CORE Case 7 Workshop Renal and GU

Learning Objectives Explain what is Contrast-Induced Nephropathy List risk factors for Contrast-Induced Nephropathy Choose which patients with known or suspected urolithiasis should be imaged by CT or US Describe the imaging findings of nephrolithiasis and urolithiasis on CT and US

Learning objectives Describe when imaging is needed in pyelonephritis Describe the imaging workup for painless hematuria Compare and contrast the typical appearance of simple renal cysts and solid renal masses on CT & US

What difficulties did you encounter with CORE Case 7?

What is Contrast-Induced Nephropathy (CIN)?

List risk factors for Contrast-Induced Nephropathy (CIN)

What if patient is on Metformin?

How can we reduce risk of Contrast-Induced Nephropathy?

How can we know who can safely get IV contrast?  

What are non-contrast CT findings of obstructive ureterolithiasis?

Can intrarenal or ureteral stones be seen on CT with IV contrast?

1 hr later

13 months later

What are usual complaints in a patient with stone disease (nephroureterolithiasis)? What can mimic stone disease?

In suspected urinary stone disease… Who would you image by CT In suspected urinary stone disease… Who would you image by CT? Who would you image by US? Why?

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How can we decrease radiation burden in patients with suspected ureteral stones?

What are the Ultrasound findings of nephroureterolithiasis?

Superior Inferior

Superior Inferior Shadowing

Superior Inferior

Superior . Longitudinal image

Patient with recurrent flank pain )

Same patient…

Same patient…

Same patient

CECT

When is imaging needed in patients with pyelonephritis?

What study would you choose in complicated pyelonephritis if the patient is pregnant?

What are the findings?

List conditions that predispose to Urinary Tract Infection

What is a CT urogram? When might we perform one?

1 2 3

What are potential causes of hematuria?

How do we approach imaging in patients with hematuria?

When is imaging workup NOT needed with microscopic hematuria When is imaging workup NOT needed with microscopic hematuria? What factors guide imaging work up in microscopic hematuria?

How do renal simple cysts look on imaging US and CT and MR?

Increased Through Transmission cyst Increased Through Transmission

How do solid renal masses look on imaging?

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Cyst Solid mass CT Density CT Enhancement Margin Character US lesion echo features US echo features deep to lesion

Cyst Solid mass CT Density CT Enhancement Margin Character Low attenuation Heterogeneous, near density of renal parenchyma CT Enhancement None Yes, heterogeneous Margin Character Smooth Irregular US lesion echo features Anechoic Mixed echogenicity US echo features deep to lesion Enhanced through transmission Not altered