1
Q
Penile fracture - what is fractured?
A
Corpus cavernosum, surrounding sheath and tunica albuginea
2
Q
MRI appearances of prostate cancer?
A
T2 dark lesion, diffusion restriction, early enhancement and delayed washout
3
Q
What type of bone mets do prostate cancer patients get?
A
Osteoblastic. The most common sites are sacrum and lumbar spine
4
Q
Other modalities in prostate cancer staging?
A
CT CAP
Tc99 bone scan
F-18 PSMA scan
5
Q
Prostate cancer T staging?
A
T2: confined to capsule
T3a: extension through capsule
T3b: invasion of seminal vesicles
6
Q
PI-RADS - which sequence is used for the evaluation of transitional zone tumours?
A
T2
7
Q
Which sequence is used for the PI-RADS evaluation of peripheral zone tumours?
A
DWI
8
Q
Which zone does BPH occur in?
A
Transitional zone (median lobe component of central gland)
9
Q
MRI appearances of BPH?
A
T2 nodular heterogeneity of transitional zone +/- diffusion restriction
10
Q
MRI appearances post-biopsy? (Peripheral zone haemorrhage)
A
T1 bright (subacute blood), T2 dark, no enhancement
11
Q
Acquired seminal vesicle cyst - location and causes?
A
Unilateral and LATERAL to prostate. Secondary to prostate surgery, BPH, chronic infection
12
Q
Congenital seminal vesicle cyst causes?
A
Renal agenesis
Vas deferens agenesis
Ectopic ureter insertion
PCKD
13
Q
Prostatic utricle cyst appearance?
A
Focal dilatation of prostatic urethra on retrograde urethrogram. MIDLINE. Pear-shaped
14
Q
Prostatic utricle cyst causes?
A
Unilateral renal agenesis
Down syndrome
Hypospadias
15
Q
Mullerian duct cyst appearance/location?
A
Does not communicate with urethra. Lateral and extends above base of prostate. Tear drop shaped
16
Q
Doppler signs in testicular torsion?
A
Increased arterial resistance and decreased diastolic flow
17
Q
US appearances of testicular appendage torsion?
A
Hypoechoic, avascular nodule along testis/epididymis. Reactive hydrocele
18
Q
US appearances of epididymitis?
A
Hyperaemia
Increased vascularity of testis
Hyperechoic fat around epididymis
19
Q
Causes of isolated orchitis?
A
- Mumps
- TB (miliary nodules)
- Syphilis
- Brucellosis
20
Q
US appearances of orchitis?
A
Hyperaemia, hypoechoic testis. Compromised venous flow (loss of diastolic flow) if severe
21
Q
Rad appearances of seminoma vs NSGCT?
A
Seminoma: microcalcifications, hypoechoic round mass
NSGCT: large calcifications, heterogeneous lesion, cystic spaces
22
Q
Which testicular cancer is associated with cryptoorchism?
A
Seminoma
23
Q
Which testicular cancer presents with a raised AFP?
A
NSGCT
24
Q
Which testicular cancer presents with a raised b-HCG?
A
Seminoma
25
Rad appearances of burned out testicular tumour?
Calcifications, small mass, residual scarring
26
What is the most common bilateral testicular tumour?
Testicular lymphoma
27
Most common testicular tumour in >60y/o?
Testicular lymphoma
28
Which testicular tumour is associated with Peutz-Jeghar?
Sertoli
29
Which testicular tumours present with gynaecomastia?
Sertoli and Leydig
30
Which testicular tumour metastasises haematogenously?
Choriocarcinoma
31
Which testicular tumour is associated with CAH?
TART
32
US: multiple hypoechoic testicular lesions, no change over time. Associated uveitis. What is the diagnosis?
Sarcoid
33
What syndrome is focal lipomatosis of the testes associated with?
Cowden
34
Route of metastasis for testicular GCTs?
Lymphatic to para-aortic and caval regions (N1 - 3). Haematogenous spread is a late occurrence (lung most commonly)
35
Epidermoid cyst of the testis - appearance?
'Onion-skin'
36
Tubular ectasia of rete testis?
A cystic dilatation next to the mediastinum testis
37
Varicocele most affected side?
Usually left.
RED FLAG if isolated right-sided
38
Intratesticular varicocele presentation?
Pain (left-sided usually). Associated with pre-pubertal orchidopexy
39
What is Zinner syndrome?
Renal agenesis and ipsilateral seminal vesicle cyst
40
Renal agenesis associations in men and women?
MEN: ipsilateral absent epididymis and vas deferens. Seminal vesicle cyst.
WOMEN: unicornuate uterus
41
Which RCC is the commonest?
Clear cell
42
Which RCC is associated with VHL?
Clear cell
43
Rad appearances of clear cell RCC?
Cystic mass with enhancing components. Equal enhancement to cortex in corticomedullary phase
44
Which RCC is assoicated with kidney transplant?
Papillary
45
Rad appearances of papillary RCC?
T2 dark, NOT hypervascular, does NOT enhance equally to cortex
46
Which RCC is sickle cell associated with?
Medullary
47
Which RCC is Birt-Hogg-Dube associated with?
Chromophobe
48
What is translocation RCC associated with?
Children with a history of cytotoxic chemotherapy
49
What type of bone metastasis is seen in RCC?
Lytic
50
What will RCC HU be?
Post-contrast enhancement >15 HU
51
How do you differentiate AML from a cancer?
AML will NOT have calcifications
52
Most common benign tumour of the kidney?
Angiomyolipoma
53
2nd most common benign tumour of kidney?
Oncocytoma (cannot be distinguished from RCC on imaging)
54
What syndrome is oncocytoma associated with?
Birt-Hogg-Dube (bilateral)
55
Multilocular cystic nephroma radiology?
Non-communicating fluid-filled locules surrounded by thick fibrous capsule. Enhancing septations
56
Aetiology of multilocular cystic nephroma?
Young boys and middle aged women
57
What does retroperitoneal lipomatosis present with?
LUTS
58
Rad of lipomatosis?
Pear-shaped bladder, narrow rectum
59
Most common primary malignant retroperitoneal tumour?
Liposarcoma
60
Rhabdomyosarcoma (retroperitoneum) rad?
Enhancing pelvic mass, possible bone destruction
61
Causes of retroperitoneal haemorrhage?
1. Anticoagulation
2. Leaking aorta
3. Bleeding AML or RCC
62
Classic sign of retroperitoneal haemorrhage that is related to over-anticoagulation?
Haematocrit level
63
Which lymphoma has early involvement of the para-aortic nodes?
Hodgkin's
64
Retroperitoneal lymphoma - effect on nearby structures?
DISPLACES rather than tethers
65
Retroperitoneal fibrosis causes
Primary/idiopathic: possibly IgG4 mediated
Secondary: Rx, neoplasms
66
Retroperitoneal fibrosis and adjacent structures?
Obstructs and tethers. Will NOT displace aorta and is rarely seen above renal arteries
67
Retroperitoneal fibrosis on PET-CT?
Avid
68
Erdeim-Chester syndrome
Histiocytic disorder with mantle-like retroperitoneal soft tissue mass. BONE - bilateral symmetric sclerosis of the metaphysis
69
Work-up for a Bosniak IIF lesion?
US/CT/MRI with follow-up at 6 months, 12 months and annually for 5 years
70
Work-up for a III or IV Bosniak lesion?
Requires surgery (or possibly radiofrequency ablation in III)
71
Complications/associations with ADPKD?
Renal failure
Berry aneurysm
Liver cysts
Increased risk of renal cancer (dialysis-related)
Seminal vesicle cysts
72
Complications/associations with ARPKD?
Hypertension
Renal failure
Portal hypertension and fibrosis
73
ARPKD and liver?
Proportion of disease severity between kidney and liver is INVERSELY related
74
Rad appearances of lithium nephropathy?
Innumerate tiny cysts, non-enhancing. Small volume kidneys
75
Uraemic cystic kidney disease and cysts
Number of cysts rises with duration of dialysis and regress following transplant. Increased risk of malignancy with dialysis x3-6
76
VHL vs ADKPD
VHL - pancreatic cysts
ADKPD - liver cysts
77
VHL aetiology?
AD multisystem disorder
78
VHL manifestations?
Renal cysts (50 - 75%)
Epididymal cysts
Cystadenoma of epididymis and broad ligament
Pancreatic cysts
Phaeochromocytoma
Haemangioblastoma cerebellum/SC
At risk of developing RCC (clear cell)
79
Tuberous sclerosis aetiology?
AD multiorgan disorder characterised by development of hamartomas
80
TS manifestations?
Bilateral renal AMLs
Renal cysts
LAM (lung)
Subependymal nodules
Giant cell astrocytoma
Cardiac rhabdomyosarcoma
RCC (young people)
81
T2 dark renal cyst - differentials?
1. Lipid-poor AML
2. Haemorrhagic cyst (T1 bright)
3. Papillary subtype RCC
82
Multicystic dysplastic kidney
Paediatric condition. Multiple cysts and NO function renal tissue (MAG)
83
Peri-pelvic vs para-pelvic renal cysts
Peri: from renal sinus, resembles hydronephrosis
Para: originates from parenchyma, may compress collecting system, bulges in
84
Pyelonephritis on excretory phase nephrogram?
Extends all the way to capsule, striated nephrogram appearance
85
Most common causative organism in emphysematous pyelonephritis?
E coli
86
Rad appearances of emphysematous pyelitis?
Gas is contained to collecting system and outlines ureters
87
Causes of renal papillary necrosis?
Diabetes
Analgesia nephropathy
Sickle cell
TB
88
Rad appearances of renal papillary necrosis?
Collections of contrast in papillary regions, 'ball-on-tee' sign, 'lobster claw' sign, sloughed papillae, blunted calyces
89
Usual cause of xanthogranulomatous pyelonephritis?
Staghorn calculus acting as nidus
90
Appearances of xanthogranulomatous pyelonephritis?
Enlarged kidney, bear-paw appearance, low attenuation renal lesions, associated psoas abscess
91
Spectrum of renal TB disease? Which is most characteristic?
1. Papillary necrosis
2. Cavity formation (most characteristic)
3. Focal stenosis of infundibulum
4. Kerr kink in renal pelvis
5. Ureteral stenosis
(Renal calcifications also)
92
Which stone is not seen on XR?
Uric acid
93
Which stone is not seen on CT?
Indinavir
94
Milk of calcium
Suspension of calcium crystals in a cyst that can mimic a stone. Layering fluid-debris level, which changes with positioning
95
Causes of medullary nephrocalcinosis?
(Hyperechoic renal pyramids which may shadow on US)
Hyperparathyroidism
Medullary sponge kidney
Renal tubular acidosis
Furosemide (paediatrics)
96
What are the causes of medullary sponge kidney?
Ehlos-Danlos
Caroli's
Beckwidth-Wiedemann
97
What is page kidney?
Subcapsular haematoma from trauma or biopsy which causes renal compression and resultant hypertension
98
Causes of delayed nephrogram?
(Unilateral)
Page kidney
Obstructing stone
99
Causes of persistent nephrogram?
Hypotension
RAS
ATN
100
Appearances of renal infarct?
Wedge-shaped hypodensity with cortical sparing. Flip-flop enhancement on delayed imaging
101
Most common cause of renal vein thrombosis in adults? Neonates?
Adults: nephrotic syndrome
Neonates: indwelling umbilical venous catheter
102
Doppler appearances of renal vein thrombosis?
Reversed arterial diastolic flow, absent venous flow
103
What is renal cortical necrosis?
Isolated necrosis of renal cortex in setting of acute renal failure. Occurs secondary to severe hypovolaemia
104
Rad of renal cortical necrosis?
Reverse rim sign (non-enhancing cortex), low T1/T2 signal of inner cortex
105
What should the normal RI be in a transplanted kidney?
<0.7
106
Most likely diagnosis for a rapidly growing anechoic fluid collection occurring 2 weeks post-transplant?
Urinoma
107
Usual site of a urinoma in a transplanted kidney?
Vesico-ureteral anastomosis
108
Most common fluid collection to cause transplant hydronephrosis?
Lymphocele (1-2months post)
109
MAG-3 findings in acute rejection?
Flow - delayed
Uptake - delayed
Urine production - slow progressive excretion
110
What will MAG-3 uptake be in ATN-driven rejection?
Normal
111
Renal artery thrombosis timeframe?
Minutes to hours post op. If occurring secondary to rejection, seen later
112
Most common vascular complication in renal transplant?
Renal artery stenosis (weeks to months)
113
Viral risk factor for RAS in transplant?
CMV
114
RAS Doppler findings?
Increased peak systolic velocity
Increased renal:aortic peak velocity ratio
Tardus parvus
115
Renal vein thrombosis timeline and features?
Peak of 48hr, occurring within first week
Oedematous kidney
Absent venous flow
Reversal of diastolic flow in arteries
116
Vascular complications of renal biopsy?
Arterovenous fistula
Pseudoaneurysm
Haematoma
117
PTLD features post-transplant
(Most commonly first year post transplant)
Encasing renal hilar mass
Nodal disease
Circumferential bowel thickening
Liver nodules
118
What subtype of RCC is associated with transplant?
Papillary (native kidney)
119
Urothelial malignancy post-transplant associations
BK virus
Cyclophosphamide
120
Grade II renal trauma features?
Cortical laceration <1cm
Haematoma confined to Gerota's fascia
121
What would increasing and decreasing attenuation collections on a delayed nephrogram suggest in the context of trauma?
Increasing: active bleeding
Decreasing: pseudoaneurysm/AVF
122
Protocol if renal laceration seen?
10 - 12 min delay to assess for urine leak (hyperdense outside of collecting system)
123
Causes of ureteritis cystica?
Chronic inflammation (stones, infection)
Diabetes
124
Malakoplakia vs leukoplakia of ureter
Leukoplakia is considered pre-malignant for SCC (malakoplakia is not)
125
What can cause ureteric deviation inwards?
Retroperitoneal fibrosis
Pelvic lipomatosis
Psoas hypertrophy (distally)
126
Subepithelial renal pelvis haematoma features
Thickened upper tract wall
Hyperdense clot on plain that does not enhance
Usually anticoagulation history
127
Rad of TCC ureter?
Champagne glass sign on CT IVP
Multifocal usually
Majority distal 1/3
128
Risk factor in Balkan nephropathy?
Aristolochic acid
129
Fibroepithelial clot vs TCC
Cannot be distinguished on imaging alone. Fibroepithelial clot will tend to affect younger patients and will resolve on follow up
130
Triad in Prune-Belly (Eage Barrett) syndrome?
1. Urinary tract dilatation
2. Cryptoorchidism
3. Abdominal wall muscle deficiency
131
Malignant complication of urachus?
Midline adenocarcinoma
132
Associations with squamous cell bladder carcinoma?
Stones/infection
Schistosomiasis
Suprapubic catheter
133
Location of bladder squamous cell carcinoma?
Trigone
134
Location of urothelial bladder ca?
Favours base of bladder
135
Rad of squamous cell carcinoma bladder?
Heavily calcified bladder and ureters
136
RFs for bladder adenocarcinoma?
Urachal remnant
Bladder exstrophy
137
Location for bladder adenocarcinoma?
Dome midline
138
Most common bladder tumour in paediatrics?
Rhabdomyosarcoma
139
Staging of bladder carcinoma? (T)
T1 - lamina propria
T2 - muscularis propria
T3 - perivesicular tissue
T4 - other organs
140
C-section complication of the bladder?
Bladder flap haematoma (haematoma over dome of bladder)
141
Extraperitoneal bladder rupture rad appearances?
Contrast fills pre-vesical space (Retzius) in a molar tooth pattern
142
Intraperitoneal bladder rupture rad appearances?
Opacified urine outlining bowel loops, POD and Morrison's pouch
143
Which type of bladder rupture is associated with pelvic fracture?
Extraperitoneal
144
Imaging modality for suspected urethral injury?
Retrograde urethrogram
145
Anterior urethral injury cause? Which segment of the urethra is injured?
Straddle injury. Bulbar urethra
146
Posterior urethral injury - associated injuries?
Pelvic fracture and extraperitoneal bladder rupture
147
Which type of urethral injury is most common (RUG classification)?
Type 3 (membranous and bulbar tear, urogenital triangle disruption, perineal contrast)
148
Straddle vs gonococcal stricture?
Straddle: short segment at bulbous urethra
Gonococcal: long, irregular segment of bulbous urethra
149
Most common urethral cancer?
Squamous cell
150
Small filling defects on RUG in HPV history?
Condyloma acuminatum
151
Rad of urethral diverticulum?
Middle 1/3 urethra, posterolateral wall, saddle-bag configuration on sagittal
152
Male, 60s, renal lesion with central/stellate scar?
Oncocytoma
153
Which testicular tunour is Carney complex associated with?
Sertoli
FRCR 2A
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