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  1. Radiological features of BPH:
    1. ‘Slit-like’ elongated and compressed urethra.
    2. Smooth filling defect/ indentation in bladder floor.
    3. Periurethral and subvesical enlargement is very pronounced may produce rounded defect in floor mimicking Foley’s balloon.
    4. Floor of bladder elevated and trigone pushed upwards, with distal ureteal ‘J’ or ‘Fish Hook’ deformity.Q
    5. Trabeculations and distension of bladder.
    6. Bladder pseudodiverticuli and calculi.
    7. Bilateral hydronephrosis and hydroureter may occur.
  2. Carcinoma Prostate
    1. Most common non-cutaneous cancer in American Men.
    2. Life time risk of developing ca prostate is 18-19% and increases with age.
    3. Location: Peripheral zone 70%, transition zone 20% and central 10%.
    4. Spread: hematogenous (bone osteoblastic metastasis)/lymphatic.
    5. Most important factor affecting prognosis/choice of treatment is presence or absence of extracapsular extension.
    6. 3D MR spectroscopy (increased choline and decreased citrate levels) + Endorectal MR imaging increase accuracy in detecting and staging of local and extracapsular extension of prostate carcinoma.
    7. Pathologically: adults (adenocarcinoma); Children (rhabdomyosarcoma).
      1. Classic imaging appearance.
    8. T2WI: Decrease signal in a normally high signal peripheral zone.
  • TRUS is most widely used imaging modality for local staging of prostatic and rectal cancer.Q
  • TRUS guided prostatic biopsy is the most important utility of TRUS in a suspected case of ca prostate.Q
  1. Radiology of TESTIS
    1. Testicular tumor is the most common neoplasm in males between ages 15 and 34 years. The complications of undescended tests include Trauma, Torsion and Tumor (3Ts). Cryptorchidism increases the risk by 10 times with incidence being 5% for the abdominal testis and 1.25% for inguinal site.
    2. Testicular tumor < 1.5 cm is hypovascular in 86% cases and hypervascular > 1.6 cm in 95% cases (color duplex). Seminoma is the most common tumor in the undescended testis. Usually appears uniformly hypoechoic and confined within tunica albugenia with lobulated confluent nodules.

Spermatic Venography is usefully employed in location of undescended testis if this is not identified using cross-sectional imaging. Now for a young man with primary infertility, low volume, fructose negative ejaculate, pathology is most likely to be in seminal vesicles, ejaculatory duct or vas.

Transrectal US is an excellent technique for demonstrating seminal vesicle anatomy and finding ejaculatory duct pathologies.


Duplex and triplex doppler US has been studied extensively in the assessment of erectile dysfunction. It also helps greatly to evaluate testicular pathologies.
Most intratesticular masses are malignant. Most extratesticular masses are benign.

Quick Specifics – GUT


Crescent sign

Rim sign

Soap bubble appearance

Polycystic kidney

Spider leg appearance

Swiss cheese nephrogram

Sun burst nephrogram

Ectopic ureter

Drooping flower appearance

Horse shoe kidney

Flower vase appearance of ureter


Spring onion appearance

Cobra head appearance

Tubercular cystitis

Thimble bladder

Schitosomiasis of bladder

Sandy patches


Fish hook bladder

Papillary necrosis

Egg in cup appearance

Signet ring sign on IVU

Lobster claw sign on IVU

Ball on Tee sign on IVU


Black nephrogram


Patchy chaotic nephrogram

Acute renal artery occlusion

Renal fascia sign

Medullary sponge kidney

Bunch of flowers appearance

Paintbrush appearance


Edling sign

Posterior Urethral Valves

Wind in the sail appearance

Keyhole appearance

Extraperitoneal bladder rupture

Sunburst appearance

Bladder in bladder appearance

Molar tooth sign

Reflux nephropathy involving the lower pole of a duplicated collecting system

Nubbin sign

Ureteral transitional cell carcinoma

Goblet sign

Bergmans coiled catheter sign

Extra Edge

  1. Global absence of nephrogram  Complete renal ischemia due - to occlusion of main renal artery
  2. Segmental absence of nephrogram
    1. Space occupying lesions                       
    2. Focal renal infarction
  3. Rim nephrogram (rim of cortex receiving collateral blood flow)
    1. Acute complete occlusion of main renal artery      
    2. Renal vein thrombosis
    3. Acute tubular necrosis                          
    4. Severe chronic urinary obstruction
  4. "Swiss cheese" nephrogram Polycystic kidney disease (ADPKD)
  5. "Sunburst" nephrogram Infantile polycystic kidney disease
  6. Striated nephrogram (mnemonic: CHOIR BOY)
    1. Acute ureteral obstruction                    
    2. Acute pyelonephritis
    3. Renal contusion                            
    4. Renal vein thrombosis
    5. Intratubular obstruction                       
    6. Systemic hypotension
    7. Autosomal recessive PCKD (Chaotic nephrogram)
    8. Medullary sponge kidney
    9. Medullary cystic disease
  7. Dense persistent nephrogram
    1. Systemic hypotension                          
    2. Intratubular obstruction/tubular damage
    3. Renal artery stenosis                            
    4. Renal vein thrombosis
    5. Urinary tract obstruction (acute)
    6. Focal parenchymal disease
  8. Increasingly dense nephrogram
    1. Acute ureteral obstruction                    
    2. Systemic arterial hypotension
    3. Severe renal artery stenosis                 
    4. Acute tubular necrosis
    5. Acute renal vein thrombosis                 
    6. Acute glomerular disease
    7. Intratubular obstruction
  9. Black nephrogram ADPKD
  10. Soap bubble nephrogram hydronephrosis
  11. Patchy chaotic nephrogram ARPKD
  12. Negative pyelogram acute obstruction

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