case review VIR
Terms
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- Leriche
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Absent femoral pulses
Buttock and hip claudication
Impotence - Leriche collateral
- SMA to enlarged marginal artery of Drummond to IMA, to internal iliacs to CFA
- Bear-paw sign
- Fragmented staghorn calculus. Fragmentation occurs due to infection. There is replacement of the parenchyma by hypodense material within which is contained calcified stone bodies. The whole thing looks like a bear's paw and represents XGP.
- Stone with long spikes
- JACK STONE = Calcium oxalate stone. Easy to lithotripse.
- Most common cause of cortical nephrocalcinosis
- Cortical necrosis due to major vascular insult
- Next 3 most common causes of cortical nephrocalcinosis
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Chronic glomerulonephritis
Oxalosis
Alports
Mnemonic == too much "coac" gives you cortical necrosis from major vascular insult.
Cortical necrosis
Oxalosis
Alports
Chronic glomerulonephritis - Most common causes of medullary nephrocalcinosis
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Medullary sponge
RTA, distal, Type 1
Hyperparathyroidism (or any cause of hypercalcemia and/or hypercalciuria) - Hypodense kidney with renal artery contrast filled right up to margin of kidney
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ARTERIAL CUT-OFF sign
= Renal artery thrombosis - Rim of perfusion at edge of kidney
- Rim sign = evidence of renal artery thrombosis
- Edge of kidney hypodense, while medullary portion enhances
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Reverse rim sign
Evidence of CORTICAL NECROSIS with preservation of medullary bloodflow. If the patient survives the vascular catastrophe, she will develop cortical nephrocalcinosis. - Enlarged central hypodensity with thin rim of enhancement
- Hydronephrotic rim sign
- Early image from XU with patches of enhancement, then on delayed nephrogram, patches become big and septations between the spots are seen
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Spotted nephrogram
=
Polyarteritis nodosa
Scleroderma
Hypertensive nephrosclerosis
ON CT, THIS LOOKS LIKE A STRIATED NEPHROGRAM - Dilated collecting system with cortical enhancement and thin line of dense enhancement directly adjacent to the calyx in the deepest portion of the medulla.
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CRESCENT SIGN
Caused by re-orientation of tubules from perpendicular to the calyx to horizontal, following the calyx. THIS INDICATES RECOVERABILITY OF FUNCTION, even if creatinine is chronically elevated, and means decompression of the collecting system should be performed.
It has a much more positive connotation than does rim sign of hydronephrosis - XU with dialated collecting system. The ureter is seen exiting the pelvis from a more inferior than normal position
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BALLOON on a STRING appearance = UPJ obstruction
LOOK FOR CROSSING VESSEL AS CAUSE, as always, ESPECIALLY in adults, as more than 1/2 are due to this. - Renal hematoma
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LOOK FOR THE CAUSE
1) Renal cell CA
2) AML
3) Aneurysm
4) Trauma - Thin fluid collection surrounding kidney
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KIDNEY SWEAT
Seen in acute renal failure - Horseshoe kidney
- LOOK FOR VERTEBRAL, ANORECTAL, TRACHEAL, AND ESOPHAGEAL ANOMALIES (VACTERL ASSOCIATION) as this can be part of the anomaly
- What does horseshoe kidney as well as pelvic kidney have
- Anomalous blood supply from the aorta, since it didn't ascend, picking up new vessels along the way.
- Indications for tips
- intractable ascites and refractory variceal bleeding.
- Goal of tips
- portal systemic gradient less than 12.
- Sign of acute vascular embolism
- meniscus sign, lack of collaterals,. Clinical syndrome of cold painful leg with pallor cyanosis or paresthesias.
- Rare cause of arterial embolus
- left heart tumor