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55 Cards in this Set
- Front
- Back
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Renal trauma grading
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AAST
Spectrum: Contusion Hematoma Laceration Vascular injury Ureteropelvic injury Grade I - minor parenchymal injury - small subcapsular hematoma Grade II - laceration < 1 cm not extending to collecting system - stable perirenal hematoma Grade III - cortical laceration < 1 cm without involvement of collecting system Grade IV - lacs involving cortex, medulla and collecting system - contained vascular injury PSA or AVF Grade V - shattered - avulsion and/or vascular pedicle injury Grade I-II conservative Grade V surgical Grade III-IV conservative or IR if unresponsive |
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Pelvic kidney a/w?
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Stones
Reflux Obstruction |
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Unilateral papillary necrosis
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Pyelonephritis
Ureteral obstruction RV thrombosis TB |
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Papillary necrosis
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More common:
DM Pyelonephritis (TB) Analgesic abuse Obstruction Sickle cell POSTCARD Pyelonephritis Obstruction Sickle cell anemia TB Cirrhosis/pancreatitis Analgesic abuse Renal vein thrombosis DM "Ball on a tee" for complete papillary necrosis "signet ring" appearance if papilla remains in calyx "Lobster claw" for edge papillary necrosis |
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Calcified renal mass
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60% are RCC
20-30% of RCC calcify 1-2% of renal cysts calcify Rim calcification is more typical of complicated cyst |
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RCC
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Robson grading system
Grade 1 - contained in renal parencyma Grade 2 - extends to perinephric fat - may involve ipsilateral adrenal Grade 3 a - ipsilateral RV/IVC b - regional LN c - regional nodes + RV/IVC Grade 4 a adjacent visceral involvement b distal mets synchronous BL in 1-2% of non-familial cases |
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TCC
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90% bladder
10% ureteropelvic If ureteral, 40% synchronous/metachronous lesions Risks: - smoking - benzene - analgesic abuse - Blakan nephropathy Presentation: Dull flank pain Hematuria Acute renal colic |
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Anechoic rounded structures in renal hilum
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Hydro
Reflux Peripelvic cysts |
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UPJ opbstruction
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Due to deficiency in smooth muscle at UPJ or crossing vessel
20% bilateral A/W - contralateral MCDK - contralateral agenesis - duplication - reflux Tx: endoscopic or open pyeloplasty |
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Uroepithelial neoplasms
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90% TCC
10 % SCC |
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Bladder mass
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TCC
Neoplasm Cystitis Fibrosis Adherent debris/clot |
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Bladder malignancies
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TCC
- 75% surface papillary - 25% invasive - 2% synchronous - 7% metachronous - Risks: smoking, male, benzene, artificial sweeteners, cyclophosphamide, - muscular layer invasion = at least T3a SCC - schistasomiasis AdenoCA - urachal remnant Lymphoma Sarcoma |
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Non midline bladder stone
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Stone in ureterocele
Stone in diverticulum Stone displaced by prostate Stone displaced by mass |
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Emphysematous cystitis
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A/W:
DM Outlet obstruction Tx: Glycemic control Abx Relief of obstruction |
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Bladder rupture
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Intraperitoneal
- emergent surgical repair - 33% Extraperitoneal - space of Retzius - bladder decompression and conservative management - 66% |
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Normal urethral glands
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Dorsal along penile urethra = Littre's glands
Within the urogenital diaphragm, with duct inserting in bulbous urethra = Cowper's glands |
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Urethral stricture
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Iatrogenic
Traumatic - majority involve membranous and bulbar urethra Gonococcal Non-Gonococcal infection Reiter's |
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Irregularity of the fallopian tube on hysterosalpingogram
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Salpingitis isthmica nodusum
- may be 2/2 prior infection - infertilty - ectopic pregnancy TB Tubal adenomyosis |
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Bilateral adrenal lesions
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Adenomas
Mets Hemorrhage Pheo TB/Sarcoid |
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Adrenal pseudolesions
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Splenic artery aneurysm
Renal cyst Panc lesion Splenule Gastric diverticulum Periadrenal venous collaterals |
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Retroperitoneal fibrosis
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Aortoiliac grafts
Infection Urinoma Hematoma Drugs - ergots A/w: Thyroiditis Orbital pseudotumor PSC |
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Hypoechoic prostatic focus
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40% cancer
60% cancer if + DRE DDx: Prostate carcinoma Focal prostatitis Atypical prostatic hyperplasia Prostatic cyst |
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Scrotal pearl
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Hydroxyapetite surrounded by fibrinoid matrix inbetween leaves of the tunica vaginalis
Extratesticular Due to inflammation or testicular appendage torsion |
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Testicular tumors a/w increased bHCG
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Seminoma
Choriocarcinoma Embryonal cell |
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Testicular tumors a/w increased AFP
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Embryonal cell
Yolk sac tumor Teratoma |
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Testicular microlithiasis
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>5 per field
May be a/w increased incidence of testicular neoplasm Some urologists perform annual US til age 40 |
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Medullary nephrocalcinosis
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Unilateral:
Medullary sponge kidney - benign tubular ectasia - may be associated with hemihypertrophy Bilateral: Hypercalcemia - Hyperparathyroidism - paraneoplastic - sarcoid - hypervitaminosis D Distal RTA Drugs - Lasix Hyperoxaluria Papillary necrosis |
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Solid renal enhancing mass
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RCC
Oncocytoma Met Lipid-poor AML - 5% |
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Bosniak classification
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I
- fluid density - imperceptable wall - no septations or nodules - no ca++ - no enhancement II - thin non enhancing septations - fine peripheral ca++ - non fluid density III - multiple thick septations - coarse ca++ - 25-45% risk of CA IV - enhancing nodular components - enhancement = 15 HU or more |
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Horseshoe kindey a/w?
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Stones
reflux UTI UPJ obstruction TCC Wilms |
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Faceless kidney
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Renal sinus fat replaced by soft tissue
TCC |
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Infiltrating renal processes
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TCC
SCC TB Lymphoma RCC Infarct |
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Ureterocele
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= Adult type ureterocele
- not a/w or GU abnormalities - my be due to partial obstruction at UVJ due to incomplete resorption of Chwalla's membrane - can cause stones, stasis, UTI, esp > 2 cm - lucent halo should be < 2 mm, otherwise suspect stone or tumor Pseudoureterocele - caused by partial obstruction at UVJ due to stone or neoplasm - lucent halo may be > 2mm, check for neoplasm - may be a/w hydronephrosis due to obstruction |
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Amputated calyx
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DDx:
TCC TB Tx: Urine cytology |
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"Goblet" sign in the ureter
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Inferior meniscus surrounding the inferior aspect of a radiolucent filling defect in the ureter, with distal dilitation of the ureter
Pathognomonic for papillary TCC (2/3rd of TCC) |
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Multiple radiolucent filling defects in the ureter
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Multifocal TCC
- mucosal lesions Radiolucent calculi Clots Fungus balls Debris Sloughed papilli Pyeloureteritis cystica - chronic irritation - no malignant potential |
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Mucosal ureteral filling defects
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TCC
Malakoplakia Leukoplakia Pyeloureteritis cystica - chronic irritation - no malignant potential |
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SCC of the bladder a/w?
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Schistosomiasis
Chronic indwelling foley Recurrent cystitis |
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AdenoCA of the bladder a/w?
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Urachal remnants
Bladder extrophy |
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"Pear shaped" "Tear drop" "Gourd shaped" bladder
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Pelvic hematoma
Pelvic lipomatosis IVC obstruction (with ureteral notching) Pelvic lymphadenopathy |
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Cystitis cystica
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Proliferative cystitis
Lobular filling defects in the bladder |
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Hemorrhagic cystitis
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May be due to:
- Radiation therapy - Drugs (cyclophosphamide, ifosfamide, PCN) - Viral infection - Amyloidosis |
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Mural bladder ca++
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Neoplasm
Schistosomiasis TB - usually descends from kidneys first - bladder volume decreased radiation cystitis alkaline-encrusted cystitis - proteus infection intravesicular chemotherapy - cyclophosphamide |
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Urethral diverticulum
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Female
P/W: dyspareunia urinary dribbling UTI Due to: Post-infectious or traumatic obstruction of ureteral gland causing diverticulum MC dorsolaterally in the middle third of urethra Tx: urethroscopy |
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Coarse renal medullary ca++
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Oxalosis
Hereditary hyperoxaluria (AR) - deposits in heart, lungs, spleen, vessels, kidneys Secondary hyperoxaluria - to bile acid metabolism |
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Cortical nephrocalcinosis
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Chronic GN
Acute cortical necrosis Alport's syndrome - deafness - hereditary nephritis Renal transplant rejection Congenital oxalosis |
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Unilateral delayed / persistant nephrogram
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Obstruction
RV thrombosis RAS Hypotension |
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Bilateral delayed / persistant nephrogram
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c
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BL circumferential perinephric low density masses
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Lymphoma
Renal lymphangectasia - abnormal perinephric lymphatics - a/w RVT, HTN TB Urinoma Seroma |
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Distended fluid filled uterus
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Cervical stenosis
- mass - endometriosis - senile atrophy - infection - iatrogenic (colposcopy, cryotherapy, radiation) - congenital (imperforate hymen) hemato / hydro / pyometria |
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Staging RCC
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Robson
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Transplant RAS
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> 200 cm/s at arterial anastamosis
> 3.5 ratio of RA velocity/Aortic velocity Tardus and parvus |
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Reversal of renal vein flow, transplant US
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RVT
Severe rejection Severe ATN Subcapsular hematoma |
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Striated nephrogram
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Pyelonephrosis
Hypotension Obstruction RVT Contusion Infarct |
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Radiolucent stones
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Uric acid
Xanthine Indinavir Matrix |
