Katz 10-16-07 Renal Imaging

Front 1

Renal Imaging Exams

Back 1

Intravenous pyelogram (IVP) (IVU)
Retrograde pyelogram
Renal ultrasound
CT
MRI
Nuclear Imaging
Angiography

Front 2

IVP contrast media

Back 2

Iodinated

Front 3

reasons to be leary of injecting IV contrast media for IVP

Back 3

Allergies to Iodine or iodinated contrast media
Elevated BUN / creatinine
Diabetics (hydrate the pt)

Front 4

Procedure of IVP

Back 4

1- Scout (Flat) (KUB) abdomen
2- Inject contrast media IV
3- 30 sec to 1 minute kidney film
4- 10 minute abdomen AP
5- ? Delayed abdomen films (?PA)

Front 5

look for what in scout film

Back 5

Calcifications
Masses

Front 6

look for what in early film (IVP)

Back 6

sharp renal cayces
renal fat (normal)
fetal lobulation (normal)
proximal ureters

Front 7

why do you not see the entire ureter on any one film?

Back 7

peristaltic action ureter

Front 8

If you see the entire ureter in one film, where is the obstruction?

Back 8

low

way, way down

Front 9

If calyces are not sharp, ...?

Back 9

pyelonehritis, hydronephrosis

Front 10

what may overlie the kidney?

Back 10

gas, fecal material

Front 11

We're usually looking for renal calculi. What may confuse us?

Back 11

phleboliths = calcified veins

Front 12

if there is lucency in the center of a calcification, what might the image be?

Back 12

phlebolith

Front 13

If the calcification is outside the confines of the bladder, a calcification is usually called a ____

Back 13

phlebolith

Front 14

Are duplicated collecting systems cause for alarm?

Back 14

no

Front 15

The examination of choice for renal and ureteral calculi

Back 15

CT ABDOMEN without contrast media

Front 16

On CT, if the aorta lights up, you know what?

Back 16

contrast media

Front 17

Looking for anything but _______ , use contrast media on CT

Back 17

renal caliculi

Front 18

What circumstance allows you to see entire ureter on CT?

Back 18

constant drip of IV contrast media

Front 19

Substance that screws up U/S

Back 19

air

Front 20

U/S is Good for differentiating cysts from ____-

Back 20

tumors

Front 21

big thing to remember about Doppler renal ultrasound

Back 21

there is a normal low resistance wave form in the artery

Front 22

What's a retrograde pyelogram?

Back 22

catheterize pt, use cystoscope, inject contrast media "backwards", careful not to inject to much, getting media into circulation

Better delineation of collecting system
Can do brushings, stone removal, etc.

Front 23

Contrast for MR of kidney?

Back 23

not necessary

Gadolinium, if no allergies

Front 24

T2. How do you know

Back 24

white spinal fluid, fluid in general is bright white

Front 25

Nephrogenic Systemic Fibrosis, Kidney Disease, and Gadolinium: Is There a Link?

Back 25

yes,

Front 26

A newly discovered disease that has been associated with the use of gadolinium-based MRI contrast agents in patients with severe renal disease, most commonly those on dialysis

Back 26

Nephrogenic Systemic Fibrosis

Front 27

It is advisable that no patient with an eGFR of <30 ml/min/m2 (Stage ___? kidney disease) should receive Gd contrast agents unless the benefits are deemed to outweigh the risks

Back 27

4 or 5

Front 28

Nuclear Imaging isotope of choice

Back 28

Tc-99m DTPA
Tc-99m MAG3
Tc-99m DMSA - kidney only

"I don't expect you to know all these"

Front 29

Nuclear Imaging is good for assessing what?

Back 29

Renal vascular disease
Renal obstruction
Renal function

Front 30

What's angiography good for?

Back 30

Vascular disease
Access for therapy
Balloon angioplasty
Stents
Embolization

Front 31

the renal arteries are at the level of what vertebra?

Back 31

L2

Front 32

The ureters exit medially from the kidney at the renal hilum posterior to the renal vessels , then course inferomedially along the psoas major muscle and ________ of the lumbar vertebrae.

Back 32

transverse processes

Front 33

If you fracture a transverse process of a lumbar vert, what should you check?

Back 33

ureters

Front 34

4 Congenital Abnormalities of kidneys

Back 34

Agenesis
Pelvic Kidney
Horseshoe kidney
Ureterocele

Front 35

tip off that you're viewing a horseshoe kidney

Back 35

kidney is angled opposite from normal

Front 36

Ureteral Obstructions (5)

Back 36

Calculi
Ureteral tumors
Ureteral fibrosis
Congenital hydronephrosis
External masses

Front 37

Urinary Calculi are Usually secondary to calcium oxalate or ____ crystals

Back 37

or calcium phosphate crystals

Front 38

CT has replaced IVU as the imaging modality of choice for detection of urinary stones. Sensitivity and specificity of CT are above __%.

Back 38

95

Front 39

Nearly all stones are radiopaque on CT while only about 50% are radiopaque on _____

Back 39

plain film

Front 40

Common locations include of urinary caliculi

Back 40

uretero-pelvic junction,
ureterovesical junction,
and the point where ureter crosses iliac vessels.

Front 41

Phleboliths (calcified pelvic veins) can be distinguished from stones by showing a central lucency or a ____ on CT

Back 41

tail sign

Front 42

Urinary stones are the most common cause of acute ureteral obstruction, occurring in up to ___% of the population.

Back 42

12

Front 43

Clinical presentation of urinary stones includes

Back 43

colicky flank pain with intermittent hematuria

Front 44

Staghorn Calculi?

Back 44

cast of the collecting system of the kidney

Front 45

Lithotripsy

Back 45

ESWL (Extra corporeal shock wave lithotripsy) is a breakiing of the stones inside the pts body by shockk waves

Non invasive

lithotripter

underwater

Front 46

UPJ Obstruction Caused by an overabundance of ______ in the ureter, leading to thickening and stricture formation, resulting in obstruction of the urinary tract.

Back 46

collagen tissue

Front 47

UPJ Obstruction :
The abnormality may be seen at prenatal ultrasound as a dilated renal pelvis or _____.

Back 47

hydronephrosis

Front 48

UPJ Obstruction :
Postnatal diagnosis is made by urography, sonography, CT, MRI, and scintigraphy, all of which show _____

Back 48

hydronephrosis

Front 49

UPJ obstruction:
Retrograde pyelography and IV urography show focal narrowing at the ______ junction

Back 49

ureteropelvic

Front 50

A congenital saccular dilatation of the terminal portion of the ureter

Back 50

Ureterocele

Front 51

Ureterocele:
It may be _____, inserting in the normal location or it may be ectopic.

Back 51

orthotopic

Front 52

Ectopic ureterocele enter the bladder in an abnormal location, such as the bladder neck or urethra. They typically arise from the upper?/lower? pole of a duplicated collecting system and are more common in the pediatric population

Back 52

upper

Front 53

Radiographically, ureteroceles have a classic appearance known as the "_____ deformity" and resembles a ____ bulging into the bladder. It is often best detected on excretory urography.

Back 53

cobra head

snake's head

Front 54

_____ are the most common renal mass. Cysts are ubiquitous with 50% of the population older than 50 having a simple renal cyst.

Back 54

Renal cysts

Front 55

Differentiating malignant from benign lesions radiographically is of utmost importance because the radiographic impression of a renal mass dictates ____

Back 55

therapy

Front 56

A solid mass is malignant?/benign? until proven otherwise

Back 56

malignant

Front 57

_____ is a worrisome characteristic of a kidney mass.

Back 57

Calcification

Front 58

only 20% of masses with peripheral calcifications are renal cell carcinoma whereas 87% with central and irregular calcifications are renal cell _____

Back 58

carcinoma

Front 59

The presence of fat is almost pathognomic for a benign lesion known as ______

Back 59

angiomyolipoma

Front 60

_____ in masses following contrast administration is very worrisome and is the most predictive finding for renal cell cancer and is, in general, an indication for surgery.

Back 60

Enhancement

Front 61

Renal cysts:
Present in over 50% of the population older than 50 years, thought to be caused by ______

Back 61

obstructed tubules or ducts

Front 62

RENAL CYSTS
Ultrasound
shows a sharp interface between cyst and adjacent renal parenchyma.
the lesion is round or oval, anechoic (black or without echoes),
has an imperceptibly thin wall and
demonstrates increased?/decreased? sound through transmission.

Back 62

increased

Front 63

RENAL CYSTS
On CT
lesions show a sharp interface with adjacent renal parenchyma,
are water density (<20HU) and
show no contrast enhancement of wall or cyst contents after ________

Back 63

IV contrast administration.

Front 64

The most frequent genetic cause of renal failure in adults, accounting for 10% of patients on dialysis in the United States.

Back 64

Polycystic Kidney Disease:

Front 65

Renal Cell Carcinoma types

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Renal adenocarcinoma, hypernephroma, clear cell carcinoma, and malignant nephroma

Front 66

presenting features of renal cell carcinoma

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Patients present with hematuria (50%), flank pain (40%), palpable mass (35%), weight loss (25%), and paraneoplastic syndrome.

Front 67

The classic triad of
renal cell carcinoma

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hematuria,
flank pain, and a
palpable abdominal mass occurs in ~10% and indicates advanced disease.

Front 68

____ percent of patients present with metastatic disease with predilection for
lung,
soft tissue,
bone, and
liver.

Back 68

Thirty

Front 69

Risk factors for renal cell carcinoma

Back 69

include smoking, obesity, male (2:1), phenacetin and other analgesics, von Hippel-Lindau disease, chronic dialysis, family history.

Front 70

CT of renal cell carcinoma show what?

Back 70

: Enhancing mass (does not enhance as intensely as normal renal parenchyma) with distortion of parenchyma, collecting system and contour abnormalities,
calcifications in 10%,
presence of filling defects in collecting system, renal veins and IVC. Look for adenopathy.

Front 71

MRI of renal cell carcinoma shows what?

Back 71

Signal characteristic variable depending on degree of hemorrhage and necrosis, calcifications not apparent with MRI, best for detecting venous invasion; good problem solving modality when CT is equivocal.

Front 72

US of renal cell carcinoma shows what?

Back 72

small tumors are generally hypoechoic, large tumors hyperechoic

Front 73

Angiography of renal cell carcinoma shows what?

Back 73

95% are hypervascular with caliber irregularities of tumor vessels, prominent AV shunting, and venous lakes (tumor neovascularity).

Front 74

Renal Abscess is Usually a complication of untreated pyelonephritis, caused by ascending infection from gram negatives organisms (especially___).

Back 74

E. Coli

Front 75

Renal Abscess stuff:

Back 75

Predisposing factors include stone disease, diabetes, or AIDS.
Complications include retroperitoneal spread and renocolic fistula.
CT findings include a well-defined focal renal mass with central necrosis (central portions showing no IV contrast enhancement), a thickened, hyperemic (enhancing) abscess wall, and perinephritic inflammation with thickening of Gerota’s fascia and stranding of perirenal fat.