Radiodiagnosis
Cardiovascular and Genitourinary Imaging
Cardiovascular and genitourinary imaging for MBBS and NEET-PG: cardiac chest film, echocardiography, CT angiography for embolism and dissection, and renal ultrasound, mapped to NMC code RD1.5.
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Cardiovascular and Genitourinary Imaging
Cardiovascular and genitourinary imaging for MBBS and NEET-PG: cardiac chest film, echocardiography, CT angiography for embolism and dissection, and renal ultrasound, mapped to NMC code RD1.5.
This chapter covers imaging of the heart, great vessels and urinary tract in common internal medicine conditions. It teaches the cardiac chest radiograph and echocardiography, the CT angiography protocols for pulmonary embolism and aortic dissection, and the ultrasound-first approach to renal disease, obstruction and masses.
High-yield: Cardiovascular and Genitourinary Imaging
- The chest radiograph gives the cardiothoracic ratio, normally under 0.5 on an erect posteroanterior film, and a higher value suggests cardiomegaly.
- Signs of left heart failure on the chest film include upper lobe blood diversion, Kerley B lines, perihilar haze and pleural effusions.
- Echocardiography is the first-line imaging test for cardiac structure, valve disease and ventricular function, using no ionising radiation.
- CT coronary angiography is used to assess the coronary arteries and to exclude significant coronary disease in appropriate patients.
- CT pulmonary angiography is the investigation of choice for suspected pulmonary embolism, showing filling defects in the pulmonary arteries.
- CT angiography is the first-line test for suspected aortic dissection, showing the intimal flap and true and false lumens.
- Doppler ultrasound assesses arterial stenosis and deep vein thrombosis, with loss of compressibility indicating venous thrombus.
- Ultrasound is the first-line investigation of the kidneys, showing size, hydronephrosis, cysts and masses without radiation.
- Non-contrast CT of the kidneys, ureters and bladder is the gold standard for urinary tract calculi.
- CT urography and intravenous urography assess the collecting system, and a filling defect may indicate a stone or urothelial tumour.
- The clinical distinction between obstructive and non-obstructive renal failure rests on finding hydronephrosis and a dilated collecting system on ultrasound.
- Micturating cystourethrography assesses vesicoureteric reflux and the posterior urethra.
- Contrast-enhanced imaging characterises renal masses, and enhancement in a solid renal lesion raises the concern for renal cell carcinoma.
- Ultrasound assesses the bladder, prostate and postvoid residual volume, and transrectal ultrasound guides prostate biopsy.
First-line imaging by problem
- **Cardiac structure and valves:** Echocardiography, no radiation, first line for function and valve disease.
- **Pulmonary embolism:** CT pulmonary angiography showing arterial filling defects.
- **Aortic dissection:** CT angiography showing the intimal flap and false lumen.
- **Renal disease:** Ultrasound first line; non-contrast CT for calculi.
NMC competencies in this chapter
- **RD1.5:** Radiological investigation and interpretation in common internal medicine conditions
Frequently Asked Questions
What is the investigation of choice for pulmonary embolism?
CT pulmonary angiography is the first-line test in most patients, showing filling defects within the pulmonary arteries. A ventilation-perfusion scan is an alternative when CT contrast is contraindicated.
How is the heart assessed on a chest radiograph?
The cardiothoracic ratio, normally under 0.5 on an erect posteroanterior film, screens for cardiomegaly, and signs such as upper lobe diversion, Kerley B lines and effusions indicate left heart failure.
Why is ultrasound first line for the kidneys?
It uses no ionising radiation and shows renal size, hydronephrosis, cysts and masses, and it distinguishes obstructive from non-obstructive renal failure by detecting a dilated collecting system.
How is aortic dissection imaged?
CT angiography is the first-line investigation, demonstrating the intimal flap separating a true and false lumen and defining the extent of the dissection to guide urgent management.
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