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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 |
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Adrenal Calcification
Adult |
Cystic disease
carcinoma Addisons dx Ganglioneuroma Inflammatory (TB histoplasmosis) Pheochromocytoma calcification rare but present in an 'eggshell' pattern |
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CT of Adrenal Masses
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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 |
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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 |
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Loss Of Renal Outline on Plain Film
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Technical Factors
Congenital absence Displaced ectopic kidney Perinephric hematoma Perinephric abscess tumor (when perinephric fat is displaced) Post-nephrectomy |
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Renal Calcification
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Calculi
Dystrophic Calcification due to Localized Disease Infection (TB, Hydatid, xanthogranulomatous pyelonephrtis, abscess) Carcinoma Aneurysm |
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Renal Calcification
Nephrocalcinosis |
May be medullary or cortical
Parenchymal calcification Associated with Diffuse Renal Lesion (ie dystrophic calcification) or metabolic abnormality (ie hypercalcemia) |
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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) |
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Renal Calcification
Nephrocalcinosis Cortical |
Acute cortical necrosis
Chronic glomerulonephritis Chronic transplant rejection |
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Renal Calculi
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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 |
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Gas in the Urinary Tract
Gas in the Bladder |
vesiculointestinal fistula
cystitis (gas forming organisms) following instumentation penetrating wounds |
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Gas in the Urinary Tract
Gas in the Bladder Wall |
emphsematous cystitis (usually in DM)
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Gas in the Urinary Tract
Gas in the Ureters and Pelvicalyceal Systems |
Any cause of gas in the bladder
Ureteric diversion Fistula Infection |
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Non Visualization of One Kidney During Excretion Nephrogram
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Absent kidney
Ectopic Kidney Chronic Obstructive Uropathy Infection Tumor Renal Artery Occlusion Renal Vein Occlusion Multicystic Kidney |
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Unilateral Scarred Kidney
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Reflux Nephropathy
TB Lobar Infarction Renal Dysplasia DDx persistent fetal lobulation |
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Unilateral Small Smooth Kidney
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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 |
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Bilateral Small Smooth Kidneys
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generalized arteriosclerosis
chronic glomerulonephritis chronic papillary necrosis arterial hypotension Causes of unilateral small smooth kidneys happening bilaterally |
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Unilateral Large Smooth Kidney
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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 |
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Bilateral Large Smooth Kidneys
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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 |
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Localized Bulge of the Renal Outline
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cyst
tumor fetal lobulation dromedary hump enlarged septum of Bertin localized hypertrophy acute focal nephritis (lobar nephronia) abscess non-functioning moiety of a duplex |
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Cortical defects in Radionuclide Imaging
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scars
hydronephrosis trauma (subcapsular or or itrarenal) renal cysts carcinoma infarct or ischemia abscesses Mets Wilm's Tumor |
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Renal Neoplasms in an Adult
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Malignant
RCC TCC SCC Leukemia/lymphoma Mets Benign Hamartoma Adenoma Other (myoma, lipoma, hemangioma, firoma-all rare) |
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Primary Renal Neoplasms in a Child
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Wilm's tumor
nephroblastomitosis congenital mesoblastic nephroma clear cell sarcoma rhabdoid tumor of the kidney multilocular cystic neoroma RCC angiomyolipoma |
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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 |
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Classification of Renal cysts
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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 |
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CT Renal Cysts
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Simple
malignant (5%of RCC are cystic) Polcystic Hemodialysis related von Hippel Lindau (associted pancreatic, hepatic cysts RCC anf pheochromocytoma Hydatid Multicystic cystic hamartoma |
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Reanal Mass in Newborn and young Infant
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hydronephrosis
multicystic kidney polycystic kidney renal vein thrombosis nephroblastomatosis or mesoblastic nephroma renal ectopia |
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Hydronephrosis in a Child
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pelviureteric obstruction (more common on the left)
bladder otflow obstruction uretervesical obstruction associated with UTI Neurogenic |
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Nephrographic Patterns
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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 |
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Renal papillary Necrosis
ADIPOSE |
analgesics
diabetes infants in shock pyelonephritis obstruction sickle cell disease ethanol |
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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 |
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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 |
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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 |
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Renal Vein Thrombosis
Children |
Dehydration and Shock
Nephrotic Syndrome Cyanotic Heart Disease |
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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 |
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Non Visualization of Calyx
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Tumor (RCC adult/Wilms child)
Obstructed Infundibulum (tumor, calculus or TB) Duplex Kidney Infection (abscess or TB) Partial Nephrectomy |
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Radiolucent filling Defect in the Renal Pelvis or a Calyx
Extrinsic with a smooth margin |
cyst
vascular inpression renal sinus lipamatosis collateral vessels |
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Radiolucent filling Defect in the Renal Pelvis or a Calyx
Seperate from the wall and with a smooth margin |
blood clot
papilloma pyeloureteritis cystica |
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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) |
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Radiolucent filling Defect in the Renal Pelvis or a Calyx
In the lumen |
Blood clot
lucent calculus sloughed papilla air |
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Dilated calyx with a narrow infundibulum
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stricture
extrinsic impression by an artery hydrocalycosis May be a congenital disorder, can only be safely diagnosed in kids when calculus tuberculosis are uncommon) |
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Dilated calyx with a wide4 infundibulum
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post obstructive atrophy
megacalyces polycalycosis |
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Dilated Ureter
Obstruction within the lumen |
calculus
blood clot sloughed papilla |
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Dilated Ureter
Obstruction in the wall |
edema or stricture secondary to calculus
tumor TB stricture schistosomiasis (especially distal ureter) post surgical trauma ureterocele megaureter |
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Dilated Ureter
Obstruction outside the wall |
retroperitoneal fibrosis
carcinoma cervix, bladder, prostate retrocaval ureter (right side only) |
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Dilated Ureter
Vesicoureteric Reflux No obstruction or reflux |
post partum
foloewing relief of an obstruction UTI Primary non obstructive megaureter |
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Retroperitoneal reflux
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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) |
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Differential Diagnosis of Medially Placed Kidneys
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Normal variant 15%
pelvic lipomatosis folowing abdominoperineal surgery Retrocaval ureter (right at level L4) |
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Filling Defect in the Bladder
In the wall or in the lumen) |
prostae
neoplasm blood clot instrument calculus ureterocele schistosomiasis endometriosis |
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Bladder calcification
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In the lumen
calculus foreign body In the wall TCC Schistosomiasis TB cyclophosphamide induced cystitis |
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Bladder Fistula
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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 |
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Bladder Outflow Obstruction in a Child
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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 |
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calcification of the Seminal Vesicles Vas Deferens
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Diabetes
chronic Infection TB, schistosomiasis, chronic UTI syphilis Idiopathic |
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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) |
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US of the Testes and Scrotum
Vascular |
Testicular torsion
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US of the Testes and Scrotum
Inflammatory |
Orchitis
Abscess |
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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 |
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US of the Testes and Scrotum
Extratesticular |
Inflammatory
Epididymitis Idiopathic Hydrocele (fluid anterolaterally) Vascular varicocele Neoplastic Adenamatoid tumor of the epididymid (benign) |