lipomatosis
folowing abdominoperineal surgery
Retrocaval ureter (right at level L4)
Filling Defect in the Bladder
In the wall or in the lumen)
prostae
neoplasm
blood clot
instrument
calculus
ureterocele
schistosomiasis
endometriosis
Bladder calcification
In the lumen
calculus
foreign body

In the wall
TCC
Schistosomiasis
TB
cyclophosphamide induced cystitis
Bladder Fistula
Congenital
Ectopia Vesicae
imperforate anus (high type)
patent urachus

Inflammatory
Diverticulae disease
Crohns Dx
Appendix Abscess

Neoplastic
Ca bldder,colon, reproductive organs
Rx

Trauma
accidental
iatrogenic
Bladder Outflow Obstruction in a Child
Causes from proxomal to distal

Vesical diverticulum (posterior behind bladder base)
Bladder neck obstruction
Ectopic uretrocele
posterior urethral valves
urethral stricture
anterior urethral diverticulum
prune belly syndrome
calculus or foreign body
meatal stenosis
phimosis

most common
male posterir urethral valves
femaes ectopic uretrocele
calcification of the Seminal Vesicles Vas Deferens
Diabetes
chronic Infection TB, schistosomiasis, chronic UTI syphilis
Idiopathic
US of the Testes and Scrotum

Neoplastic
Germ cell Neoplasms (95% primary germ cell tumors 40% mixed histology 8% bilateral)
a seminoma most common
embryonal cell carcinoma
choriocarcinoma
teratoma

Non germ cell tumors (usually benign may screte estrogens (Sertoli) or Testoterone (Leydig)
(Mets kidney, prostate,brochus
more common than germ cell tumors over 50)
US of the Testes and Scrotum

Vascular
Testicular torsion
US of the Testes and Scrotum

Inflammatory
Orchitis
Abscess
US of the Testes and Scrotum

Idiopathic non-neoplastic cysts
Tunica Albuginea Cyst 2-5mm upper/anterior/lateral part of the testis uni/multilocular

Simple cyst > 40yo 2-20 mm usually solitary loacted near the mediastinum
US of the Testes and Scrotum
Extratesticular
Inflammatory
Epididymitis

Idiopathic
Hydrocele (fluid anterolaterally)

Vascular
varicocele

Neoplastic
Adenamatoid tumor of the epididymid (benign)