Calcifications in breast and what they indicate:

Egg-shell
B. Sedimented.
C. Tubular.
D. Dot-dash.
E. Coarse.

Oil cyst
Milk of calcium
Vascular
Fine pleomorphic=DCIS
Fibroadenoma

Grades of reflux
Mc organism in xanthogranuloma is Protus infection

Memics of adenomyosis and how to differ them

Contractions…. Focal not diffuse, its transient
Pseudo thickening of the junctional zone occurs on the 2 nd
day of cycle

Both conditions don’t have T2 hyperechoic foci

The appearance of ureteral dilatation around and below an

intraluminal filling defect is described as

Goblet sign

Male breast cancer imaging appearance: . This is typically

retroareolar and hyperdense on mammography with
irregular margins. Secondary features such as nipple
retraction and skin thickening are usually present. Ultrasound
will show a non-parallel, hypoechoic mass.

Fibrothecoma imaging appearance?

These are typically solid lesions on ultrasound and have
marked acoustic shadowing in 18–52% of cases. This
shadowing is not secondary to calcifi cation, but is related to
marked attenuation of sound by the dense hypoechoic mass
itself. This can be a useful sign for identifying fibrothecoma
on ultrasound
Classifications of ovarian lesions:
epithelial, Cystadenomas/adenocarcinomas belong to the
epithelial group of malignancies
germ cell, Dysgerminomas and embryonal cell carcinomas
sex cord-stromal, :Sertoli–Leydig cell tumours, granulosa cell
tumours, and fibrothecomas
metastatic neoplasms

imaging appearance of a kidney leiomyoma?

It appears as a well-circumscribed, homogeneous, exophytic
solid mass that shows uniform enhancement on contrast-
enhanced CT.

Imaging appearance of metanephric adenoma?

Well defined unencapsulated, solitary mass that may be

hyperattenuating on unenhanced CT. Calcifi cation can be
seen in up to 20%
Associated with polycythemia

Juxtaglomerular cell (JGC) neoplasm or reninoma is an

extremely rare, benign renal neoplasm of myoendocrine cell
origin, which is associated with a clinical triad of
hypertension, hypokalaemia, and high plasma renin activity.
It typically appears as a unilateral, well-circumscribed,
cortical tumour and often measures less than 3 cm, but
otherwise is indistinguishable from other cortical neoplasms.

Hemangioma of the kidney occurs as an unencapsulated,

solitary lesion that frequently arises from the renal pyramids
or the pelvis. Contrast-enhanced CT or MRI may show early
intense enhancement, with persistent enhancement on
delayed images.

Clinically testicular lymphoma is distinct from other testicular

neoplasms in that it occurs in a much older age group. It is
the most common testicular neoplasm over the age of 60
years. It is also the most common bilateral testicular
neoplasm (up to 38% of cases). The epididymis and spermatic
cord are commonly involved. The sonographic appearance is
variable and indistinguishable from germ cell tumours.
Typically they are discrete hypoechoic lesions that may
completely infi ltrate the testicle.

the most predictive feature of the breast MR image

interpretation is ?
irregular margins

factors rendering renal artery reembolization useless?

Small kidneys
RI more than 0.7
PSV less than 180 because it doesn’t suggest RA stenosis

Location of Bartholin duct cyst

Bartholin’s glands are located behind the labia minora and
their ducts open onto the posterolateral vestibules on each
side. (PL aspect of vagina).
Placenta membranacea is a thin membranous structure
circumferentially occupying the entire periphery of the
chorion. There is an increased risk of placenta praevia, as a
portion of the placenta completely covers the internal

In the renal artery, a peak systolic velocity of over 180 cm/s

combined with a renal/aortic velocity ratio of over 3 is
reported as being the most sensitive method of detecting
RAS.

Adrenal cortical carcinoma manifests as?

manifesting with Cushing’ syndrome, feminization,
virilisation, or a mixture of these. Hypertension is common in
all syndrome types.
The corticomudullary phase CTU is used for? e is helpful for
showing the normal cortico-medullary pattern in
pseudotumours such as prominent columns of Bertin or focal
renal hypertrophy. It is also useful for suspected
abnormalities such as vascular malformations and
pseudoaneurysms of the kidney

Imaging features suggestive of phylloid tumor?

rapidly growing mass, which is lobulated on mammography.
Calcifi cations are rarely seen. A solid mass containing cystic
spaces on ultrasound and demonstrating posterior acoustic
enhancement

Post RFA syndrome

Post-RFA syndrome occurs 24-48 hours post-ablation. It is a
likely inflammatory response to tumour necrosis or cytokine
production.

Features of chronic torsion

Hypoechoic small and harder testis
Absence of hydrocele and normal scrotal wall/skin
In Krukenberg tumours, there are distinctive findings,
including solid components secondary to stromal reaction
that are low T2WI and high T1W signal.

A Sertoli–Leydig tumour is a sex cord-stromal tumour that

occurs in young women (less than 30 years old). It manifests
as a well-defi ned, enhancing solid mass with intra-tumoral
cysts. They constitute 0.5% of ovarian tumours. They are
rarely bilateral

Dysgerminomas are rare ovarian tumours that occur

predominantly in young women. Serum B-HCG is increased in
5%. Calcifi cation may be present in a speckled pattern.
Characteristic imaging fi ndings include multilobulated solid
masses with prominent fi brovascular septa. They are rarely if
ever bilateral.

Fibromas are benign solid tumours of the ovary, which are of

low signal on T1W and very low signal on T2W sequences.
They can be associated with ascites and pleural effusions
(Meigs syndrome), and dense calcifi cations are often seen.
Together with fi brothecomas they form a spectrum of
benign tumours
Endodermal sinus tumour, also known as yolk sac tumour, is
a rare malignant ovarian tumour that usually occurs in the
second decade of life. These tumours manifest as a large,
complex pelvic mass that extends into the abdomen and
contains both solid and cystic components. They are rarely
bilateral. They grow rapidly and have a poor prognosis.
Affected patients have an elevated serum alpha feta protein.

HIFU ( high intensity focused ultrasound) mechanism of

action on fibroids?
Coagulation necrosis.

MC finding of invasive lobular carcinoma is?

Invasive lobular carcinoma

Uterus signs for ectopic pregnancy

Pseudogestational sac.
Trilaminar endometrium.
Thin-walled decidual cyst( could be normal or abnormal

A double decidual sac sign is

two concentric hyperechoic rings that surround an anechoic
gestational sac in a normal intrauterine pregnancy.
How can fibroid treatment affect the ovary?
Ovarian dysfunction is a known complication of fi broid
embolization

Ultrasound-guided needle aspiration is a suitable method of

treatment for abscesses if ?
less than 3 cm in maximum diameter.

Bilateral MCDK is uncommon, but associated anomalies of

the contra-lateral kidney are seen in up to 50% of cases.
Vesico-ureteric refl ux (30–40%) is the most common
associated anomaly, followed by pelvi-ureteric junction
obstruction (10–20%).

How to deal with a small solid renal lesion that is less than 1
cm?
Repeat CT after 3-6 months then yearly follow up if the lesion
reaches 1 cm full workup is done.
Sporadic aniridia is associated with?
nephroblastomatosis (multiple nephrogenic rests) and an
increased risk of Wilms tumour
Any new, enlarging, or heterogenous mass in the setting of
nephroblastomatosis indicates the development of
a Wilms tumour

Contrast enhancement during the pyelographic phase of the

CT examination indicates?
the presence of a urine leak.

Intense enhancement within a renal laceration during the

early phase indicates?
active haemorrhage.

The cortical rim nephrogram is a sign of ?

a devascularized kidney, which occurs due to laceration of
the main renal artery.

multiple cysts or lattice-like enhancement of the

endometrium post contrast are encountered frequently in
tamoxifen therapy
effects of IUCD on uterus ?
UCD placement most likely results in myometrial
hypertrophy. The associated findings are symmetrical
globular enlargement of the uterine corpus, cervical
elongation and enlargement, and diffuse or localized
myometrial thickening.

the most common manifestation of uterine lymphoma is?

diffuse symmetrical uterine enlargement with relatively high
signal on T2WI and epithelial preservation: the endometrium
is usually normal. The myometrium will also lack its standard
zonal appearance. There will almost always be associated
lymphadenopathy.

Lymphangitis carcinomatosis usually occurs secondary to the

spread of (adeno-) carcinoma, most commonly

bronchogenic, breast, and stomach. The mnemonic Certain

Cancers Spread By Plugging The Lymphatics (Cervix Colon
Stomach Breast Pancreas Thyroid Larynx) is useful.
Lymphangitis carcinomatosis is occasionally associated with
cervical carcinoma and certainly more so than with the other
options presented
Localized cystic renal disease is?
replacement of all or localized areas of a kidney by multiple
variably sized cysts. These cysts form clusters that are
separated by thin areas of normal renal parenchyma. The
aggregated cysts in localized cystic disease can frequently
appear like a multi-septate mass, but they do not form a
distinct encapsulated mass and do not show mural
irregularities.

Lipoma of the cord will have what signals on MRI?

high signal on both T1-weighted and T2-weighted images.
Neurofibroma will demonstrate what signal on T2?
a target sign on T2-weighted images and is of low attenuation
on CT.

Both corpus spongiosum and the corpora have ………..on T1-

weighted images and ………on T2-weighted images

a low signal
high signal
The periurethral tissue is………..on T2-weighted images

is low signal

can MRI differentiate between Buck’s fascia and tunica

albuginea?
No, They are depicted as a single, thick, low-signal rim.

………….coil is used for local disease staging of penile cancer

A surface coil.

The proximal urethra is not routinely identifiable, unless ?

the patient is catheterised or has had previous TURP.

Malakoplakia vs leukoplakia?
Malakoplakia affects elderly females with a history of E. coli
infections. It primarily affects the bladder, and affects the
remainder of the renal tract with decreased incidence as one
progresses proximally
Leukoplakia may have similar appearance, but is more
common in males with bladder involvement, and is
characterised by the passage of gritty soft-tissue flakes.

MC breast mets in order

Lymphoma
Melanoma
Rhabdomyosarcoma.

MC cause of polyhydramnious
DM mother

MC cause of oligohydrmous
demise of the fetus, drugs and renal anomalies.

Gartner duct cyst are associated with which syndrome?

Herlyn–Werner– Wunderlich syndrome (ipsilateral renal
agenesis and ipsilateral blind vagina) and ectopic ureter
inserting into the cyst.

Typical appearance of endomertrial polyp?

Typical ultrasound appearance is of a hyperechoic
endometrial mass which may or may not contain cystic
spaces. A feeding vessel is often demonstrated from its base
on power Doppler
a mass which contains a central fibrous core that enhances
post-contrast and also contains well-demarcated T2-
hyperintense cysts suggests endometrial polyp
. Posterior urethral injuries can be seen in up ……….to of
pelvic fractures in males
to 20%

Bladder and rectal involvement in prostate cancer are best

seen on ?
coronal images

. Retroperitoneal air may indicate

pulmonary injuries
Air in the retroperitoneum can follow pneumothorax.
However, in the absence of pneumo-thorax, it is strongly
indicative of duodenal/colonic injuries .

The retroperitoneum is divided into three zones

Which zone is the most common site for hematoma?

I – midline retroperitoneum; II – lateral retroperitoneum;

and III – pelvic retroperitoneum. Zone III is the commonest
site for haematoma following blunt injury.
Adrenal injuries are more common on which side?
The right

Contrast in the paracolic gutters suggests ?

intraperitoneal rupture of the bladder. This is associated with
a different method of injury, typically rupture at the bladder
dome following blunt trauma with a distended bladder or
secondary to iatrogenic injury such as cystoscopy.

Where do we find the contrast in extraperitoneal rupture of

the bladder?
Contrast is seen to extravasate with a streaky or flame-
shaped appearance and collects in the space of Retzius,
upper thighs, inguinal regions, perivesical fat and anterior
abdominal wall.

In order to assess the presence or absence of a heartbeat

accurately crl should be
on TV scanning, the crown rump length needs to be >6 mm.
On TA scanning the crown rump length needs to be >10 mm

The most commonly associated cancer with paget’s disease is

is ductal carcinoma in situ (60%). The next most common is
invasive ductal carcinoma.

The diagnosis of PCOS can be supported when ?

one or more of the following ultrasonographic features are
demonstrated:
1-Twelve or more follicles (3–12 mm diameter) are present
in an ovary (either peripheral or diffusely arranged).
2- Ovarian volume >10 ml when no follicles measuring over
10 mm in diameter are present

a very FDG-avid fat-containing retroperitoneal tumour is

quite likely
a hibernoma.( tumor of brown fat)

commonest intratesticular benign neoplasm

commonest benign tumours in the spermatic cord

epidermoid cyst
lipoma

causes of decreased placental size

Pre-eclampsia, IUGR, chromosomal abnormality and
intrauterine infection.
The causes of placentomegaly
maternal diabetes, chronic intrauterine infection (e.g.
syphilis), maternal anaemia, thalassaemia and twin–twin
transfusion syndrome. Fetal chromosomal abnormalities may
cause either a large or small placenta

characteristic imaging features of Krukenberg’s tumour?

bilateral, sharply marginated oval tumours which preserve
the contour of the ovary. Identification of hypointense solid
components on T2-weighted imaging corresponding to areas
of dense collagenous stroma is also considered characteristic.

Granulosa cell tumours are the most common ovarian

tumours with oestrogenic manifestations that are classified
as sex-cord-stromal tumours. They are subdivided into adult
and juvenile types. The juvenile form affects prepubertal
children and causes pseudoprecocity. In about a third of
cases Sertoli–Leydig cell tumours cause virilisation. Thecomas
are oestrogen-producing tumours but more than 80% occur
in postmenopausal women. Immature teratomas are
extremely rare but do occur in children. Elevated alpha-
fetoprotein is found in up to 65% of cases. Sclerosing stromal
tumours usually affect women younger than 30 years of age
and a few cases have shown androgenic or oestrogenic
manifestations.
MC cause of adrenal calcification is
Adrenal h’age
Cloacal malformation is a single perineal orifice for the
bladder, vagina and rectum caused by early embryonic
arrest. It manifests in the newborn period. Hydrometra is
fluid within the uterus and may be due to cervical or vaginal
dysgenesis. Rectal duplication cysts may reveal an echogenic
cystic mass in childhood but they often present with
constipation and faecal soiling.

Endometrial thickness excluding endometrial cancer

An endometrial thickness of 3 mm can be used to exclude
endometrial cancer in women who: Have never used HRT, or
Have not used any form of HRT for one year, or Are using
continuous combined HRT

An endometrial thickness of 5 mm can be used to exclude

endometrial cancer in women using sequential combined
HRT (or having used it within the past year).

TCC common sites in order

Bladder
Pelvis
Upper ureter.

complications of pregnancy that cause acute cortical necrosis

placental abruption, infected abortion and severe eclampsia

two mri enhancement features suggesting malignancy

Rim-like enhancement is a relatively rare finding, but has a
high correlation with malignancy (positive predictive value
84%). A focal area of hyperintense signal on T2 near a lesion
is highly suggestive of malignancy.
.

Brodel’s avascular plane is located?used in nephrostomy

just posterior to the convex lateral margin.

Which calyceal group is accessed in simple nephrostomy is

interventional nephrostomy?
Whilst an easily accessible lower pole calyx is usually the
target for a simple nephrostomy drainage, for ureteral
interventions, a posterior calyx in the mid or upper polar
region may be better
Spider legs appearance on IVU is
ADPKD

Cervical Ca has higher T2 signal than stroma and enhances

post contrast

Fournier’s gangrene is necrotizing fasciitis of the testis

Causes of prepuberty vaginal bleeding

Vaginal foreign body

This is a very common cause of vaginal bleeding in pre-
pubertal girls. Other causes include vaginal
rhabdomyosarcoma, precocious puberty, haemangioma and
vascular malformation

What is Mesoblastic nephroma and how to differ it from

wilms
This is a hamartoma and is the most common solid neoplasm
in neonates. It typically involves the renal sinus and there is
no invasion of the veins (differentiating it from Wilms’
tumour) or the collecting system.
 In patients with pelvic fractures, bloody
meatus and inability to void
Next step?
This should raise the possibility of urethral injury. A
retrograde urethrogram should be performed to exclude
urethral injury before inserting a Foley’s catheter or
cystography for bladder ruptures

DDX small non palpable stellate lesion with arch distortion

Cancer , fat necrosis , radial scar fibrosed fibroadenoma aand

granular cell myoblastoma.

Leydig tumors secreate which hormone? Estradiol

Atherosclerosis in the renal artery usually involves which

segment?
Proximal 2 cm of main renal artery.

Comet tail artifact in the pelvis refers to ?

Phleboliths
Antibiotics and anaesthesia are now standard in prostate
biopsy
5-7.5 Hz probes are used

Regarding TCC

How does pyosalpinx appear onT2?

Amorphous /geographic shading on T2

Ddx hemorragic mets to breast

Melanoma
RCC
Choriocarcinoma
Kaposi sarcoma
A pancreatic tail mass would displace the splenic vein ?
Posteriorly
DDX memics of an adrenal lesion include
The upper pole of the kidney
Pancreatic tail mass
Splenic lobulation or accessory spleen
Gastric diverticuli

Ddx breast edema

Venous or lymphatic obstruction
Radiotherapy
Inflammatory Ca
Breast abcess
Recent surgery
Breast edema appearance on mammography
Dense right breast
Skin thickening
Coarse reticular pattern
Prominent cooper ligament
 What is wolman disease

In Percutaneous nephrostomy we usually puncture?

The lower calyx via posterior approach

MC ovarian mass in a child

Teratoma
Features suggestive of male breast cancer
high-density, well-defined mass with lobulated or spiculated
,

margins at mammography.
An eccentric position is highly suspicious for breast cancer
Calcifications is less common than female
LAN occurs only in 50%
Causes of incompetent cervix
cervical trauma, in utero diethylstilbestrol exposure (cervical
hypoplasia), and oestrogen treatment

seminoma appearance on T2 MRI

uniform intermediate signal with band-like low-signal septa.
There is contrast enhancement, especially of the septations.

What is whitaker test

The Whitaker test is a pressure– flow study to evaluate
ureteral obstruction or resistance in dilated non-refluxing
upper tracts. Being invasive and time-consuming, it is usually
performed only when excretory renograms are equivocal. A
pressure difference of greater than 15cmH2O is abnormal

Best time to estimate the gestational age is ?

The first trimester using CRL if the fetal pole is not yet seen
we use the gestational sac.

Causes of bilateral smooth renal enlargement include

diabetic nephropathy, acute glomerulonephritis, collagen
vascular disease, vasculitis, AIDS nephropathy, leukaemia,
lymphoma, autosomal recessive polycystic renal disease,
acute interstitial nephritis, sickle cell disease, thalassaemia,
acromegaly, amyloidosis, myeloma and acute urate
nephropathy

When the bilateral renal enlargement is caused by masses,

the differential diagnosis includes autosomal dominant
polycystic disease, acquired renal cystic disease, lymphoma,
metastases, Wilms’ Module 4: Genitourinary, Adrenal,
Obstetrics & Gynaecology, and Breast: Answers 211 tumours,
tuberous sclerosis, von Hippel –Lindau syndrome, multiple
oncocytomas and nephroblastomatosis

TCC staging
T1 refers to invasion of the subepithelial connective tissue,
whereas a T2 tumour invades the muscularis. T3 tumours in
the renal pelvis invade the peripelvic fat or renal
parenchyma, whereas those in the ureter invade the
periureteric fat. T4 tumours invade adjacent organs or
perinephric fat
For renal and ureteric transitional cell carcinoma, the group
stages I –III are determined by the T status, all these stages
having no involved nodes and no metastases. T4 primaries or
any involved nodes or metastases give stage IV disease.
There is no stage V.
Affect of ptosis of the kidney on DEMSA scan?
Ptosis of the mobile kidney when erect can cause symptoms
and underestimation of parenchymal DMSA uptake.

Perineal tears degree

First-degree perineal tear involves skin only. Perineal muscle
is torn in a second-degree tear and so includes episiotomy.
Anal sphincter damage defines third-degree injury, this being
subdivided into types 3a, involving less than 50% of external
sphincter, 3b, more than 50% of external sphincter, and 3c,
when the internal sphincter is torn. A tear extending into the
anal epithelium is a fourth-degree tear

Renal cell carcinoma, cysts, abscess, haematoma, scar and

infarct would be seen as ………..areas on DMSA SPECT, if large
enough.

Photopenic

Regional and mets LN groups in prostate cancer

Internal iliac, obturator, external iliac and sacral are the regional nodal groups. Common iliac, para-
aortic and inguinal involved lymph nodes are regarded as metastases

MC urethra tumor is

Squamous cell ca

Hematoma of abruption appearance with time

. The haematoma forms a complex hypoechoic collection within 1 week of abruption, and usually
appears as an anechoic collection within 2 weeks.

typical findings in carcinoma of the prostate are increased relative peak enhancement, increased
contrast wash-in rate, reversal of the choline plus creatine/citrate ratio on spectroscopy, restricted
diffusion and increase in permeability on pharmacokinetic modelling.

n ultrasound scan, the endometrium is seen as an echo-bright stripe. Unless the patient is taking
tamoxifen or hormones, the postmenopausal endometrium should be less than 4mm. A cut-off of
3mm when performing screening for endometrial cancer has a 99% negative predictive value

For cord entanglement, the twins must be in the same amniotic sac

MRI appearance of penile lesions

an ill-defined infiltrating lesion hypointense to the corpora on both T1W and T2W images. Tumours
enhance following contrast, but to a lesser degree than the normal corporal bodies

Stauffer syndrome is

described a syndrome of nephrogenic hepatopathy in which a renal cancer without liver metastases
causes hepatosplenomegaly and abnormal liver function. Renal cell carcinoma paraneoplastic
phenomena include erythrocyte.

Contraindication to brachytherapy is prostate size more than?

60 cc

Seminal vesicles may appear low in signal on T2 when ?

atrophic, empty or with tumour involvement

Acute arterial hypotension, arteriosclerosis, nephrosclerosis and hereditary nephropathies including
medullary cystic disease and Alport syndrome are all causes of bilateral small kidneys.

FMD Produces moth-eaten nephrograms after?

thrombosis of the microaneurysms

Considering solid lesions of the paratesticular space, which is the most common benign tumour?

Adenocarcinoid tumor

Prostate sarcoma . Typically presents as?

a large solid and cystic mass with rapid hypervascular and heterogenous soft tissue occupying all or
most of the prostate.

1st nodes involved in prostate cancer are?

Obturator