Ultrasound in urological urgencies: what a resident radiologist needs to know
Number:27ESURABS0046
Type:Educational Electronic Presentation
Authors: Cristina Mota, Filipa Marques Dos Santos, Inês Matos, Francisco Antunes, Carlos Senra, Ana Teresa Almeida
Keywords:Urologic urgencies, nephrolithiasis, pyelonephritis, renal abscess, obstructive anuria, bladder blood clots, emphysematous cystitis, epididymitis, orchiepididymitis, testicular torsion, Fournier gangrene, testicular tumors, penile fracture.
SECTIONS
Educational objective

In this educational exhibit, and using ultrasound images from our hospital, we aim to provide a “pictorial review” of the specific sonographic features of the main urological urgencies. Some cases will be complemented with computerized tomography (CT) images.


Topic Review

A significant proportion of the urological complaints seen in most emergency rooms (ERs) are acute urological urgencies. The urological pathology is very broad and its timely diagnosis is of particular importance, to prevent long-term complications, and to achieve an optimum satisfactory outcome.

The most common pathologies encompass acute scrotal conditions, acute urinary retention, acute renal colic, macroscopic hematuria, urinary tract infection, penile fracture, and Fournier gangrene (Figure 1).

In these contexts, ultrasound is the first-line imaging method. Although imaging techniques such as CT or magnetic resonance imaging (MRI) are still often required, due to their superior resolution capabilities in specific situations, ultrasound is an innocuous test, easily available, and highly sensitive in the hands of an expert radiologist. Nowadays, it has become an...

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Figure 1: Common urologic pathologies seen in the ER.
Figure 2: Nephrolithiasis. A) Hydronephrosis due to the presence of obstructive calculus in the ureterovesical junction (B). C) Staghorn calculus, also called coral calculi, evidenced by a hyperechogenic foci with acoustic shadowing. D) An axial contrast CT scan showing moderate left hydronephrosis and a left renal pelvic calculus. © Imaging Department, CHVNG/E, Portugal.


Conclusions

Urological urgencies are frequent in the context of an ER. Their correct diagnosis is crucial to determine the appropriate treatment. Specific sonographic features have proven accurate in the diagnosis of both common and uncommon urogenital pathologies. Ultrasonography is, therefore, an innocuous test that is easily available and has a high sensitivity. Its use plays a pivotal role in the context of most hospital ERs.

 

 

References:

- Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies. RadioGraphics. 2013; 33:721-774.

- Hertzberg BS, Middleton WD. The requisites: ultrasound. 3rd edition, Elsevier, 2016.

- Manjunath AS, Hofer MD. Urologic Emergencies. Med Clin N Am. 2018;102:373-385.

- Moreno CC, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, Hartman M, Mittal PK....

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