Differential Gu

Front 1

Ovarian/Adnexal cystic mass:

Back 1

ectopic pregnancy, hemorrhagic cyst, tubovarian abscess, cystic neoplasm, endometrioma

Front 2

Paratubal adhesions by HSG (obstructed tube or loculated contrast collection outside tube):

Back 2

scaring secondary to PID, endometriosis

Front 3

Adrenal masses:

Back 3

tumor - adenoma, mets (esp small cell), pheochromocytoma, lymphoma, neuroblastoma, carcinoma, hemangioma; fatty – adenoma, myelolipoma, lipoma; cystic – simple cyst, pseudocyst from hemorrhage; other – hemorrhage, TB, Wolman’s disease; bilateral – hemorrhage, mets, lymphoma, bilateral pheochromocytoma (MEN2, VHL, NF), TB, histo, adenomas, hyperplasia

Front 4

Renal mass lesions:

Back 4

tumor – solid, cysts; infection – lobar nephronia, abscess, XGP; congenital – duplicated collecting system; pseudotumors – fetal lobulation, dromedary hump, column of Bertin; trauma - hematoma

Front 5

Solid renal neoplasm:

Back 5

RCC, oncocytoma, adenoma, AML, TCC, mets (lung, colon, melanoma, RCC), lymphoma, Wilms, mesoblastic nephroma, nephroblastomatosis, MFH

Front 6

Cystic renal masses:

Back 6

tumor – cystic RCC, multilocular cystic nephroma, cystic Wilm’s, cystic mets; true cysts – cortical cysts, localized cystic disease, medullary cystic disease, ADPKD, VHL, TS, endstage renal failure, hemorrhagic or infected cyst; other – hydronephrosis/duplicated system, renal artery aneurysm, abscess

Front 7

Hyperechoic renal mass:

Back 7

AML, RCC, milk of calcium cyst, nephritis (XGP, emphysematous pyelonephritis, focal nephritis, Candida), hematoma, infarction, mimics (renal sinus fat, duplicated collecting system)

Front 8

Renal sinus mass:

Back 8

TCC, RCC, lymphoma, papilloma, renal artery aneurysm, renal sinus hemorrhage, complicated parapelvic cyst

Front 9

Wedge-shaped renal lesion:

Back 9

renal mets, infarction, lobar nephritis

Front 10

Infiltrative renal:

Back 10

TCC, mets, lymphoma, infarction, pyelonephritis, XGP

Front 11

Diffusely hyperechoic kidneys:

Back 11

glomerulonephritis, DM, HTN, AIDS nephropathy, SLE, vasculitis, ATN, HUS, multiple myeloma, endstage renal failure, medullary or cortical nephrocalcinosis, ARPKD

Front 12

Renal calcifications:

Back 12

tumors – cysts, RCC; infection – TB; metastatic calcification – medullary nephrocalcinosis, cortical nephrocalcinosis; collecting system – calculi

Front 13

Fat in kidney:

Back 13

AML, lipoma, replacement lipomatosis

Front 14

Hypoechoic perirenal fat:

Back 14

normal variant, perirenal hemorrhage, cyst rupture, SLE, PAN

Front 15

Filling defect in collecting system:

Back 15

tumor – TCC, papilloma, leukoplakia, malakoplakia; mobile filling defect – blood clot, sloughed papillae, calculus, fungus ball; other – vascular impression, overlying bowel gas

Front 16

Papillary necrosis:

Back 16

POSTCARD – pyelonephritis, obstruction, sickle cell, TB, cirrhosis, analgesics, RVT, DM

Front 17

Delayed (persistent) nephrogram:

Back 17

prerenal – RAS, hypotension; renal – acute glomerulonephritis, ATN (contrast, ischemia, transplants), acute cortical necrosis (pregnancy, sepsis, dehydration), tubular precipitation (uric acid, hemolysis, myeloma), acute interstitial nephritis (antibiotics), papillary necrosis, RVT; postrenal – obstruction (stone, stricture); rule of thumb – symmetric bilateral is medical disease, asymmetric unilateral is surgical

Front 18

Striated nephrogram:

Back 18

acute pyelonephritis, renal contusion, RVT, ureteral obstruction, medullary sponge kidney

Front 19

Large kidney with spindled calices:

Back 19

lymphoma, leukemia, pyelonephritis, acute RA occlusion, acute RVT, acute obstruction

Front 20

Normal size kidney with spindled calices:

Back 20

multiple cysts (parapelvic or peripelvic), renal sinus lipomatosis

Front 21

Hypodense rim:

Back 21

acute cortical necrosis, perinephric lymphoma

Front 22

Subcapsular rim sign:

Back 22

infarct, ATN, RVT

Front 23

Extracalyceal contrast:

Back 23

striations – medullary sponge kidney, early papillary necrosis, pyelosinus or pyelovenous backflow in obstruction, interstitial edema; focal collections – late papillary necrosis, calyceal diverticulum, cavity from cyst rupture, abscess

Front 24

Dilated calyces/collecting system:

Back 24

obstruction, papillary necrosis, congenital megacalyces, calyceal diverticulum, reflux

Front 25

Bilaterally enlarged kidneys:

Back 25

ADPKD, lymphoma, glomerulonephritis, HIV, amyloid, bilateral RVT

Front 26

Bilaterally small kidneys:

Back 26

chronic inflammation, bilateral RAS, chronic reflux, ESRD

Front 27

Unilateral renal atrophy (smooth):

Back 27

chronic ischemia (RAS, RVT), postobstructive atrophy, renal hypoplasia, chronic subcapsular hematoma, radiation

Front 28

Unilateral renal atrophy (irregular):

Back 28

reflux nephropathy, analgesic nephropathy, DM

Front 29

Renal TB:

Back 29

parenchymal calcs, putty kidney, papillary necrosis, tuberculoma, scarring, mucosal irregularity, infundibular stenosis, amputated calyx, corkscrew ureter, purse-string stenosis of renal pelvis, pipestem ureter, calculi, small contracted thick-walled bladder, urethral fistulas (watering can perineum)

Front 30

Hypercalcemia:

Back 30

parathyroid adenoma or hyperplasia, Addison disease, milk alkali, sarcoid, carcinomatosis, HPT, myeloma, immobilization, vitD, thiazides

Front 31

Cortical nephrocalcinosis:

Back 31

chronic glomerulonephritis, cortical necrosis (pregnancy, shock, sepsis, toxins), AIDS nephropathy, Alport’s, oxalosis, chronic transplant rejection

Front 32

Medullary nephrocalcinosis:

Back 32

HPT, RTA, medullary sponge kidney, papillary necrosis, Lasix therapy in kids

Front 33

Renal vein thrombosis:

Back 33

tumor - RCC, Wilm’s, lymphoma, TCC, adrenal, gonadal, pancreatic CA, extraluminal compression by retroperitoneal tumor; renal disease – membranous glomerulonephritis, SLE, amyloid; other – hypercoagulable state, extension of ovarian vein or IVC thrombosis, trauma, surgery, transplant complication, dehydration in kids

Front 34

Dilated ureter:

Back 34

criteria - >8mm, ureter visible in entire length, no peristaltic waves; obstruction – primary megaureter (functional), ureteral stricture, calculus, BOO, urethral stricture; reflux; diuresis

Front 35

Ureteral stricture:

Back 35

tumor – TCC, mets, lymphadenopathy; inflammatory – TB (corkscrew appearance), Schistosomiasis, Crohn’s, PID; congenital – ectopic ureterocele, primary megaureter, congenital stenosis; metabolic, drugs – amyloid, morphine, methysergide (retroperitoneal fibrosis); trauma – iatrogenic, radiation; vascular – aneurysm, ovarian vein syndrome, lymphocele, crossing vessel

Front 36

Multiple ureteral filling defects:

Back 36

wall – ureteritis cystica (more common in upper ureter), vascular impressions, multiple papillomas, melanoma mets, submucosal hemorrhage, fibroepithelial polyp (single); luminal (acute angles) – calculi, blood clot, sloughed papillae, fungus ball, air bubbles, TCC

Front 37

Ureteral diverticula:

Back 37

congenital, pseudodiverticulosis, TB (also strictures)

Front 38

Deviated ureters:

Back 38

lateral – bulky RP adenopathy, primary RP tumors, RP fluid collection, aneurysm, malrotated kidney, ovarian or uterine mass; medial – posterior bladder diverticulum (#1 cause of distal medial deviation), fibroids, RP fibrosis, postoperative, enlarged prostate, retrocaval ureter (only on R side)

Front 39

Bladder wall thickening:

Back 39

criteria - >5mm, trabeculations; tumor – TCC, lymphoma; inflammation – radiation, cytoxan, infection, IBD, appendicitis, diverticulitis; BOO – BPH, PUV, ectopic ureterocele, urethral stricture; neurogenic

Front 40

Bladder filling defect:

Back 40

tumor – TCC, SCC, mets, leiomyoma, endometriosis, polyps; infection – PID, Schistosomiasis, fungus ball, leukoplakia, malacoplakia, cystitis cystica, cystitis glandularis; luminal – calculi, blood clot, BPH, foreign body, ureterocele, pseudoureterocele; adjacent inflammatory process e.g. appendicitis or divertiticulitis; rare – amyloid

Front 41

Bladder neoplasm:

Back 41

TCC, SCC, adenocarcinoma, leiomyoma, pheochromocytoma, mets (melanoma, prostate), lymphoma, urachal adenoCA (dome); risk factors: TCC – smoking, cytoxan, radiation, interstitial nephritis, aniline dyes, phenacetin; SCC – Schistosomiasis, calculi, chronic infection, leukoplakia; adenoCA – bladder exstrophy, urachal remnant, cystitis glandularis

Front 42

Bladder wall calcification:

Back 42

SCRITT – Schistosomiasis, cytoxan, radiation, interstitial cystitis, TB, TCC

Front 43

Air in bladder:

Back 43

instrumentation, catheter, bladder fistula (diverticulitis, Crohn’s, colon CA), emphysematous cystitis (DM)

Front 44

Teardrop bladder:

Back 44

normal variant, iliopsoas hypertrophy, hematoma, abscess, lymphoma, pelvic lipomatosis, RP fibrosis, IVC obstruction

Front 45

Bladder fistulas:

Back 45

diverticulitis, Crohn’s, CA, surgery, radiation

Front 46

Bladder diverticula

Back 46

congenital (Hutch, urachal), acquired (BOO)

Front 47

Bladder rupture:

Back 47

trauma, radiation, tumor, cystitis, neurogenic bladder

Front 48

“Female prostate”:

Back 48

central filling defect at base of bladder; urethral diverticulum, urethral tumor, periurethritis, pubic bone lesion

Front 49

Urethral stricture:

Back 49

GC, trauma, iatrogenic

Front 50

Adrenal calcifications:

Back 50

tumor – neuroblastoma, pheochromocytoma, carcinoma, myelolipoma, hemangioma; infection – TB, histo, meningococcemia; trauma – hemorrhage; congenital – Wolman’s, Addison’s; cyst

Front 51

Adrenal pseudotumors:

Back 51

gastric fundus, varices, tortuous splenic artery, pancreatic tail, medial splenic lobulation

Front 52

Large retroperitoneal mass:

Back 52

hematoma, abscess, adenopathy from lymphoma or mets, liposarcoma, leiomyosarcoma, MFH, neurogenic tumor, germ cell tumor

Front 53

Retroperitoneal hematoma:

Back 53

anticoagulation, trauma, iatrogenic, ruptured AAA, RCC, AML

Front 54

Retroperitoneal air:

Back 54

trauma (perforation), ERCP, emphysematous pyelonephritis

Front 55

Retroperitoneal abscess:

Back 55

pancreatitis, renal inflammatory disease, osteomyelitis

Front 56

Retroperitoneal fibrosis:

Back 56

idiopathic, methysergide, radiation, surgery, lymphoma, mets, retroperitoneal fluid, inflammation from other organs