laboratory skills session on radiology

OS 214

Laboratory Skills Session: Radiology

Kristina, Richard, Leah, Dalvie

Outline:I. Interpretation of Imaging ResultsII. CT ScanIII. UltrasoundIV. X-Ray

NOTE: NO COPY OF THE PPT WAS GIVEN. HENCE, THE IMAGES IN THIS TRANS ARE STOLEN PICTURES OF THE PPT.

It is important to develop the skill, early on, in detecting the most common diseases that one will encounter in his/her medical practice. With that, we have been presented with the imaging results of the typical diseases in the country.

INTERPRETATION OF IMAGING RESULTS

Ptotic or Pelvic Kidney Wandering kidney The normal level of the kidney is T12 to L3 and the left

kidney is normally higher by 2 cm. o Sometimes it starts at T11.o For the ptotic kidney, the level is lower than this.

On chest X-ray, a pulmonary mass may be seen. Make sure that this is not a kidney as there have been cases of intra-thoracic kidney.

Common complaints of pain and dysuria Possible complication is infection.

Horseshoe Kidney The inferior pole of each kidney is connected to each

other. Usually, the ureters are normal. However, sometimes,

the ureters might be caught up. Possible complication is infection. A good exam question but we rarely see it.

Crossed Ectopy Aberrant position of the kidneys and the lateral

positioning of the calyces. There could be formation of kinks and predispose one to

the formation of stones. The two kidneys could be on one side. In this case, both

kidneys are lower than the normal level.

Renal Cortical Cyst On ultrasound, it is hypoehoic. On X-ray, it is seen as lucency within the renal shadow,

which is typically increased in this case. The overlying bowel segments can be confused as

cysts. Claw or Beak Sign where in the calyces are compressed

making them appear like a lobster claw.

Polycystic Kidney Disease Multiple cysts On CT scan, it is seen as hypodensities that are fluid

filled. It can exist by itself or with other diseases. Can be found in obese women with hormonal problems.

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Duplication Anomalies The most common congenital anomaly Duplication of collecting systemo It could be the pelvocalyx or the ureter.

Weigert-Meyer Ruleo 2 moieties drained by 2 collecting systemo The lower ureter drains 2/3 of the kidney and is prone

to obstruction.o The upper ureter drains 1/3 of the kidney and is more

associated with hydronephrosis.

GU TB Waste basket It might be TB when one doesn’t know what is going

wrong Calcifications are the most common manifestation of TB

in the renal system. It can cause strictures. If one has GU TB, most probably the patient had already

presented with pulmonary symptoms. However, there could be cases when there are no pulmonary symptoms and the TB is already disseminated to the other systems.

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Pyelonephritis Enlargement of solitary kidney Perilesional fat strandingo Sign of inflammatory process.o It could be infection or carcinoma

Renal Abscess On CT scan, it can be seen as mixed echoic focus,

heterogeneously enchancing.

On X-ray, it can be seen as hypolucencies in the kidney. Enlarged renal shadow with air pockets within. Normal size of the kidney based on US values is 10-15

cm. In the Philippines, it’s about 6-8 cm. It can be normal as long as it is within this reference ranges. Start thinking it’s pathologic when the difference in size in both kidneys is more than 1.5 cm.

Nephrocalcinosis Calcification of parenchymao 95% at the medullao 5% at the cortex

Usually, bilateral. It follows the shape of the renal pyramids. Nephrolithiasis usually conforms to the contour of the

pelvocalyx. If it is of the staghorn type, it is managed surgically.

Urolithiasis Stone anywhere in the urinary tract Staghorn calculus Bladder calculus or cystolithiasiso Pathognomonic sign is lamellated, ovoid/circular,

overlying the urinary bladder within the pelvic cavity.

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Renal Cancer Differential is abscess. Mixed attenuating, heterogeneously enhancing. It leads to necrosis giving rise to fluid and solid

densities. Hence, there will be hypo- and hyperdensities.

Cystitis Infection of the bladder Irregular lining Thickened mucosal lining Christmas tree sign

Bladder Mass There is filling defect.

Bladder Exstrophy Widened symphysis pubiso Normal value is 5 mm. If more than this, check for

history of trauma. Outline of bladder protruding If post-partum, the symphysis pubis is normally laxed

reaching about 7-10 mm. It will take 2 weeks to 1 month before it returns to normal.

Bladder Diverticulum Outpouching of the bladder Can be seen as Mickey Mouse. It can lead to urinary tension. Symptom is urgency. There is urine retention and incomplete emptying of the

bladder.

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Prostatomegaly Filling defect at bladder base Increased incidence among males, age more than 50

and if presenting with dribbling and hesitancy.

CT SCAN

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Used to image the GU system Cystonogram can detect stones within the GU tract. Done in a cranial to caudad direction. Ask the patient to ingest fluids to so the bladder will be

full and can be assessed adequately. Hyperdensityo Whitish and similar to bone

Isodensityo Like soft tissue

Hypodensityo Gray to dark gray and like fat

Circle function is used to assess the composition.o -1000 or lower

Airo -40 to -100

Fato 0

Watero 40 to 80

Soft tissueo 50 to 75

Fresh bloodo 100 to 1000

Osseous structures Ounce/unit is used to characterize densities. If the kidney is smaller and no long appear as bean-

shaped, it is more diseased. To check cortical thickness, do NOT use CT scan. Use

ultrasound.

ULTRASOUND

Curvilinear probe is used for deeper structures. Linear probe is used for superficial structures.

X-RAY

GREETINGS

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Tin:

Ricky:

LeeAnn:

Dalvie: Hello! And Yes! Mara is back! Alive na Alive! And oh oh oh! I am Number 10! I am Number 4 is just soooooo! Pak na Pak! Haaay. Better than Twilight series. But I still love Twilight. And Enrique Gil is back! Mula sa Puso Remake! I so love Thia (Pinoy Power) and Stefano! American Idol Season 10! May GOD BLESS you all!

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laboratory skills session on radiology

Documents

pelvic kidney

left kidney

ptotic kidney

horseshoe kidney

system o

medulla o

urinary bladder

bladder mass