Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘GU’ Category

Wilm’s Tumor

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  • Age: 80% <6yo; most common abdominal neoplasm 1-8 yo.
  • Appearance: solid mass in kidney (claw sign), pushing away vessels, not crossing mid-line
  • IVC and renal vein thrombosis
  • Mets to lung, liver, brain, bone
  • Staging
    • I = confined to kidney
    • II = local extension to perinephric space
    • III = lymph nodes
    • IV = distant mets
    • V = bilateral renal
  • DDx: neuroblastoma (crosses mid-line, encases vessels, calcify), multilocular cystic nephroma, sarcoma, RCC, nephroblastomatosis, mesoblastic nephroma, AML, renal medullary carcinoma


Written by lmwong

October 28, 2011 at 1:17 pm

Posted in abdomen, GU, pediatrics, renal

Urethral Injury Types

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urethral injury typesPosterior urethra: from bladder neck, through prostate, to membranous urethra

Anterior urethra: bulbar and penile urethra

  • type 1: stretched, periurethral hematoma
  • type 2: rupture above urogenital diaphragm, extraperitoneal contrast
  • type 3: rupture below urogenital diaphragm, extraperitoneal and perinium contrast
  • type 4: bladder extending to urethra
  • Type 5: anterior urethral injury

Written by lmwong

March 31, 2010 at 2:53 pm

Posted in classification, GU, trauma

Bladder Rupture Classification

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  • Type 1: contusion
  • Type 2: intraperitoneal rupture
  • Type 3: interstitial bladder injury
  • Type 4: Extraperitoneal rupture; a = simple; b = complex
  • Type 5: Combined bladder injury

Written by lmwong

March 31, 2010 at 2:48 pm

Pediatric Renal Tumors

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  • Wilm’s tumor
  • nephroblastomatosis
  • Clear cell sarcoma
  • Rhabdoid tumor
  • Hamartoma
  • Angiomyolipoma
  • Ossifying Renal Tumor of Infancy
  • Metanrphric Adenoma
  • Adjacent Neuroblastoma from adrenal gland

Written by lmwong

March 20, 2010 at 10:57 am

Pediatric Cystic Renal Lesions

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Written by lmwong

March 19, 2010 at 2:26 pm

Uterine Shapes

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Written by lmwong

February 2, 2010 at 5:57 pm

Posted in differential, GU, OB, uterus

Increased renal echogenicity

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Cortical only:

  • Acute/Chronic Glomerulonephritis
  • Nephrosclerosis
  • Acute tubular necrosis

Medullary only:

  • Medullary nephrocalcinosis
  • Renal pyramidal fibrosis

Cortical and Medullary:

  • Chronic Plyeonephritis
  • Chronic Glomerulonephritis


  • Infection
  • Scarring
  • Renal Vein thrombosis

Written by lmwong

January 22, 2010 at 1:44 am

GU Buzz Words

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  • nubbin sign = testicular torsion on DTPA NM scan
  • Cobra shaped ureter = ureterocele
  • Tip of the iceberg = dermoid
  • paintbrush striations (IVP) = medullary sponge kidney
  • string of beads renal artery = fibromuscular dysplasia
  • putty kidney = tuberculosis of kidney
  • staghorn calculus = xanthogranulomatous pyelonephritis (XGP)
  • multiple renal aneurysms = polyarteritis nodosa

Written by lmwong

January 16, 2010 at 10:52 am

Posted in buzz, GU

Big Kidneys Differential

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  • Compensatory hypertrophy
  • Pyelonephritis
  • Duplex kidney
  • Renal Vein Thrombosis
  • Hydronephrosis
  • Acute renal infarct


  • Unilateral cases as above
  • Glomerulonephritis
  • Acute tubular necrosis
  • Diabetic nephropathy

In Kids:

  • Nephroblastomatosis
  • Nephrotic Syndrome
  • Polycystic Kidney disease
  • Glycogen Storage
  • Lymphoma/Leukemia

Written by lmwong

January 16, 2010 at 10:45 am

Posted in differential, GU, renal

Uterine Filling Defect Differential

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  • bubble
  • bloodclot
  • mucoid material
  • fold
  • synechiae; uterine adhesion
  • submucosal fibroid
  • septate uterus
  • uterine carcinoma
  • retained conceptus
  • molar pregnancy
  • pregnancy related
  • IUD

Written by lmwong

January 16, 2010 at 9:00 am

Renal Laceration Grading

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Grade 1

  • hematuria, normal imaging
  • contusion
  • nonexpanding subcapsular hematomas

Grade 2

  • nonexpanding perinephric hematoma confined to the retroperitoneum
  • laceration <1cm deep, collecting system not involved

Grade 3

  • laceration >1cm, collecting system not involved

Grade 4

  • laceration extending to collecting system
  • involve main renal artery or vein
  • segmental infarctions without associated lacerations
  • expanding subcapsular hematomas compressing kidney

Grade 5

  • shattered or devascularized kidney
  • ureteropelvic avulsions
  • complete laceration or thrombus or main RA or V

Written by lmwong

January 14, 2010 at 7:36 am

Posted in abdomen, GU, renal, trauma

Vesicoureteral Reflux (VUR) Classification

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Grade I – reflux into non-dilated ureter
Grade II – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; papillary impressions

Written by lmwong

September 8, 2008 at 12:04 am

Uretheral Injury Classification

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The classification system of Goldman et al (6) is as follows:

Type I injury: The posterior urethra is stretched and elongated but intact. The prostate and bladder apex are displaced superiorly due to disruption of the puboprostatic ligaments and resulting hematoma.

Type II injury: Disruption of the urethra occurs above the urogenital diaphragm (UGD) in the prostatic segment. The membranous urethra is intact.

Type III injury: The membranous urethra is disrupted with extension of injury to the proximal bulbous urethra and/or disruption of the UGD.

Type IV injury: Bladder neck injury with extension into the proximal urethra.

Type IVA injury: Injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury.

Type V injury: Partial or complete pure anterior urethral injury.


Written by lmwong

September 8, 2008 at 12:00 am

Posted in classification, GU, trauma

Grades of Ureteral Reflux

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Grade Findings
I Reflux confined to ureter only
II Reflux to the level of the intrarenal collecting system without dilatation
III Grade II + mild or moderate dilatation of the ureter or renal pelvis, but no or only slight forniceal blunting
IV Grade II + calyceal dilatation and obliteration of the sharp angle of the fornices, but maintainance of the papillary impressions
V Gross dilatation and tortuosity of the ureter; gross dilatation of the renal pelvis and calices; papillary impressions are no longer visible

Grades I-III: Typically resolve as the child grows

Grades IV-V: Typically require surgery to correct

Written by lmwong

May 27, 2008 at 8:29 pm

Retroperitoneal Structures

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Organs are retroperitoneal if they only have peritoneum on their anterior side.

Primarily retroperitoneal:
  • Adrenal glands
  • kidneys
  • ureter
  • bladder
  • aorta
  • inferior vena cava
  • esophagus
  • rectum
  • uterus
Secondarily retroperitoneal:
  • head and neck of pancreas
  • 2nd and 3rd portion of duodenum
  • ascending and descending colon

Written by lmwong

April 17, 2008 at 1:16 am

Posted in abdomen, gi, GU, retroperitoneal

Bladder Wall Calcification

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  • Schistosomiasis
  • Tuberculosis
  • Postirradiation cystitis
  • Bacillary UTI


  • TCC
  • SCC
  • leiomyosarcoma
  • hemangioma
  • neuroblasomta
  • osteogenic sarcoma

Mneumonic = “SCRITT”

  • Schistosomiasis
  • Cytoxan
  • Radiation
  • Interstitial cystitis
  • Tuberculosis
  • TCC

Written by lmwong

April 16, 2008 at 2:40 pm

Bladder Tumors

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Epithelial Carcinoma (95%)

  • TCC (90%)
  • SCC
  • Adenocarcinoma

Nonepithelial Mesechymal Benign Tumors

  • Leiomyoma
  • Rhabdomyoma
  • Hemangioma
  • Neurofibroma/neurofibromatosis
  • Nephrogenic adenoma
  • Endometriosis
  • Pheochromocytoma

Nonepithelial Mesechumal Malignant Tumors

  • Lymphoma
  • Rhabdomyosarcoma
  • Leiomyosarcoma

Secondary Tumors

  • Metastases
  • Lymphoma
  • Leukemia
  • Direct extension (prostate, retum, sigmoid, cervix, ovary)

Written by lmwong

April 16, 2008 at 2:35 pm

Renal Masses

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see differentials for solid and cystic renal masses.

Solitary Expansile Masses

  • Cystic Lesions
  • Renal Cell Carcinoma
  • Oncocytoma
  • Multilocular Cystic Nephroma
  • Renal Abscess
  • Focal XGP
  • Renal Metastasis
  • Angiomyolipoma

Multiple Expansile Masses

  • Polycystic Kidney Disease
  • Medullary Cystic Disease
  • Juvenile Nephronophthisis
  • von Hippel-Lindau Disease
  • Acquired Cystic Disease of Dialysis
  • multiple RCC (2% of RCC)
  • metastasis (colon)
  • lymphoma
  • multiple abscesses
  • multiple oncocytomas (central stellate scar)

Geographic Infiltrating Masses

  • Transitional Cell Carcinoma
  • Squamous Cell Carcinoma
  • Renal Medullary Carcinoma (invade renal sinus, African Americans)
  • Collecting Duct Carcinomas
  • Lymphoma and Metastasis
  • Pyelonephritis
  • renal tuberculosis
  • XGP
  • Renal Infarction

Written by lmwong

April 15, 2008 at 1:20 pm

Posted in abdomen, differential, GU, renal

Ureteral Dilitation

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  • Obstruction: Ureterolithiasis
  • Congenital: Chronic vesicoureteral reflux, posterior urethral valves, megaureter, Prune-belly syndrome.
  • Infection/Inflammation: UTI, appendicitis, diverticulitis
  • Compression: pelvic or abdominal mass

Megaureter: disproportionally enlarged compared to the rest of the renal collecting system

  • reflux
  • obstruction
  • other: congenital megaureter, polyuria, infection

Written by lmwong

April 11, 2008 at 5:39 pm

Lateral Ureteral Deviation

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Upper ureter:

  • Lymphadenopathy
  • Aortic aneurysm
  • Retroperitoneal hematoma

Lower ureter

  • Pelvic mass, e.g. uterine fibroids

Written by lmwong

April 11, 2008 at 5:10 pm