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15 - Genitourinary Radiology

The document discusses various imaging techniques used in genitourinary radiology. It describes radiography, IVP, CT scans, and their uses in investigating conditions like renal stones, staghorn calculi, renal TB, horseshoe kidney, duplicated kidney systems, ureterocele, polycystic kidney disease, and adrenal lesions. Key imaging findings are outlined for many of these topics.

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Abhijith J Puttananickal
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32 views9 pages

15 - Genitourinary Radiology

The document discusses various imaging techniques used in genitourinary radiology. It describes radiography, IVP, CT scans, and their uses in investigating conditions like renal stones, staghorn calculi, renal TB, horseshoe kidney, duplicated kidney systems, ureterocele, polycystic kidney disease, and adrenal lesions. Key imaging findings are outlined for many of these topics.

Uploaded by

Abhijith J Puttananickal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Genitourinary Radiology

Common imaging investigation 00:21

1. Radiography
2. IVP
3. CT Scan

Radiography 00:30

S t a g h o r n C a l c ul u s

Renal Stones ?

Radio opaque (90%)

• Calcium oxalate • Uric acid


• Triple phosphate • Matrix
• CaPO4 • Xanthine
• Cystein (Sulphur) • Indinavir
• Trimtrene
• Missed on CT
Hardness of Stone: • Very radiolucent

Hardest ® Cystine

Brushite

Ca Oxalate Monohydrate

1
Investigation:

Diagnosis ® NCCT

Characterization ® Dual source CT

Staghorn calculi:

i. S/i alkaline urine


ii. Usually infected
iii. M.C organism: Proteus Mirabilis

Damage to kidney and replacement of kidney cells by lipid containing macrophages

XANTHOMA cells

XANTHOMA GRANULOMATOUS
PYELONEPHRITIS
Biopsy: Xanthoma cells look similar to clear cell variant of RCC

CT: “Bear Paw Sign”

Emphysematous Pyelonephritis:

• S/i diabetic patient


• Infection is via E.Coli
• Hallmark feature: Air in Kidney
• Surgical Emergency

CEMENTED KIDNEY/ PUTTY

• Plain X RAY KUB


• Complete kidney calcified

2
• s/i Renal TB

RENAL tb 03:09

• Most common symptom of Renal TB – Frequency


• Most common sign of Renal TB – Sterile Pyuria
• Most common radiological feature of Renal TB – Blurring of Papillary outline –
MOTH EATEN CALYX
• IOC for early diagnosis of renal TB – IVP
• IOC for advance renal TB - CECT

IVP

1. IVP – Conventional 2. IVP – CT (CT Urography)

3. 3D CT IVP

3
COMMON GENITOURINARY IMAGES 08:50

1. Horse Shoe Kidney


• Joining hand sign
• Flower vas apearance
Q. Which artery prevents the upward migration of the following entity?
Solution: Inferior Mesentric Artery

2. Crossed Ectopia

4
3. Duplicated System

4. Cobra/ Adder Head Appearance – URETEROCELE

Polycystic Kidney Disease

5
• Polycystic kidney disease – Multiple cyst
• Spider leg appearance – IVP of PCKD

NORMAL MCU

Key hole appearance – POSTERIOR URETHRAL VALVE

VESCICOURETERIC REFLEX

• Reflex of dye to B/L ureter

6
CHRISTMAS TREE BLADDER

s/i Neurogenic Bladder

Renal Stone

• Hydronephrosis
• Acoustic shadowing

USG of Kidney

InxOC for diagnosing Renal stone

NCCT

Left ureteric stone

7
”BEER PAW SIGN” ?

Ramification of Staghorn calculus

s/i XANTHOGRANULOMATOUS
PYELONEPHRITIS

• CT Scan with oral and IV contrast


• Mass in left kidney ® MC Renal
cell carcinoma
• Any enhancing lesion in kidney is
Renal cell carcinoma unless
proven otherwise

Left kidney Ab N

• Any fat containing lesion in the kidney is ANGIOMYOLIPOMA unless proven


otherwise

Adrenal gland 07:00

• Location: Between kidney and liver


• Most common site of metastasis from Ca lung
• Common site of incidentaloma
• Incidentaloma ® adenoma
• Metastasis?

ADENOMA

• Rich in microscopic fat


• HU Value: < 10 on NCCT
• Fat poor > 10 ® ? metastasis

8
CT SCAN ADRENAL PROTOCOL

• NCCT
• CECT Microscopic fat pickup
• 15 minutes delayed CT
• Any lesion in adrenal which shows rapid uptake of contrast and rapid washout is
Adenoma
• Any lesion which show rapid uptake, contrast stays longer time and washed out is
Metastasis
• MRI ® Chemical shift imaging picks up Microscopic fat

BEST METHOD TO DIFFERENTIATE BETWEEN ADENOMA AND METASTASIS

FDG – PET

• Metastasis shows increased activity in FDG – PET

PHEOCHROMOCYTOMA

10% Rule ® 10% - B/L

• Extra adrenal
• Malignant
• Diagnosis is clinical
• Supported by lab test
• Radiology localize the site of pheochromocytoma
Preferred: MRI : T2W

“Light Bulb Appearance”

EXTRA ADRENAL PHEOCHROMOCYTOMA

MIBG
Best investigation: DOPA - PET

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