DDx Adrenals, Urinary Tract and Kidneys
Terms
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Adrenal Calcification
Child -
cystic disease (usually the result of hemmorrhage that may be secondary to trauma, infection, birth trauma) arterial or venous thrombosis.
Neuroblastoma 90% CT (node and mets may also calcify)
Ganglioneuroma -
Adrenal Calcification
Adult -
Cystic disease
carcinoma
Addisons dx
Ganglioneuroma
Inflammatory (TB histoplasmosis)
Pheochromocytoma calcification rare but present in an 'eggshell' pattern - CT of Adrenal Masses
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Functioning Tumors
Conn's Adenoma
Pheochromocytoma (associations with Men II, von Hippel Lindau, neurofibromatosis MIBG isotope)
Malignant Tumors
Mets
Carcinoma
Lymphoma
Neuroblastoma
Benign Tumors
Non-functioning Adenoma
Angiomyolipoma
Cyst
Post traumatic hemorrhage -
MIBG imaging
Methyl-iodo-benzyl-guanine -
Normal
Myocardium
Liver and Spleen
Bladder
Adrenal Galnds
Salivary Glands
Nasopharynx
Thyroid
Colon
Abnormal
Pheochromocytoma
Neuroblastoma
Carcinoid
Paraganglioma
Medullary Thyroid Carcinoma
Ganglioneuroma - Loss Of Renal Outline on Plain Film
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Technical Factors
Congenital absence
Displaced ectopic kidney
Perinephric hematoma
Perinephric abscess
tumor (when perinephric fat is displaced)
Post-nephrectomy - Renal Calcification
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Calculi
Dystrophic Calcification due to Localized Disease
Infection (TB, Hydatid, xanthogranulomatous pyelonephrtis, abscess)
Carcinoma
Aneurysm -
Renal Calcification
Nephrocalcinosis -
May be medullary or cortical
Parenchymal calcification Associated with Diffuse Renal Lesion (ie dystrophic calcification) or metabolic abnormality (ie hypercalcemia) -
Renal Calcification
Nephrocalcinosis
Medullary (pyramidal) -
First 3 70% of cases
HPT
Renal Tubular Acidosis (rickets, osteomalacia Distal tubular defect)
Medullary Sponge Kidney
Renal Papillary necrosis (calcification of necrotic papillae) -
Renal Calcification
Nephrocalcinosis
Cortical -
Acute cortical necrosis
Chronic glomerulonephritis
Chronic transplant rejection - Renal Calculi
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OPAQUE
calcium phosphate/calcium oxalate
POORLY OPAQUE
Cystine
NON OPAQUE
With normocalcemia (obstruction, UTI renal tubular acidosis, medullary sponge kidney)
With Hypercalcemia (HPT, excess Vit D, milk-alkali synd. sarcoid)
PURE CALCIUM OXALATE due to HYPEROXALURIA
Primary Oxaluria rare AR
Enteric Oxaluria
URIC ACID
With hyperuricemia (gout, myeloproliferative disease, antimitotic chemotherapy
With normouricemia idiopathic)
XANTHINE
Due to failure of normal oxidation of purines -
Gas in the Urinary Tract
Gas in the Bladder -
vesiculointestinal fistula
cystitis (gas forming organisms)
following instumentation
penetrating wounds -
Gas in the Urinary Tract
Gas in the Bladder Wall - emphsematous cystitis (usually in DM)
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Gas in the Urinary Tract
Gas in the Ureters and Pelvicalyceal Systems -
Any cause of gas in the bladder
Ureteric diversion
Fistula
Infection - Non Visualization of One Kidney During Excretion Nephrogram
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Absent kidney
Ectopic Kidney
Chronic Obstructive Uropathy
Infection
Tumor
Renal Artery Occlusion
Renal Vein Occlusion
Multicystic Kidney - Unilateral Scarred Kidney
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Reflux Nephropathy
TB
Lobar Infarction
Renal Dysplasia
DDx persistent fetal lobulation - Unilateral Small Smooth Kidney
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With a Dilated Collection System
post obstructive atrophy
With a Small-Volume Collecting System
Ischemia
Ischemia due to Renal artery Stenosis
Radiation Nephritis
End result of renal Infarction
With 5 or Less Calyces
Congenital hypoplasia - Bilateral Small Smooth Kidneys
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generalized arteriosclerosis
chronic glomerulonephritis
chronic papillary necrosis
arterial hypotension
Causes of unilateral small smooth kidneys happening bilaterally - Unilateral Large Smooth Kidney
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Compensatory hypertrophy
Obstructed kidney
pyonephrosis
duplex kidney
Tumor
crossed fused ectopia
multicystic kidney
acute pyonephritis
trauma (hematoma/urinoma)
renal vein thrombosis
acute arterial infarction
adult polycystic kidney disease - Bilateral Large Smooth Kidneys
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PROLIFERATIVE AND NECROTIZING DISORDERS
acute glomerulonephritis
polyarteritis nodosa
Wegener's granulomatosis
Goodpasture's
SLE
DEPOSITION of ABNORMAL PROTEINS
amyloid
multiple myeloma
ABNORMAL FLUID ACCUMULATION
acute tubulat necrosis
acute cortical necrosis
NEOPLASTIC INFILTRATION
leukemia and lymphoma
INFLAMMATORY CELL INFILTRATION
acute interstitial nephritis
MISC
Polycystic Kidney disaese
Sickle Cell Anemia
Acromegaly - Localized Bulge of the Renal Outline
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cyst
tumor
fetal lobulation
dromedary hump
enlarged septum of Bertin
localized hypertrophy
acute focal nephritis (lobar nephronia)
abscess
non-functioning moiety of a duplex - Cortical defects in Radionuclide Imaging
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scars
hydronephrosis
trauma (subcapsular or or itrarenal)
renal cysts
carcinoma
infarct or ischemia
abscesses
Mets
Wilm's Tumor - Renal Neoplasms in an Adult
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Malignant
RCC
TCC
SCC
Leukemia/lymphoma
Mets
Benign
Hamartoma
Adenoma
Other (myoma, lipoma, hemangioma, firoma-all rare) - Primary Renal Neoplasms in a Child
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Wilm's tumor
nephroblastomitosis
congenital mesoblastic nephroma
clear cell sarcoma
rhabdoid tumor of the kidney
multilocular cystic neoroma
RCC
angiomyolipoma -
CT Kidney
Focal Hypodense Lesions -
Tumors Malignant
RCC
Mets
Lymphoma
TCC
Wilm's
Benign Tumors
oncocytoma (adenoma arising from proximal tubular cells, sometimes has centarl scar if > 3cm)
Angiomyolipoma
Inflammation
Ascess
Xanthogranulomatous pyelonephritis
acute focal bacterial nephritis
Vascular
infarcts - Classification of Renal cysts
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Renal Dysplasia
multicystic kidneys
focal anf segnental cystic dysplasia
posterior urethral valves in males
Polycystic Disease
ARPKD
ADPKD
Cortical Cysts
simple cyst
multilocular nephroma
syndromes associated with cysts
Zellweger's
TS
Turner's
von Hippel-Lindau
trisomy 13 18
Meduallary Cysts
calyceal cyst (diverticulum)
medullary spong kidney
papillary necrosis
juvenile nephronopthisis (medullary cystic disease)
Miscellaneous Intrarenal Cysts
Inflammatory (TB, calculus, hytatid)
Neoplastic (cystic degeneration of a carcinoma
Traumatic
Extraparenchymal renal Cysts
Parapelvic cysts (does not communicate with the renal pelvis)
perinephric cyst ( beneath the capsule or between the capsule anf the perinephric fat - CT Renal Cysts
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Simple
malignant (5%of RCC are cystic)
Polcystic
Hemodialysis related
von Hippel Lindau (associted pancreatic, hepatic cysts RCC anf pheochromocytoma
Hydatid
Multicystic
cystic hamartoma - Reanal Mass in Newborn and young Infant
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hydronephrosis
multicystic kidney
polycystic kidney
renal vein thrombosis
nephroblastomatosis or mesoblastic nephroma
renal ectopia - Hydronephrosis in a Child
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pelviureteric obstruction (more common on the left)
bladder otflow obstruction
uretervesical obstruction
associated with UTI
Neurogenic - Nephrographic Patterns
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Immediate Faint Persistent Nephrogram
proliferative necrotizing disorders
renal vein thrombosis
chronic severe ischemia
Imeddiate Distinct Persitent Nephrogram
acute tubular necrosis
other causes of acute renal failure
acute on chronic renal failure
acute hypotension
Increaingly Dense Nephrogram
acute obstruction
acute hypotension
acute tubular necrosis
acute pyelonephritis
multiple myeloma
renal vein thrombosis
acute glomerulonephritis
amyloid
acute papillary necrosis
Rim Nephrogram
severe hydronephrosis
acute complete arterial occlusion
Striated Nephrogram
Acute ureteric obstruction
infantile polycystic kidney disease
medullary sponge kidney
acute pyelonephritis -
Renal papillary Necrosis
ADIPOSE -
analgesics
diabetes
infants in shock
pyelonephritis
obstruction
sickle cell disease
ethanol -
Renal Induced Hypertension
Renal Artery -
Athrosclerosis 66%(stenosis of the proximal 2cm)
FMD 33% (string of beads appearance, mainly females< 40 bilateral 40%)
Thromboosis
Embolism
Arteritis
Neurofibromatosis
Trauma
Aneurysm
arteriovenous fistula
extrinsic compression -
Renal Induced Hypertension
Chronic Bilateral Parenchymal Disease -
Chronic Glomerulinephtitis
Reflux nephropathy
Adult polycystic Disease
Diabetic glomerulosclerosis
Connective Tissue disorders (sle scleroderma PAN)
Rx
Analgesic nephropathy
Renal vein thrombosis -
Renal Induced Hypertension
Unilateral Parenchymal Disease -
less common cause of hypertension
Reflux nephropathy
Tumors (rare juxtaglomerular tumor secretes renin)
Xanthogranulomatous pyelonephritis
Rx
renal vein thrombosis -
Renal Vein Thrombosis
Children -
Dehydration and Shock
Nephrotic Syndrome
Cyanotic Heart Disease -
Renal Vein Thrombosis
Adults -
Extension of renal cell carcinoma into renal veins
Local compression by tumor or retroperitoneal nodes
Extension of thrombus from IVC
Trauma
Secondary to Renal Disease - Non Visualization of Calyx
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Tumor (RCC adult/Wilms child)
Obstructed Infundibulum (tumor, calculus or TB)
Duplex Kidney
Infection (abscess or TB)
Partial Nephrectomy -
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Extrinsic with a smooth margin -
cyst
vascular inpression
renal sinus lipamatosis
collateral vessels -
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Seperate from the wall and with a smooth margin -
blood clot
papilloma
pyeloureteritis cystica -
Radiolucent filling Defect in the Renal Pelvis or a Calyx
Arising from the wall with an irregular margin -
TCC
SCC
RCC
Squamous metaplasia (cholesteatoma (occurs rarely in association with acute inflammation) -
Radiolucent filling Defect in the Renal Pelvis or a Calyx
In the lumen -
Blood clot
lucent calculus
sloughed papilla
air - Dilated calyx with a narrow infundibulum
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stricture
extrinsic impression by an artery
hydrocalycosis May be a congenital disorder, can only be safely diagnosed in kids when calculus tuberculosis are uncommon) - Dilated calyx with a wide4 infundibulum
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post obstructive atrophy
megacalyces
polycalycosis -
Dilated Ureter
Obstruction
within the lumen -
calculus
blood clot
sloughed papilla -
Dilated Ureter
Obstruction
in the wall -
edema or stricture secondary to calculus
tumor
TB stricture
schistosomiasis (especially distal ureter)
post surgical trauma
ureterocele
megaureter -
Dilated Ureter
Obstruction
outside the wall -
retroperitoneal fibrosis
carcinoma cervix, bladder, prostate
retrocaval ureter (right side only) -
Dilated Ureter
Vesicoureteric Reflux
No obstruction or reflux -
post partum
foloewing relief of an obstruction
UTI
Primary non obstructive megaureter - Retroperitoneal reflux
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Idiopathic >50%
Retroperitoneal malignancy (lymphoma mets from testicular ca)
Aortic aneurysm (secondary to blood)
trauma (")
surgery (")
Inflammatory conditions
connective tissue diseases (ank spond, sle, wegeners, Pan
Drugs (methysergide) - Differential Diagnosis of Medially Placed Kidneys
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Normal variant 15%
pelvic lipomatosis
folowing abdominoperineal surgery
Retrocaval ureter (right at level L4) -
Filling Defect in the Bladder
In the wall or in the lumen) -
prostae
neoplasm
blood clot
instrument
calculus
ureterocele
schistosomiasis
endometriosis - Bladder calcification
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In the lumen
calculus
foreign body
In the wall
TCC
Schistosomiasis
TB
cyclophosphamide induced cystitis - Bladder Fistula
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Congenital
Ectopia Vesicae
imperforate anus (high type)
patent urachus
Inflammatory
Diverticulae disease
Crohns Dx
Appendix Abscess
Neoplastic
Ca bldder,colon, reproductive organs
Rx
Trauma
accidental
iatrogenic - Bladder Outflow Obstruction in a Child
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Causes from proxomal to distal
Vesical diverticulum (posterior behind bladder base)
Bladder neck obstruction
Ectopic uretrocele
posterior urethral valves
urethral stricture
anterior urethral diverticulum
prune belly syndrome
calculus or foreign body
meatal stenosis
phimosis
most common
male posterir urethral valves
femaes ectopic uretrocele - calcification of the Seminal Vesicles Vas Deferens
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Diabetes
chronic Infection TB, schistosomiasis, chronic UTI syphilis
Idiopathic -
US of the Testes and Scrotum
Neoplastic -
Germ cell Neoplasms (95% primary germ cell tumors 40% mixed histology 8% bilateral)
a seminoma most common
embryonal cell carcinoma
choriocarcinoma
teratoma
Non germ cell tumors (usually benign may screte estrogens (Sertoli) or Testoterone (Leydig)
(Mets kidney, prostate,brochus
more common than germ cell tumors over 50) -
US of the Testes and Scrotum
Vascular - Testicular torsion
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US of the Testes and Scrotum
Inflammatory -
Orchitis
Abscess -
US of the Testes and Scrotum
Idiopathic non-neoplastic cysts -
Tunica Albuginea Cyst 2-5mm upper/anterior/lateral part of the testis uni/multilocular
Simple cyst > 40yo 2-20 mm usually solitary loacted near the mediastinum -
US of the Testes and Scrotum
Extratesticular -
Inflammatory
Epididymitis
Idiopathic
Hydrocele (fluid anterolaterally)
Vascular
varicocele
Neoplastic
Adenamatoid tumor of the epididymid (benign)