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

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 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

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• 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

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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

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3. Duplicated System

4. Cobra/ Adder Head Appearance – URETEROCELE

Polycystic Kidney Disease

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• 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

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CHRISTMAS TREE BLADDER

s/i Neurogenic Bladder

Renal Stone

• Hydronephrosis
• Acoustic shadowing

USG of Kidney

InxOC for diagnosing Renal stone

NCCT

Left ureteric stone

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 ”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

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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