1. No category

2006 ORAL BOARD REVIEW: GU
Diagnosis
Modality
Information
ADRENAL
Previous infection, Granulomatous disease,
of hemorrhage resultin in Addison's
disease. Think TB, Sarcoid.
Adrenal Calcification
CT
Adrenal Cortical Carcinoma
CT
Non-Adenoma Adrenal mass. DDx: Adrenal
Cortical Carcinoma, Pheo, Mets.
Adrenal Cortical Carcinoma
MRI
Large and Heterogeneous with nonenhancing central "scar-like" necrosis. 50%
are functional. Mets via renal vein and
regional LN.
Adrenal Cyst
CT
Fluid attenuation on CECT with no
perceptible wall.
Adrenal Hemmorhage
CT
DDx: Mets, adenoma, granulomatosis (TB,
Histo), MEN (B pheo). Hemm may lead to
IVC thrombosus and Addison's
Adrenal Hemorrhage
MRI
Irregular with low signal. Hem in underlying
adrenal adenoma, in this case. Underling
Mets/ACC cannot be excluded.
Adrenal Hyperplasia
CT
Bilateral Nodular Thickening. DDx: Mets,
Granulomatous Infection, Hem.
Adrenal Lipid Poor Adenoma CT
(E-D)/(E-U) > 60%
Adrenal Myelolipoma
CT
Macroscopic Fat
Adrenal Myelolipoma
MRI
Largesuprarenal mass with fat supression.
If very large and in RP location, can't
entirely excluded Liposarcoma.
Ganglioneuroma
MRI
Heterogeneous Adrenal Mass. No signal
loss on OOP -> not an adenoma. No focal
fat to suggest AML. Large size favors
malignancy: Mets vs. Primary - ACC, Pheo,
Ganglioneuroma
Lipid Rich Adenoma
MRI
Signal loss on out-of-phase sequence.
Visual vs. Quantitative (>16.5% signal drop)
Pheochromocytoma
CT
Heterogeneous Adrenal Mass with cystic
components. Pheo>Mets or ACC
Pheochromocytoma
MRI
T2 "Lightbulb" bright, may be
heterogeneous. No signal loss with fat
suppression or phase opposition.. DDx:
Lipid Poor Adenoma
GU
Other
5/22/2007 2:56 PM
Irregular Large Mass. 50% may be functioning.
Must be homogeneous to do washout calculation
Macroscopic Fat (fat saturation) vs. Microscopic Fat
(out of phase signal loss = Lipid Rich Adenoma)
Adrenal Fat : Signal Loss on Opposed phase =
microscopic fat = Lipid Rich Adenoma. Fat
Suppression = macroscopic fat = Myelolipoma.
Pheo seen in MEN I, MEN II, and NF.
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2006 ORAL BOARD REVIEW: GU
BLADDER
Double density, medial deviation.
Bladder Diverticulum
IVU
Bladder Leiomyoma
MRI
Smooth bladder wall mass in a young
woman. DDx: TCC, Leiomyosarcoma,
pheo.
Emphysematous Cystitis
CT
Wall + Lumen. Lumen only => fistula.
Extraperitonal Bladder
Rupture
CT
Molar tooth sign = Space of Retzius
Hemorrhagic Cystitis
IVU
Multiple blood clots in Bladder. Causes:
chemical toxin, cyclophasamide, radiation,
immune mediated, idiopathic.
Inguinal Bladder Herniation
MR
Two stage voiding.
Lymphoma
CT
Diffuse bladder wall thickening: Cystitis
(cyclophosphamide, radiation, TB) TCC
(generally more focal), neurogenic bladder,
outlet obstruction, Lymphoma.
Urachal Adenocarcinoma
CT
Adenocarcinoma: Bladder Extrophy, Cystitis
Glandularis, Prune-Belly
Hypotension + Tachycardia
IVU
Endometrioma
MR
Gonadal (Ovarian) Vein
Thrombosis
CT
Post-partum uterus with throbosed and
expanded vessel
Mucinous Cystadenoma
MRI
Unilocular Ovarian Cyst. Management:
Follow-up or resect base on size (>3 cm or
>5cm?)
Ovarian Dermoid (Teratoma) MR
DDx: Dermoid [Fat Sat], Hyperdense Cyst,
Endometrioma [T2 Shading]
GU
RX: Different that emphysematous cholecystis.
Bladder Calcification: TRASH = TB, Radiation,
A lkaline Encrustation, Schistosomiasis, Hemoragic
Cystitis (Cytoxan)
CONTRAST
Anaphylactoid. Start 0.9 NS with elevation
of feet. Titrate: 1-3 ml of 1:10,000
Epinephrine over 3-5 minutes.
OVARY
Homogenous Ovarian Mass. DDx:
Hemorrhagic Cyst [T1 and T2 bright],
Dermoid [Drop with Fat Suppresion],
Endometrioma [Shading = less bright on T2,
often bilateral]
5/22/2007 2:56 PM
CA-125 may be elevated in endometrioma and
other benign conditions, such as leiomyoma and
PID.
Rx: Abx and anti-coagulation
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2006 ORAL BOARD REVIEW: GU
Ovarian Firbrous Tumor
MRI
Enhancing T1/T2 Dark ovarian tumor. DDx:
Fibroma, Fibrothecoma, Thecoma
Thecoma associated with endometrial hyperplasia
and cancer. Fibroma associated with Meig's
Syndrome.
Papillary Serous Tumor
MR
Partially cystic enhancing mass. Papillary
projections = ovarian epithelium neoplasm
Increasing number = higher risk of
malignancy.
Paratubal Cyst
MRI
PCOS (Stein-Leventhal)
MR
T2 bright cystic lesion superior to gravid
uterus. DDx: Corpus lutein or theca lutein
cyst, paraovarian cyst (peritoneal inclusion
or paratubal), duplication or urachal
remnant.
Multiple peripheral cysts. DDx: Overarian
hyperstimulation.
Ovarian Tumors : Epithelial (Serous or Mucinous
Cystadeno(carcino)ma, endometrioid, clear cell,
brenner); Germ Cell (Dysgerminoma,
choriocarcinoma, \etc); Sex chord-stromal
(Granulosa, Sertoli-Leydig, Thecoma, Fibroma);
Mets (Uterine, Stomach, Colon, Breast, Thyroid,
Lymphoma)
No contrast given secondary to pregnancy.
PROSTATE
Prostate CA
MRI
ADPCKD
MR
RENAL
Affecting Liver and kidneys. Internal debris.
Air in collecting system
IVU
Infection, instrumentation, fistual (xgp).
Angiomyolipoma
MR
Macroscopic Fat (fat saturation India Ink)
vs. Microscopic Fat (out of phase signal
loss = Clear Cell RCC)
Angiomyolipoma (TS)
IVU
Dysmorphic splaying of Bilateral Calyces =
multiple renal masses. RCC in VhL. Cysts
in APCKD. AML in TS.
Calyceal Diverticulum
CT
Layering milk of calcium in renal cystic
lesion.
Clear Cell RCC
MRI
Opposed phase signal loss WITHOUT India
Ink artifact
GU
Tumor is dark on T1 and T2 in background
of glandular tissue in peripheral zone.
Contralateral T1 bright area is post-biopsy
bleeding.
5/22/2007 2:56 PM
No contrast given at UofM for prostate.
Renal microscopic fat = Clear Cell RCC.
Macroscopic=AML
AML = India ink and Fat Sat = macroscopic fat.
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2006 ORAL BOARD REVIEW: GU
Cystic Renal Mass
CT
If extends into the renal sinus, may suggest
Multilocular Cystic Nephroma , but still
categorize.
Fungus ball (infectious
debris)
IVU
Candida. Common with indwelling
catheters or with immunocompromise and
systemic candida.
Hemorrhagic Renal AML
CT
Fat containing lesion with retroperitoneal
fluid.
Large Smooth Kidneys
IVU
Malignancy: Leukemia, Lymphoma, Protein
deposition of MM. Inf/Inl: HIV, GN, AIN,
ATN. Deposition: Amyloid, Storage
diseases. CVD. Metabolic: DM. If NOT
smooth: add APCKD.
Medullary Nephrocalcinosis
US
95% of Nephrocalcinosis = medullary. DDx:
Hyperparathyroidism (#1), distal RTA,
Medulary Sponge Kidney, hypercalcemia,
hypercalcuria.
MSK is likely diagnosis in UNILATERAL medullary
nephrocalcinosis. MSK is bilateral 70%, likely
inherited = asymptomatic tubular ectasia.
Multilocular Cystic Nephroma CT
Cannot be differentiated from Cystic RCC
by imaging.
Herniation to pelvis.
Nephrocalcinosis - Cortical
Chronic GN, Acute cortical necrosis
(Ischemia: hypotension), Other: Oxalososis,
Alport's, transplant rejection.
HPTH, RTA, Medullary Sponge Kideny
CT
Nephrocalcinosis - Medullary CT
Bosniak Classification. Surg vs. Non-Surg
I: Simple benign cysts II: <3 thin (≤ 1 mm)
septations, thin/fine calcification. Simple
hyperdense cyst (nonehancing + < 3 cm with ¼ of
wall extending outside the kidney) IIF: Minimally
complicated cysts that need follow-up. III: Uniform
wall thickening, nodularity, thick/irregular
calcification, or multilocular. Non-category II
hyperdense cyst. IV: Nonuniform or enhancing
(>10 HU) thick wall, enhancing or large, or clearly
solid components in the cystic lesion
Medullary Nephrocalcinosis: HPTH, RTA-1,
Medullary Sponge Kidney
Nephrocalcinosis - Medullary CT
Secondary to HPTH
Irregular renal calcification. DDx =
medullary nephrocalcinosis: HPTH, RTA,
Medullary Sponge (together = 80%), other.
Oncocytoma
CT
Chocolate Starfish. Wagon Wheel.
Central Scar. Origin=proximal tubular
epithelium. DDX = RCC, which cannot be
excluded.
Central Scars : FNH, Oncocytoma, Serous
Cystadenoma
Papillary necrosis
IVP
Sloughed papilla in collecting system with
blunted and deformed calyces. Etiologies:
DM, Sickle Cell, Analgesic abuse, Infection
(TB), obstruction.
Calyceal blunting. DDx: SAD = SSdz, Analgesia,
DM.
Perirenal Lymphoma
CT
May look like fluid and be unilateral. Key =
perihilar extension. DDx: Bleeding tumor.
Polyarteritis Nodosum
CT
Renal low attenuation with overlying cortical
defects. DDx: Prior ischemia: emboli,
vasculitis, FMD, or Reflux.
GU
5/22/2007 2:56 PM
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2006 ORAL BOARD REVIEW: GU
Pyelonephritis
CT
Bilateral ill-defined low attenuation renal
lesions. DDx: Leukemia/Lymphoma,
Infection, Infart.
Radiolucent Uric Acid Stone
IVU
RCC
CT
Renal pelvic filling defect: TCC, Clot,
Stone, Fungus Ball/infectious debris.
Patient has Gout.
Evaluate for Tumor thrombus
RCC
IVU
Calcified Renal Mass
60% of calcified renal masses are RCC. Rim of
calcification, however, is more common with
complicated cysts than RCC (80:20%)
RCC
US
Hyperechoic mass without posterior
acoustic shadowing. Looks like an AML!!!
RFA: Need for nephron sparing, non-surgical
candidate, small size, polar location, no heat sink.
RCC (Clear Cell)
MRI
Renal Mass (countour abnormality) with
signal loss on opposed phase. =
microscopic fat. No macroscopic fat to
suggest AML>
Renal microscopic fat = Clear Cell RCC.
Macroscopic=AML
RCC in Acquired Cystic
Renal Disease
CT
Ascites and peritoneal calcification
consistent with PD.
RCC with IVC invasion
MRI
IVC has both tumor (enhancing with signal
following that of tumor) and upstream bland
(non-enhancing) thrombus.
Reflux nephropathy
IVU / MR Calyceal blunting with thinning of overlying
cortex.
Renal Artery Aneurysm
CT
Looks like renal mass but on contrast
imaging is as bright as the aorta. Don't
Biopsy!!
Renal Failure
IVU
Markedly delayed Nephrogram (Days)
Renal Infarct
CT / MR DDx: Pyelonephritis. "Cortical Rim Sign" or
capsular enhancement is supposed to be
diagnostic.
Renal Lymphoma
CT
Multiple LALs DDx: Mets (lung, breast,
melanoma), abscess, infarct, RCC (vHL),
oncocytoma, Lymphoma.
Renal Lymphoma
MR
DDx: Mets (breast, lung), multiple RCC
(rare), leukemia.
Renal Lymphoma
US
Multiple hypoechoic lesions. DDx:
Pyelonephritis. If bilateral = lymphoma.
GU
5/22/2007 2:56 PM
Classic = Striped nephrogram . DDx: Obstruction,
RVT, arterial insult.
Robson Staging: Stage 1 - Confined to the
kidney, Stage 2 - Confined to Gerota's fascia
intact, Stage 3 - Spread into renal vein, Stage 4 Spread into adjacent or distant organs
RCC is generally debulked regardless of stage.
But extension above the diaphragm changes the
surgical approach.
Renal Parenchymal Loss - Focal: Infarction. Multifocal: Reflux. Global: Post-obstructive atrophy,
RAS. If calices are blunted = reflux/obstruction.
Renal Lymphoma patterns (5): #1= multiple
masses. Single mass, diffuse infiltration,
perinephric, or hilar.
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2006 ORAL BOARD REVIEW: GU
Renal Medullary Cancer
CT
Type of RCC.
Sickle Cell Disease
Renal Obstruction
CT/US
Delayed/Persistent Nephrogram with
echogenic focus at ipsilateral UVJ. May
have asymmetric jet.
Unilateral Delayed Nephrogram DDx: RVT,
Pyelo, Obstruction. Bilateral: add ATN,
Hypotension, contrast nephropathy.
Renal TB
CT
Caliectasis with calcification. Also note
psoas calcifications.
Putty Kidney
Renal TB
IVU
Infundibular Stenosis: TCC or mass, TB.
May show irregular "smudgy" calyx.
RVT
US
Elevated RI's with reversal of diastolic flow.
DDx: Severe Rejection or ATN. May look at
flow in Renal Vein in new transplant <Fresh
Xplant lacks collaterals>
Schistosomiasis
IVU
Cowhorns - distal beaded ureter
Shock Nephrogram
IVU
Delayed Nephrogram (>15 minutes) =
Shock vs. ATN.
Staghorn Calculus
CT
If associated mass --> XGP
Subcapsular/perinephric
Hematoma
CT
DDx: Trauma, Iatrogenesis, Underlying
Mass. Must follow-up to resolution to
exclude mass.
TCC
CTU
Irregular filling defect in mid ureter. DDx =
clot vs. TCC. Goblet sign = distal dilatation.
Bergman's sign = coiling of catheter on
retrograde. Evaluate for
MULTICENTRICITY. TRx =
nephroureterectomy for proximla lesion,
ureterectomy with anastamosis for distal
lesion.
TCC
MRI
Filling defect in dilated renal pelvis. DDx:
Stone, clot, sloughed papilla, fungal.
Tuberous Sclerosis
CT
Bilateral AMLs. >2 or larger than 3-4 cm =
TS
Urinoma
MR
Secondary to obstruction and calyceal
rupture or traumatic UP laceration.
VHL: Renal>Pancreatic. ADPCKD: Renal>Liver.
von Hippel Lindau
CT
Renal and pancreatic cysts. 40% will
develop RCC.
VHL: Renal>Pancreatic. ADPCKD:
Renal>Liver.
AD Inheritance: variable expression of: CNS
hemangioblastomas, retinal angiomas; renal
cysts and carcinoma; adrenal
pheochromocytoma; epididymal cystadenomas;
pancreatic cysts, cystadenomas,
cystadenocarcinomas, islet cell tumors, and
hemangioblastomas; hepatic adenomas and
hemangiomas.
GU
5/22/2007 2:56 PM
Scisto ascends. TB descends.
Trauma vs. Iatrogenic. Must follow-up.
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2006 ORAL BOARD REVIEW: GU
XGP
CT
Blood clot in renal pelvis
MRU
Fibroepithelial polyp
IVU
Elongated well defined linear filling defect in
the ureter. Urothelium over connective
tissue stalk.
Lateral Deviation of Ureters
IVU
Lateral = >1cm lateral to transverse
processes. DDx: RP Mass vs. normal
variant.
Medial Deviation of Ureters
IVU
Medial = medial to pedicles. DDx: RPF,
normal variant, APR (if in pelvis), pelvic
lymph nodes.
Obstructing calculus
US
Stone seen in mid ureter with
pelvicaliectasis.
Plakias
X
Malakoplakia - chonic inflammation.
Leukoplakia - premalignant.
Primary Megaureter
IVU
Primary vs. Secondary (obstruction, reflux,
diabetes insipidus. Primary = unilateral,
L>R, M>W, NO UPPER DILATATION.
MUST SEE PERISTALISIS IN PROXIMAL
URETER to call primary megaureter,
otherwise = obstruction -> TCC
Pseudodiverticulosis
IVU
Invagination of Mucosa. Benign marker for
malignancy.
Pseudoureterocele
IVU
If lucent outline >2mm a pseudoureterocele
should be questioned -- secondary to
obstructive lesion: stone vs. tumor.
Retrocaval ureter
IVU
Highly redundant. Wraps around cava.
May be symptomatic.
TCC
IVU
Ureter: Goblet Sign = distal dilatation
Urerteral
Pseudodiverticulosis
IVU
Associated with Neoplasm. Ureteritis
Cystica is NOT associated with neoplasm.
Ureteral Bud
IVU
Aborted duplication. May be secondarily
complicated by stone or infection.
GU
Chronic obstruction with struvite staghorn
calculus. Organisms: Proteus and E. Coli.
**When focal, may look like RCC
URETER
Irregular high T1 in pelvis. Must evaluate
for underlying cause: instrumentation,
trauma, anti-coag, inflammatory (stone vs.
infection), or neoplasm.
5/22/2007 2:56 PM
DDx of fibroepithelial polyp: Clot or TCC
Primary Megaureter = diminished peristalsis
through a distal segment that lacks normal
musculature. Similar to achalasia.
Not associated with Primary Megacalyces :
congenital underdevelopment of medullary
pyramids.
Orthotopic ureterocele is secondary to congenital
anomaly with failure of complete recanalization of
the fetal urter.
Renal: Calyceal location can cause and
"Amputated Calyx" secondary to obstruction.
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2006 ORAL BOARD REVIEW: GU
Ureteral Calculi
IVU
TB, Schisto (ascending), Stones
(steinstrasse)
Ureteral TB
IVU
Ureteritis Cystica
IVU
Shaggy Ureter with multiple strictures. TB
is descending, so kidney shows disease.
Innumerable fixed mural filling defects.
Results from chronic infection/inflammation.
May present with hematuria. No increased
risk of malignancy. DDx: multifocal TCC
(unlikely).
Ureterocele
IVU
Ectopic, Orthotopic (pseudoureterocele secondary to pathology, rim > 2mm)
Vascular Notching
IVU
Extensive crossing vessels. May indicate
RAS or RVT.
Diabetes
AXR
Ganglioneuroblastoma
MR
Surrounding IVC. DDx: Lymphoma, Neural
tumor, RPF, extra-adrenal pheo.
Non-Seminomatous GCT
CT/US
Obturator Hernia
CT
Solid RP Mass: Lymphoma, Sarcoma, LN
mets. Testicular US shows testicular
calcification = burnt-out GCT.
Lateral to inguinal hernia.
Plexiform Neurofibromas
CT
NF1. Looks like severe lymphoma with
expansionof neural foramina.
Psoas Abscess
CT
Cystic lesion of psoas. DDx: Abscess (TB,
Diverticulitis, Appendicitis), Tumor
(sarcoma), Hematoma (trauma,
iatrogenesis).
Retroperitoneal Fibrosis
CT
DDx: Lymphoma > mets, Sarcoma. Dx:
requires deep biopsy. Rx: steroids. Primary
= autoimmune. Secondary: drugs
(methergiside), malignancy, radiation,
aneurysm. DDx: Lymphoma,
aortitis/anuerysm, mets. May obstruct
kidneys.
Retroperitoneal Fibrosis
IVU
Medial deviation of the ureters: DDx:
Lymphoma - pushes ureters out in the
pelvis. APR will cause medial deviation in
the pelvis, secondary to loss of rectum.
Retroperitoneal Hematoma
CT
DDx: Anti-coag, iatrogrenic, trauma,
underyling tumor.
GU
Also with goblet sign in this case - ? Long standing
RETROPERITONEUM/PELVIS
Calcification of Vas and seminal vessicles.
5/22/2007 2:56 PM
8 of 12
2006 ORAL BOARD REVIEW: GU
Retroperitoneal Liposarcoma CT
Types: well-differentiated (least malignant),
myxoid, pleomorphic, round cell, dedifferentiated (most malignant). May calcify,
but calcification is more consistent with
teratoma.
Retroperitoneal Liposarcoma CT
DDx: Lipoma or fat containing sarcoma
Sarcral NF
CT
In NF1
Spindle Cell Sarcoma
MR
Large pelvic mass with cystic degeneration.
Sarcoma (leiomyosarcoma, rhabdomyosarc
in kids). Adenocarcinoma (prostate), but too
large in this case.
Burned Out Germ Cell
Neoplasm
US/CT
Course testicular cancer with low
attenuation LAD in RP.
Seminoma
MR
T2 is the best sequence for evaluation of
testicle. DDx: other germ cell tumors.
Solitary mass so other malignancies are
unlikely.
Testicular Mass
US
Following trauma. Must do short term followup. ?8-12 weeks to ensure resolution and
exclude mass.
Testicular Microlithiasis
US
Seen with testicular tumors. Questionable
significance.
Tubular Ectasia of the Rete
Testis
US
Dilated tubes.
Adenocarcinoma in Urethral
Diverticulum
Complicated Urethral
Diverticulum
MRI
#1 = SCCa
MRI
Septations c/w infection. Other
complications: infection, stone, cancer
(SCCa vs. AdenoCa)
Testicular staging: evaluate for local extension and
abdominal RP lymph nodes -- skips the pelvis.
URETHRA
Perforated Urethral Stricture RUG
Watering Can perineum = TB. Iatrogenesis
from instrumentation of stricture.
Squamous Cell Carcinoma
MR
Mass encasing the urethra. SCCa #1. DDx:
TCC, mets, leiomyoma, Adenocarcinoma if
from diverticulum.
TB Urethritis
RUG
Watering Can perineum = TB. DDx:
Radiation
Type III Urethral Injury
Pelvis/RUType I = stretch. Type II = above UG
Diaphragm. Type III = Extends below the
UGD.
GU
5/22/2007 2:56 PM
Iatrogenic stricture are short length, generally at
junction of ant/post urethra. Infectious most
common in anterior urethra with beaded longer
appearance. Glands of Littre visible in infection.
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2006 ORAL BOARD REVIEW: GU
Urethral Diverticulum
MRI
Fluid filled with F/F level. Look for neck.
Urethral Stricture
RUG
Infection likely to be anterior.
Adenomyoma
MR
Adenomyosis
HSG
Ectopic endometrial glands in the
myometrium (lollipop configuration). Diffuse
form enlarges the uterus (junctional zone
>12 mm on MRI). Focal disease =
adenomyoma DDx: leiomyoma.
Adenomyoma is oval and poorly
marginated, contiguous with the junctional
zone. Punctate high T2 in surrounding low
T2 mass.
Arcute Uterus
MRI
Normal variant
Artifacts
HSG
Air, mucus, clot. Carcinoma is rare in the
fertility population. Carcinoma is very
irregular.
Bicornuate Uterus
HSG /
MRI
DDx: Septate Uterus Intercornual distance
>4cm, or cleft >1cm implies bicornuate over
septate.
SEE GRAPHIC
UTERUS
Adenomyosis. Dx= junctional zone > 12
mm. 10-12 - equivocal, unless show
punctate high T2 foci. DDx of Adenomyoma
= Fibroid, which has more mass effect.
MRI: Divergent horns with cleft >1cm. Septum may
be myometrial or fibrous. Bicollis = Septum in
Cervix, Unicollis = no septum in cervix.
Bicornuate Uterus +
MRI
transverse septum in vagina
+ obstructed hemivagina
Cervical Agenesis
MRI
DDx: Stenosis -> Cancer, radiation,
instrumentation
Cervical Carcinoma
MRI
Look for intact rim of dark cervix and
invasion of parametrial fat.
Cervical Carcinoma - Late
Stage
MRI
Lobular mass centered at cervix with
extension to bladder.
GU
5/22/2007 2:56 PM
Staging is important. Look for invasion beyond the
parametrium which divides IIA from IIB and higher
stages. Stage: IA = confined to cervix, IB =
extension to uterus, IIA = extension to upper
vagina, IIB = extension to parametrium, IIIA =
extension into lower vagina , IIIB = pelvic wall
(hydronephrosis), IVA = adjacent organs, IVB =
distant organs.
Stage: IA = confined to cervix, IB = extension to
uterus, IIA = extension to upper vagina, IIB =
extension to parametrium, IIIA = extension into
lower 1/3 of vagina. IIIB = Hydronephrosis. IVA =
Adjacent Organs. IVB = Distant Mets.
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2006 ORAL BOARD REVIEW: GU
Coaptation
HSG
Central adhesion.
DES exposure
HSG
Hypoplastic T-shaped Uterus with bulbous
cornua, and irregular, lumpy cavity.
Didelphys Uterus
HSG
Note: two specula indicating two vaginas.
Didelphys Uterus
MRI
Septum in Vagina
Endometrial polyp
HSG
Smaller filling defect. DDx: bubble. May
involve the body, cornua or tube. Tubal
polyp = ectopic endometrium.
Endometrial polyp
MR
Demonstrates a stalk. DDx: endometrial
carcinoma vs. submucosal fibroid. TRx:
removal secondary to symptoms, collision
tumor, or malignant degeneration.
Essure sterilization
HSG
Endoscopically placed occlusion devices in
the tubes. HSG to ensure occlusion.
Hydrosalpynx.
HSG
Secondary to PID. Peri-tubal halo = spill
of contrast contained by adhesions.
Imperforate Hymen
MRI
Low vs. Vaginal agenesis = high
Intravasation
HSG
In-Utero DES exposure
HSG
T-Shaped irregular uterus. Increased risk of
Clear Cell Carcinoma of the Vagina
Isthmic occlusion
HSG
"Fill to you spill" or to point of
intravasation.
Proliferative endometrium
HSG
Multiple irregular confluent defects.
Salpingitis Isthmica Nodosum HSG
(SIN)
Salpingitis Isthmica Nodosa. Associated
with Infection: Diverticula of epithelium into
the muscular layer of the isthmus. DDx =
TB - larger collections, affecting
tubes>uterus. May obstruct.
Septate Uterus
HSG /
MRI
High rate of infertility. Must describe the
length of fibrous or muscular septum.
Septate Uterus (Complete)
HSG
DDx: Didelphys
Septate Uterus (partial)
HSG
DDx: Bicornuate
GU
5/22/2007 2:56 PM
DDx: Bicornuate
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2006 ORAL BOARD REVIEW: GU
Septate Uterus with 2
cervices
MRI
Synnechiae
HSG
Decreased uterine distension with angular
filling defect(s). May lead to Asherman's
syndrome, if assoc. with infertility.
Unicornuate Uterus
HSG
DDx: Didelphys with cannulation of only one
cervical os. Also cannot exclude noncommunicating rudimentary horn.
Unicornuate Uterus
MRI
+/- rudimentary horn
Ureteral Striation
IVU
Nodularity at renal pelvis. May be redudant
epithelium secondary to relieved
obstruction.
Urethral Diverticulum
VCUG
Female VCUG is going to be for tic.
Note: endovaginal coil baloon is not
inflated.
Uterine Agenesis/Hypoplasia MRI
Mullerian duct anomalies are associated
with renal anomalies.
Uterine Fibroid
Large Fibroid causes architectural
distortion, resulting in an elongated,
stretched dysmorphic uterine cavity to the
left of midline.
HSG
Uterine Fibroid - Intracavitary MRI
Enhancing T2 Dark lesion in endometrium.
Well circicumscribed. DDx: Poly (not T2
Dark - looks like endometrium),
Adenomyoma (not well circumscribed and
would have other evidence of
adenomyomatosis)
Uterine Fibroid - Submucosal HSG
Large filling defect. May stretch/enlarge the
uterine cavity.
Uterine Synechiae
HSG
May lead to Asherman's syndrome.
Vaginal Agenesis
MRI
Uterus with fluid, but no dark vaginal line.
GU
5/22/2007 2:56 PM
Incidental intravasation noted.
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