This document summarizes the role of imaging in diagnosing acute and emergent genitourinary conditions using case studies. It discusses how CT, ultrasound, and MRI can help diagnose conditions like urolithiasis, bladder rupture, retroperitoneal hematoma, pyelonephritis, emphysematous pyelonephritis, epididymitis, penile fracture, tuboovarian abscess, and ectopic pregnancy by identifying signs such as calculi, extravasated contrast, hematomas, decreased renal enhancement, gas in the parenchyma, enlarged hypoechoic organs, penile fractures, adnexal masses, and extrauterine pregnancies. The goal is to show radiologists
This document summarizes the role of imaging in diagnosing acute and emergent genitourinary conditions using case studies. It discusses how CT, ultrasound, and MRI can help diagnose conditions like urolithiasis, bladder rupture, retroperitoneal hematoma, pyelonephritis, emphysematous pyelonephritis, epididymitis, penile fracture, tuboovarian abscess, and ectopic pregnancy by identifying signs such as calculi, extravasated contrast, hematomas, decreased renal enhancement, gas in the parenchyma, enlarged hypoechoic organs, penile fractures, adnexal masses, and extrauterine pregnancies. The goal is to show radiologists
This document summarizes the role of imaging in diagnosing acute and emergent genitourinary conditions using case studies. It discusses how CT, ultrasound, and MRI can help diagnose conditions like urolithiasis, bladder rupture, retroperitoneal hematoma, pyelonephritis, emphysematous pyelonephritis, epididymitis, penile fracture, tuboovarian abscess, and ectopic pregnancy by identifying signs such as calculi, extravasated contrast, hematomas, decreased renal enhancement, gas in the parenchyma, enlarged hypoechoic organs, penile fractures, adnexal masses, and extrauterine pregnancies. The goal is to show radiologists
Genitourinary Conditions: What the Radiologist Needs to Know
By : Monica Novyanti Nasution
Consultant : dr. Dieby Adrisyel, Sp.Rad Emergent genitourinary conditions require timely diagnosis and treatment to ensure a favorable clinical outcome and to prevent morbidity and mortality. CT is typically the imaging modality of choice for most emergent conditions of the genitourinary tract, and ultrasound is used less frequently. MRI is primarily used as a problem-solving modality because of its improved soft-tissue characterization and higher resolution. The aim of this article is to summarize the role of imaging in diagnosing acute and emergent genitourinary conditions using a case-based approach and to show how imaging can aid in the diagnosis of common clinical entities presenting to the emergency department Urinary System Patient 1 : 45-year-old man with acute onset of right flank pain The diagnosis is urolithiasis. Urolithiasis is a condition in which there are dense calculi within the kidney or ureteral lumen and possible hydroureteronephrosis, with dilatation of the ureter proximal to the calculus and normal-caliber ureter distal to the calculus (Fig. 1). Secondary signs of ureterolithiasis include hydroureteronephrosis, perinephric and periureteral inflammatory stranding, and unilateral renal enlargement or a subtle hypodensity related to parenchymal edema. Patient 2 : 18-year-old woman in a motor vehicle collision with a pelvic fracture and gross hematuria The diagnosis is bladder rupture. Bladder rupture is seen as the presence of extravesicular contrast material on CT cystography. In intraperitoneal bladder rupture, contrast material accumulates around the bowel loops and in the peritoneal recesses including the paracolic gutters, rectovesical or rectouterine pouch, and subphrenic space (Fig. 2A). In extraperitoneal rupture, the extravasated contrast material tracks into the perivesicular and prevesical space of Retzius to form the classic molar tooth sign (Fig. 2B). Combined intraperitoneal and extraperitoneal bladder ruptures involve both spaces. Patient 3 : 69-year-old woman with acute right flank pain The diagnosis is retroperitoneal hematoma. Retroperitoneal hematoma is seen as a high- density retroperitoneal collection with an occasional blood-fluid level (Figs. 3A3C) and occasional associated lesion (Fig. 3C). Patient 4 : 21-year-old woman with a history of urinary tract infections presents with flank pain The diagnosis is pyelonephritis. Pyelonephritis is seen on imaging as renal parenchymal edema, often with one or more wedge-shaped areas of decreased enhancement and with decreased corticomedullary differentiation. A striated nephrogramconsisting of linear areas of decreased enhancement from the papilla to the cortex can also be seen (Fig. 4A). Urothelial thickening and enhancement of the renal pelvis and ureter are suggestive of pyelitis (i.e., urinary tract infection ascending to the collecting system) and may be seen with or without parenchymal changes indicative of pyelonephritis. Patient 5 : 75-year-old diabetic man presents with flank pain, hypotension, and urinary retention The diagnosis is emphysematous pyelonephritis (EPN). EPN appears on imaging as small bubbles or linear foci of parenchymal gas, gas-fluid levels, fluid collections, parenchymal enlargement and destruction, and tissue necrosis (Fig. 5A). Male Reproductive Organs Patient 6 : 18-year-old man with acute testicular pain and swelling The diagnosis is epididymitis and orchitis. Epididymitis and orchitis manifest as heterogeneity, enlargement, and hypoechogenicity of the epididymis or testicle with associated hypervascularity on color Doppler imaging (Fig. 6A). Reactive hydroceles and scrotal edema and thickening are commonly seen. Doppler flow can be helpful in differentiating epididymitis and orchitis from testicular torsion with absent flow. Patient 7 : 32-year-old man with pelvic pain after trauma The diagnosis is penile fracture. Penile fracture is seen as a focal disruption of the tunica albuginea with an adjacent hematoma and can be seen on both ultrasound and MRI (Fig. 7). Female Reproductive Organs Patient 8 : 23-year-old woman with acute pelvic pain The diagnosis is tuboovarian abscess (TOA). A TOA has a variable appearance on ultrasound and may be a solid, cystic, or complex mass in the adnexa or cul-de-sac with adjacent fluid (Fig. 8A). CT findings suggestive of TOA include uniformly thick walls with internal septations. Pyosalpinx is a common associated finding manifesting as a fluid-filled tubular structure with a thick enhancing peripheral wall. On MRI, a TOA is typically hypointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging, although the signal intensity is variable and depends on the internal protein concentration and viscosity. Hypointense meshlike strands secondary to adhesions or fibrosis are common findings on T2-weighted images and may enhance on contrast-enhanced T1-weighted images (Fig. 8B). Patient 9 : 26-year-old woman with positive HCG value and pelvic pain The diagnosis is ectopic pregnancy. Ectopic pregnancy is visualized on imaging as an extrauterine pregnancy where a fetal heartbeat may be present. More commonly, ectopic pregnancies are seen as an extraovarian adnexal mass that can manifest as a tubal ring containing a yolk sac and embryo, a tubal ring with only a yolk sac and no embryo, or a complex mass separate from the ovary (Fig. 10A).