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43 Cards in this Set
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ADPKD
Associated with: Intracranial aneurysms (15%) Hepatic (75%), pancreatic (10%), splenic, epididymis, seminal vesicle cysts Same risk of RCC as general population Presents 3rd to 4th decades Progress to renal failure, requires dialysis |
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TS with AML/LAM
Associated with: AML in 80% of TS patients (bilateral, multifocal) Renal cysts CNS: giant cell astrocytoma, subependymal/cortical tubers LAM (a/w chylous effusion), cardiac rhabdomyoma Adenoma sebaceum, shagreen patches Risk of hemorrhage (> 4cm), treat with arterial embolization Triad: Adenoma sebaceum, mental retardation, seizures |
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XGP
Types: diffuse and focal DDX: RCC Secondary to chronic UTI (Proteus, E. coli) Features: Renal enlargement Dilated calyces, thin cortex Staghorn calculi (renal pelvis) US: loss of corticomedullary differentiation Stones: composed of magnesium ammonium phosphate (struvite) sequelae of UTI Proteus mirabilis: MC organism associated with urolithiasis |
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Papillary necrosis
Result from ischemia of the medulla, results in papillary necrosis DDX (POSTCARD): Pyelonephritis, obstruction, SCD, TB, cirrhosis/pancreatitis, analgesics (phenacetin), RVT, DM Unilateral process: POTR Features: Sloughing of papilla Lobster claw deformity Signet ring sign Forniceal abnormalities (arrows) Sloughed papilla (arrow) DDX extracalyceal contrast Papillary necrosis Medullary sponge kidney Renal tuberculosis, Calyceal diverticulum Post-obstructive atrophy Congenital megacalyx |
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Adrenal adenoma
Intracellular lipid not present in metastasis, pheochromocytoma, carcinoma CT: < 10 HU virtually diagnostic Enhance vigorously, rapid washout (slower washout in metastasis) Adrenal adenoma: washout > 50% contrast on 15-minute delayed MR: loss of signal on opposed-phase imaging |
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Retroperitoneal fibrosis
Etiology: Idiopathic (Ormond’s) Secondary RPF: medication (methysergide), radiation, hematoma Features: Encases aorta and IVC, level L4-5 Ureteral obstruction, medial deviation of ureters DDX: Lymphoma: ST proliferation behind the aorta (elevates aorta) |
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Oxalosis
Case findings: Coarse medullary nephrocalcinosis (MC finding) Hereditary hyperoxaluria: Rare AR, diffuse oxalate deposit in the kidneys, heart, blood vessels, lungs, spleen, and bone marrow Cortical nephrocalcinosis Secondary hyperoxaluria: Associated with disturbances of bile acid metabolism Medullary nephrocalcinosis Skeletal deossification Primary hyperparathyroidism Paraneoplastic syndromes associated with lung and renal carcinomas (ectopic parathyroid hormone production) Metastatic carcinoma to bone Multiple myeloma Cushing’s syndrome/steroid therapy Increased absorption of calcium from GI tract Sarcoidosis Hypervitaminosis D Milk alkali syndrome Hereditary causes RTA type 1 (distal convoluted tubules) Hyperoxaluria (95% of cases) Medullary sponge kidney (renal tubular ectasia) Cortical nephrocalcinosis Chronic membranous glomerulonephritis Acute cortical necrosis Congenital oxalosis (5% of cases) Alport’s syndrome: deafness and hereditary nephritis Rejected renal transplants |
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Unilateral delayed/persistent nephrogram
DDX: Renal artery stenosis Renal vein thrombosis Urinary obstruction Hypotension |
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Schistosomiasis
Case findings: Diffuse bladder wall thickening with some irregularity Curvilinear calcification of the bladder wall MC in Africa and Middle East Schistosoma haematobium: trematode (fluke) family Increased risk of squamous cell carcinoma of the bladder Classic: calcification of bladder and ureters with possible strictures and obstruction DDX bladder wall thickening and calcification: TB: involvement of the kidneys prior to the ureters and bladder making differentiation possible Other chronic infection, including parasites Post-radiation cystitis Post-cyclophosphamide cystitis Transitional cell and squamous cell carcinoma (rare) |
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Renal lymphangiectasia
Case findings: US: Anechoic multiloculated collections containing thin septae surrounding both kidneys Echogenicity of the renal parenchyma is normal without evidence of focal renal mass, shadowing renal calculus, or hydronephrosis CT: Bilateral perirenal fluid collections with attenuation measurements consistent with fluid Kidneys are well perfused and there is no delay in function DDX: Urinoma Seroma Perinephric abscess Other names: renal lymphangiomatosis, renal lymphangioma, peripelvic lymphangiectasia, and renal peripelvic multicystic lymphangiectasia Rare disorder of the lymphatic system that occurs in all ages Characterized by ectatic perirenal, peripelvic, and intrarenal lymphatic vessels MC bilateral Associated with: renal venous thrombosis, hypertension Diagnosis: aspiration of chylous fluid |
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Cervical stenosis
Case findings: Uterus is enlarged and endometrial cavity is distended with low density fluid Fallopian tubes are distended with fluid of the same density Hematometra: accumulation of blood in the uterus Hematosalpinx: accumulation of the blood in the fallopian tubes Hematocolpos: accumulation of blood in the vaginal vault |
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Renal cell carcinoma
Case findings: IVP: no function of right kidney with a partially visible right renal mass CT: large, partially necrotic, enhancing mass in the right kidney DDX low-density or necrotic renal mass: RCC, non-Hodgkin’s lymphoma Abscess Angiomyolipoma Oncocytoma Metastatic disease Renal Adenoma Complex renal cyst, renal infarct Sarcoma, TCC Renal cell carcinoma (Robson staging system) Stage I: confined within capsule of kidney Stage II: invading perinephric fat but still contained within Gerota’s fascia Stage III: III-a: invading the renal vein or IVC III-b: regional lymph-node involvement III-c: both nodes and IVC/renal vein Stage IV: invading adjacent viscera (excluding ipsilateral adrenal) or distant metastases |
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Undescended testicle
In RLQ, there is a soft tissue density Only a left testicle is seen in the scrotum 80% of all undescended testes naturally descend to the scrotum during the first year of life DDX: Neoplasm Lymphadenopathy Focal, dense fluid collection (hematoma) Congenital abnormality |
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Medullary nephrocalcinosis
CT: faint calcifications within the renal medulla MC etiology: Hyperparathyroidism Medullary sponge kidney (renal tubular ectasia) RTA type I (distal convoluted tubules) LC etiology: Hypervitaminosis D Milk-alkali syndrome Nephrotoxic drug use (e.g., amphotericin B) Any hypercalcemic or hypercalciuric state (including sarcoidosis) Chronic pyelonephritis |
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Renal lymphoma
NHL >> HD Patterns of involvement: MC direct extension from RP disease Hematogenous extension (common) Primary renal lymphoma (rare) Features: Multiple hypoechoic, hypodense masses Diffuse involvement Adenopathy |
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Oncocytoma
Rare type of adenoma Arise from oncocytes (epithelial cells) of proximal tubule Classic: (DDX of central scar: adenocarcinoma) Central stellate scar composed of fibrous tissue Angiography: spokewheel appearance, homogeneous blush Well-defined sharp borders Treatment: renal-sparing surgical resection |
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Renal tuberculosis
Case findings: Small densely rim calcified left kidney due to longstanding tuberculosis Putty kidney: small calcified end stage kidney resulting from autonephrectomy due to renal TB Papillary necrosis Calyceal dilatation, amputated calyx Parenchymal scarring Infundibular stenosis Classic: corkscrew ureter, with multiple infundibular and ureteral stenosis Classic: Multifocal caliectasis due to irregular infundibular strictures Papillary necrosis Retrograde pyelogram showing complex stricturing of the right upper pole infundibulum, with associated caliectasis Corkscrew ureter Putty kidney |
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Pelvic lipomatosis
Case findings: IVP: inverted teardrop bladder caused by extrinsic compression Ureters are dilated, tortuous, and displaced laterally DDX tear-drop bladder: Hypertrophy of the iliopsoas muscles Retroperitoneal fibrosis Large pelvic abscess Large hematoma, usually due to trauma or anticoagulation therapy Collateral venous circulation from IVC obstruction Large iliac artery aneurysms Adenopathy from lymphoma, and prostatic carcinoma |
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Pyelosinus backflow
Due to forniceal rupture Backflow is categorized as depending on the pathway taken by the contrast exiting the calyx: Pyelotubular, pyelointerstitial: Contrast passing through the collecting ducts and interstitium Result in a wedge-shaped striated area or blush extending from a calyx to as far as the renal outline Pyelosinus Pyelolymphatic: Contrast entering the lymphatic channels Opacification of multiple fine vesicles channels in the hilum of the kidney directed towards the para-aortic lymph nodes Pyelovenous: Contrast entering the renal veins (rarely recognized radiographically) |
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Medullary sponge kidney
Case findings: Bilateral nephrocalcinosis Features: Tubular ectasia with linear collections of contrast identified within medullary pyramids With time, these will progressively dilate and form cystic cavities Cavities result in urinary stasis, leading to stone formation May be sporadic or associated with: Caroli’s disease Hemihypertrophy Ehlers Danlos syndrome DDX of benign tubular ectasia: Common finding Linear paint brush striations arising from the medullary pyramids which fill with contrast on IVU Unlike medullary sponge kidney, NO evidence of cystic dilatation within the tubules or formation of calcification |
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Calyceal diverticulum
Outpouching of the collecting system into the corticomedullary region MC asymptomatic but may develop calculi or milk of calcium |
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Retrocaval ureter
Normally, right ureter remains lateral to the IVC Classic: J-shaped ureter Ureter passes behind the IVC and exits between the aorta and IVC Medial looping at L2-3 May cause ureteral narrowing and obstruction |
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Pyeloureteritis cystica
Multiple small subepithelial cysts in the renal pelvis and ureter Seen in setting of chronic obstruction or infection NOT premalignant Classic: Multiple small, well defined, lucent, filling defects seen in the renal pelvis and ureter Lesions seen in profile cause scalloping of ureteric margin Predilection for upper 1/3 of ureter May be bilateral |
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Ureteric pseudodiverticulum
MC associated with chronic infectious or inflammatory states MC seen in older patients 50% develop uroepithelial malignancy, and therefore need close surveillance |
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Urethral stricture
Etiology: MC used to be gonococcal Periurethritis: indwelling urethral catheters Urethritis Inflammatory strictures in bulbar urethra, which is the most dependent part and contains the greatest number of paraurethral glands Strictures caused by instrumentation occur in naturally narrowed segments of the urethra Straddle injuries MC in bulbar urethra Direct blows injure the pendulous urethra Retrograde urethrogram showing a tight focal stricture (arrow) in the upper urethra Reflux of contrast into Cowper's duct and gland |
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Adrenocortical carcinoma
Case findings: Large left adrenal cortical carcinoma with tumor extension into IVC (arrow) MC > 5 cm at presentation Large heterogenous suprarenal mass with areas of hemorrhage, necrosis, and calcification Well circumscribed, despite its large size, and a well defined capsule-like rim May contain areas of lipid detected on opposed-phase chemical shift imaging Classic: IVC extension Coronal T2: large right adrenal cortical carcinoma with extension of tumor into IVC (arrow) |
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Gartner's duct cyst
Case findings: Well circumscribed non-enhancing thin-walled cyst anterolateral to the vagina (paravaginal location) Retention cyst arising from Gartner’s ducts, occurring along the Wolffian duct remnant Paravaginal and anterolateral in position DDX: Squamous inclusion cyst of the vagina Ureteric diverticulum Bartholin’s gland: located more distally and superficially adjacent to the vulva |
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Nabothian cyst
Case findings: Multiple clustered small Nabothian cysts Inclusion cyst formed in the uterine cervix when the opening of a Nabothian duct located within the cervix is covered by epithelial cells and the fluid is then retained |
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Prostatic utricle cyst
Midline lesion posterior and superior to the verumontanum Abnormality in the regression of mullerian duct Can also be acquired due to posterior urethritis and verumontanitis DDX mullerian duct cyst: larger and extend above the base of the prostate |
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Ovarian neoplasm
Diagnosis: Ovarian serous cystadenocarcinoma Epithelial: Serous cystadenoma/cystadenocarcinoma Mucinous cystadenoma/cystadenocarcinoma Clear cell carcinoma Brenner tumor Stromal: Granulosa cell tumor (estrogen) Call-Exner bodies Sertoli-Leydig (androgen) Thecoma, fibroma (low T2) Meig’s syndrome: ovarian fibroma, ascites, pleural effusion Germ cell tumor: Dysgerminoma (similar to seminoma): radiosensitive Yolk sac tumor (endodermal sinus tumor): elevated AFP Embryonal cell carcinoma Choriocarcinoma Teratoma (dermoid cyst) Metastasis: Lymphoma Primary uterine tumor Stomach, colon, breast Kruckenberg tumor: ovarian metastasis from stomach or colon primary Ovarian serous cystadenoma Axial T2: bilateral cystic adnexal masses with minimal internal complexity |
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Subcapsular renal hematoma
Case findings: Right kidney is compressed with a delayed nephrogram relative to the left kidney Page kidney: chronic long-standing compression of underlying renal parenchyma by subcapsular haematoma can result in hypertension, due to local ischemic change causing excess secretion of renin |
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Urethral diverticulum
Males: congenital urethral diverticula Females: urethral diverticula are acquired |
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Epidermoid cyst of the testis (keratocyst)
Case findings: Solid mass in the right testis with calcification and acoustic shadowing Comprise layers of keratin, within a fibrous capsule lined with simple squamous epithelium US: Solid mass with echogenic rim and peripheral acoustic shadowing Onion-ring (lamellated) pattern of the periphery with a target appearance Treatment: enucleation thereby avoiding an orchiectomy DDX: Calcified haematoma Intratesticular cyst (anechoic centre and through transmission) Teratoma |
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Tubular ectasia of the testis (cystic transformation of rete testis)
Case findings: US: well-defined tubular structures in the region of the mediastinum testis Anastomotic ducts are located in the mediastinum testis, in which numerous seminiferous tubules drain and connect with the head of the epididymis Secondary to obstruction of seminiferous tubules following infection or trauma Associated with: ipsilateral epididymal cyst DDX: Intratesticular varicocele: rare, increases in size on the Valsalva maneuver and shows blood flow Cystic dysplasia of the testis: rare, associated with congenital abnormalities Cystic malignant testicular tumor: can occur anywhere in the testis Teratoma: may present as a cystic tumor, although this is very rare |
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Seminal vesicle cyst
Case findings: Slight peripheral enhancement of the cyst wall No internal septations Aberrations of distal Wolffian ducts lead to atresia or stenosis of the ejaculatory ducts, resulting in obstruction and congenital seminal vesicle cyst formation DDX testicular cyst: Bladder or ureteral diverticulum Seminal vesicle abscess Müllerian duct cyst Cystadenoma of the seminal vesicle or of the prostate Dermoid cyst Teratoma Echinococcus cyst (rare) |
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Axial fat-suppressed T1-weighted
Coronal T2-weighted post-Gd Coronal fat-suppressed T1WI post-Gd |
Ovarian fibroma
Case findings: Large multilobulated solid ovarian mass Heterogenous enhancement Low T2 signal Fibroma associated with Meig’s syndrome (ovarian fibroma, ascites, pleural effusion) DDX low T2 ovarian lesion (fibrous components): Fibroma Fibrothecoma Cystadenofibroma Brenner’s tumor |
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Sagittal T2WI
Coronal T1WI |
Pseudomyxoma peritonei
Case findings: US: complex cystic lesion which is septated with solid areas CT: Scalloping of the liver due to the gelatinous nature of the fluid Fluid in the peritoneal cavity with areas of calcification (arrows) MR T2WI: Gelatinous fluid in the pelvis and surrounding the viscera Also seen invading the anterior abdominal wall and extending into the perianal region Mucinous implants of the peritoneum Gelatinous ascites secondary to a benign or malignant tumor of the appendix, ovary or other organs (pancreas, colon, etc.) Enhancement helps to differentiate from ascites Walls may show calcification |
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Multilocular cystic nephroma (MLCN)
Case findings: Well-marginated, rounded, or polycyclic cortical mass that extends beyond the normal renal outline Multilocular cystic renal tumor: term that encompasses two histologically distinct entities Multilocular cystic nephroma (MLCN) 1/3 of MLCN theoretical risk of cystic RCC, MC adult women Cystic partially differentiated nephroblastoma (CPDN) CPDN: 2/3 of MLCN, MC young children, theoretical risk of Wilms’ tumor Imaging cannot distinguish between MLCN and CPDN Clinical presentation: Painless abdominal mass with rapid enlargement Features: Well-marginated cysts with multiple septa (only septa enhance) Congenital lesion with large (> 10 cm) cystic lesions Compared with the poorly defined necrotic cystic appearances of a degenerative Wilms' tumor Multilocular cystic renal tumor features: Round, well-encapsulated multilocular cystic mass Central location Invasion into renal sinus Prolapse into collecting system (pathognomonic finding) Contain multiple non-communicating cysts with thin septa separating the cysts DDX: Cystic Wilms' tumor Wilms' tumor coexisting with CPDN Current thinking suggests that cystic nephroma, CPDN and Wilms’ tumor represent a spectrum of disease MLCN: benign end of the spectrum Wilms' tumor: malignant end of the spectrum CPDN: intermediate stage where blastemal elements are present within internal septa Multilocular cystic nephroma |
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Subepithelial hemorrhage
Case findings: Findings are masked on CECT CECT: mild calyceal dilatation and constriction of lumen of renal pelvis NCCT: high-attenuation thickening of pelviureteric wall caused by hemorrhage Bleeding may be parenchymal, subcapsular, perinephric, subepithelial (rare) Subepithelial renal sinus hemorrhage is NC seen in coagulopathic patients DDX on IVP: focal pelviureteral wall irregularity may be indistinguishable from Subepithelial hemorrhage Transitional cell carcinoma Pyeloureteritis cystica Submucosal edema |
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Perinephric hemorrhage
Case findings: Left perinephric (PN) and anterior pararenal (AP) hematomas Focal defect in the left renal cortex (arrow) represents renal parenchymal scarring Selective right renal angiography showed small aneurysms (not shown) Diagnosis: perinephric hemorrhage due to polyarteritis nodosa DDX on CECT: Lymphoma Perinephric hemorrhage Causes of subcapsular perinephric hemorrhage: Trauma: Renal laceration Avulsion of the renal artery Neoplasm Malignant (renal cell carcinoma) Benign (angiomyolipoma) Vasculitis: polyarteritis nodosa AVM Aneurysm Anticoagulant therapy Acute infection Acute or chronic nephritis Angiomyolipoma Intratumoral hematoma (H) with perinephric hematoma (arrow) Renal cell carcinoma Hypoattenuating mass (M) in the lower pole, which is displaced anteriorly by a perinephric hematoma with a fluid-fluid level (arrow) |
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Renal infarct
Case findings: Global infarct of the right kidney with rim of enhancement in capsule (cortical rim sign) Thromboembolism Aneurysm of aorta or renal artery Atherosclerosis Subacute bacterial endocarditis (septic emboli) Dissection of the aorta or renal artery Vasculitis: polyarteritis nodosa, SLE, drug-induced Trauma Avulsion of the renal artery Occlusion of the renal artery Penetrating vascular injury Hypercoagulable state Acute venous occlusion Renal vein thrombosis Hypercoagulable states Nephrotic syndrome SLE Dehydration Trauma Neoplasm: RCC, TCC, Wilms’ tumor Aneurysm Left ovarian vein thrombosis |
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Acute cortical necrosis
Case findings: Lack of enhancement of the renal cortex. Narrow subcapsular rim of enhancement (arrows) Rim of subcapsular cortical enhancement from collateral flow of capsular vessels Results from ischemic necrosis of the renal cortex with sparing of the renal medulla Ischemia due to vasospasm of small vessels, toxic damage to glomerular capillary endothelium, and primary intravascular thrombosis Associated with: Complications of pregnancy Sepsis, shock, severe dehydration Hemolytic uremic syndrome Cortical necrosis can result from any condition that produces acute, prolonged shock |
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Endometrioma
Case findings: T1: mass in the right ovary with high SI T2: low SI (“shading”, arrow) US: cystic mass with diffuse low-level echoes DDX high T1 adnexal lesion: Hemorrhagic cyst Endometrioma Dermoid (ask for fat-saturation sequence) MC ovarian (80%) US: Cystic mass with diffuse, low-level echoes (this case) Cystic to complex May have a solid appearance MRI: High T1, T2 shading Multiplicity Mature cystic teratoma (dermoid) High T1 adnexal mass Fat-saturation of the lipid omponent of the mass (arrow) |
