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+====== Contrast Rxn ======
+{{reaction.jpg?500|Don't freak out}}
+====== Pelvis ======
+===== Anatomy =====
+  * Extraperitoneal cavity: contiguous with retroperitoneal space
+  * Retropubic space of Retzius: contiguous with posterior pararenal space + extraperitoneal fat
+  * Perineum: below pelvic diaphragm
+  * Parametrium: contained within broad ligament
+  * Denonvillier’s fascia: positioned between prostate and rectum
+====== Kidneys ======
+  * Combination of coritcal & medullary nephrocalcinosis suggests primary oxaluria
+===== Grades of Vesicoureteral Reflux =====
+{{:gradesofreflux.jpg|Grades of Vesicoureteral Reflux}}
+===== Cortical Nephrocalcinosis (COAG) =====
+  * Cortical Necrosis (Acute)
+  * Oxalosis
+  * Alport Syndrome
+  * Glomerulonephritis (Chronic)
+===== Medullary Nephrocalcinosis (MARCH) =====
+  * Medullary Sponge Kidney
+  * Alkali Excess
+  * RTA (Type 1, Distal), Renal Medullary/Cortical Necrosis
+  * Chronic Glomerulonephritis
+  * Hyperoxaluria, Hypercalcemia (Hyperparathyroidism), Hypercalciuria
+===== Papillary Necrosis (POSTCARD) =====
+  * Pyelonephritis
+  * Obstruction
+  * Sickle Cell
+  * TB/Trauma
+  * Cirrhosis
+  * Analgesic Nephropathy
+  * Renal Vein Thrombosis
+  * Diabetes
+===== Diffusely Hyperechoic Kidneys (HIV MAN) =====
+  * HIV
+  * Inflammation
+    * Glomerulonephritis
+    * HTN, DM
+  * Vascular
+    * SLE / Vasculitis
+  * Multiple Myeloma
+  * Acute Tubular Necrosis / ARPCKD
+  * Nephrocalcinosis
+  * ESRD
+  * Hemolytic Uremic Syndrome
+===== Bilaterally Enlarged Kidneys (TIM VPC) =====
+  * Tumor
+    * Leukemia / Lymphoma
+    * Myeloma
+  * Inflammation (acute)
+    * Glomerulonephritis
+    * Interstitial Nephritis
+    * ATN
+  * Metabolic
+    * Amyloid
+    * Diabetes
+    * Gaucher's
+    * Acromegaly
+  * Vascular
+    * Bilateral renal vein thrombosis
+  * Polycystic Kidney Disease
+  * Collagen Vascular Disease
+===== Bilaterally Small Kidneys (IR RAS) =====
+  * Inflammation (chronic)
+    * Pyelo, Glomerulonephritis, Interstitial Nephritis
+  * Reflux (chronic infection)
+  * Bilateral renal artery stenosis
+===== Unilaterally Small Kidney (VOX HS) =====
+  * Vascular (RAS / RVT)
+  * Obstruction
+  * XRT
+  * Hypoplasia
+  * Subcapsular hematoma (chronic)
+===== Urethral Stricture =====
+  * iatrogenic
+  * post-infectious (gonococcal or non-gonococcal)
+  * non-infectious irritation (chemical or Reiter's)
+  * traumatic injury
+  * neoplasm (long, irregular stricture ± fistula)
+===== Bosniak Classification =====
+  * Category I - No atypical features
+    * US - anechoic without internal echoes, with good thru transmission and a barely perceptible but well defined wall
+    * CT - fluid density, no enhancement and imperceptible wall
+  * Category II - homogeneously hyperdense cyst that is not enhancing, or thin (<1mm) septations or thin wall Ca+
+    * must be 3 cm or less in diameter, have one quarter of its wall extending outside the kidney so the wall can be assessed, and be nonenhancing after contrast material is administered
+  * Category IIF - minimally complicated cysts that need follow-up
+    * not well defined by Bosniak but consists of lesions that do not neatly fall into category II
+    * have some suspicious features that deserve follow-up up to detect any change in character.
+  * Category III - true indeterminate cystic masses that need surgical evaluation, although many prove to be benign
+    * thicker septations or multiloculated, coarser Ca+ or solid component that is not enhancing
+    * may show uniform wall thickening, nodularity, thick or irregular peripheral calcification, or a multilocular nature with multiple enhancing septa
+    * hyperdense lesions that do not fulfill category II criteria are including in this group.
+  * Category IV - needs nephrectomy
+    * nonuniform or enhancing thick wall, enhancing or large nodules in the wall, or clearly solid components in the cystic lesion
+    * enhancement of at least 10 HU
+===== RCC Staging =====
+  * Stage 1 -> confined by renal capsule (completely in kidney)
+  * Stage 2 -> beyond capsule but confined within Gerota’s fascia
+  * Stage 3A -> extension to renal vein or IVC
+  * Stage 3B -> positive lymph nodes
+  * Stage 3C -> both venous extension and adenopathy
+  * Stage 4A -> grows through gerotas fascia into adjacent organs (other than adrenal)
+  * Stage 4B -> distant mets
+===== Grading of Renal Lacerations =====
+FIXME
+====== Ureter & Bladder ======
+===== DDx Small Bladder (CITRUS) =====
+  * cystitis cystica
+  * interstitial cystitis
+  * TB
+  * rads
+  * unused bladder
+  * surgery and schistosomiasis
+===== DDx Pear-shaped Bladder (CILLI) =====
+  * Collection - urinoma, hematoma, abscess
+  * IVC obstruction
+  * Lymphoma / adenopathy
+  * Lipomatosis
+  * Iliopsoas hypertrophy
+===== DDx for ureteral filling defects =====
+  * Fungus ball
+  * Ureteritis cystica -> epithelial/ subepithelial cysts due to inflammation or irritation (metaplasia of Brunn’s nests)
+  * Clot
+  * Fibroepithelial polyp
+  * Endometriosis
+  * Stone / Sloughed papilla
+  * Tumor / TB
+  * Leukoplakia: associated with Schistosomiasis; premalignant → squamous cell carcinoma
+  * Malakoplakia: chronic gram (-) infection (E. coli #1); ↑ DM → foamy macrophages (Hansemann) with PAS (+) inclusions (Michaelis-Guttman bodies); raised yellow lesions
+    * looks like ureteritis cystica
+===== DDx hemorrhagic cystitis =====
+  * viral and bacterial infection
+  * drugs - cyclophosphamide (cytoxan)
+  * eosinophilic
+  * cystitis cystica
+===== Pseudodiverticulosis =====
+  * 1-3 mm outpouchings
+  *  DDx -> calculi / infections / CA (#1 = TCC)
+===== Ureteral TCC =====
+  * Risks: azo-dyes, cyclophosphamide, phenacetin
+  * Radiographic:
+    * “Wine glass/goblet” deformity (dilated distal ureter)
+    * Bergman sign (coiled retrograde catheter)
+===== Ureteral displacement =====
+  * Distribution:
+^    ^  **Medial**  ^  **Lateral**  ^
+|**Above Pelvis**|Retroperitoneal fibrosis\\ Retrocaval ureter \\ (right; at L3)|Psoas hypertrophy\\ LAD\\ AAA\\ Central tumor|
+|**Below Pelvis**|Pelvic lipomatosis\\ Iliac LAD/ aneurysm\\ Iliopsoas hypertrophy\\ Hutch diverticulum|Fibroids\\ Ovarian masses|
+  * Medial
+    * Retroperitoneal fibrosis: drugs (methylsergide, ergotamine); XRT; prior surgery; malignancy; connective tissue disorders
+    * Retrocaval ureter (right only)
+    * Pelvic lipomatosis: ↑ black males; “tear-drop” or “pear”-shaped bladder; associated with ureteritis cystica
+    * Other: hematoma; iliac LAD or aneurysms; adnexal mass; surgery
+  * Lateral:
+    * AAA
+    * LAD; psoas hypertrophy
+    * Central pelvic mass
+    * Retroperitoneal fat (≠ pelvic lipomatosis)
+===== DDx for ureteral stricture =====
+  * Infection: TB; Schistosomiasis; abscess; fistula
+  * CA: metastases; local extension; TCC; lymphoma
+  * XRT
+  * Inflammation: calculi; instrumentation; stent; endometriosis
+===== DDx for ureteral dilatation =====
+  * Obstruction
+  * Reflux
+  * Primary megaureter (“beak” sign)
+===== DDx for bladder filling defects =====
+  * Tumor: TCC; adenocarcinoma; squamous cell carcinoma; metastases (pheochromocytoma)
+  * Extrinsic masses: BPH; uterus (fibroids); etc.
+  * Other: calculus; thrombus; ureterocele (pseudoureterocele due to inflam/ tumor); foreign bodies
+===== Hutch Diverticulum =====
+  * adjacent to UVJ; ↑ vesicoureteral reflux
+===== Bladder Carcinoma =====
+  * Clinical: transitional cell (90% malignant); risks = azo-dyes; phenacetin; cyclophosphamide; focal thickening of bladder wall; perivesical spread; LAD (> 10 mm)
+  * Staging:
+    * Stage A: limited to mucosa + submucosa
+    * Stage B1: superficial muscular layer
+    * Stage B2: deep muscular layer
+    * Stage C: perivesical fat
+    * Stage D: seminal vesicles, prostate, or rectum
+===== Bladder Trauma =====
+  * Contusion: interstitial
+  * Extraperitoneal: due to pelvic fracture, dissection into retroperitoneum + scrotum + thigh
+  * Intraperitoneal: usually blunt trauma with distended bladder; DX requires adequate bladder distention (> 250 ml)
+===== DDx for Bladder Ca2+ (SCART) =====
+  * Schistosomiasis (↑ squamous cell carcinoma)
+  * CA; cyclophosphamide (cytoxan); calculus
+  * Alkaline encrusting cystitis
+  * Radiation
+  * TB
+====== Urethra ======
+===== Urethral Anatomy =====
+==== Anatomy (male) ====
+  * Anterior = penile + bulbous (penoscrotal junction)
+  * Posterior = membranous (between inferior margin of verumontanum + tip/ cone of bulbous urethra) + prostatic
+    * Cowper’s glands: contained within membranous urethra with ducts entering the bulbous urethra
+    * Glands of Littré: located primarily along dorsal penile urethra → infections (gonococcus; chlamydia)
+{{urethra.png}}
+===== Urethral Injuries =====
+  * Clinical: risks = pelvic trauma (especially multiple pelvic fractures); absence of blood at meatus does not exclude urethral injury → RUG
+  * Subtypes:
+  * Type I: posterior urethra stretched
+  * Type II: posterior disruption (above urogenital diaphragm)
+  * Type III: anterior + posterior disruption
+  * Type IV: bladder neck injury with extension to urethra
+  * Type IVa: periurethral extravasation with intact urethra
+  * Type V: anterior disruption (“saddle” injury); ↑ bulbous urethra
+===== Female Urethral Diverticulum =====
+  * Clinical: most often acquired due to infection of Skene’s glands; ↑ posterior wall; SXS = dysuria + dribbling + dyspareunia (3 D’s);
+TX = surgical resection (diverticulectomy)
+  * Radiographic: focal outpouching along posterior urethra; impression along inferior bladder (= “male prostate”); best seen on MRI
+  * Complications: infection; calculi; CA (squamous cell)
+===== DDx for Urethral Strictures (TIICB) =====
+  * Trauma
+  * Inflammatory; infections (prostatitis; phlegmon; etc.)
+  * Calculus
+  * BXO (= balanitis xerotica obliterans): variant of lichen sclerosis et atrophicus (white plaques) → phimosis/ meatal stenosis; premalignant (penile squamous carcinoma)
+===== Hypospadias =====
+  * ↑ cryptorchidism (30%) + inguinal hernias (10%)
+===== DDx for Urethral Tumors =====
+==== Benign ====
+  * Fibroepithelial polyp: solitary; pedunculated; attached near veru montanum; ↑ child/ young adult
+  * Transitional cell papilloma: ↑ prostatic/ bulbomembranous urethra; ↑ bladder papillomas; older adults
+  * Adenomatous polyp: ↑ young men; adjacent to veru montanum
+  * Penile squamous papilloma / condyloma acuminata: verrucous lesion in penile urethra; associated with cutaneous disease
+==== Malignant ====
+  * Squamous cell carcinoma (70%): distal 2/3 of urethra; risks = venereal disease; ↑ stricture (> 80%)
+  * TCC (10-20%): posterior 1/3 of urethra; ↑ multifocal
+  * Adenocarcinoma (10-20%): arise from periurethral glands (Skene; female) and glands of Cowper/ Littré (male)
+====== Testes ======
+===== Testicular Cancer =====
+  * Clinical: seminomas → orchiectomy + XRT; nonseminomas (radioresistant) → orchiectomy + chemotherapy
+  * Staging:
+    * Stage I: limited to testes and spermatic cord
+    * Stage II: lymph nodes below the diaphragm
+    * Stage III: lymph nodes above the diaphragm
+      * A: lymph nodes only
+      * B: extranodal mets
+  * Lymphatic spread: along gonadal veins → renal hilar nodes; external iliac nodes → para-aortic nodes
+  * Hematogenous spread: uncommon except for choriocarcinoma
+  * Cryptorchidism: located from inferior renal pole to superficial inguinal ring; ↑ risk of torsion (↑ 10x) + malignancy (↑ 50x); usually atrophic
+===== Extratesticular Mass DDx =====
+  * Inguinal hernia
+  * Inflammatory mass such as infection, sarcoidosis
+  * Benign neoplastic processes such as adenomatoid tumor, epidermoid inclusion cyst
+  * Malignant processes such as soft tissue sarcomas, mesothelioma of the tunica, lymphoma, and metastatic disease.
+===== Peyronie's Disease =====
+  * Calcification of tunica albuginea of corpora cavernosa
+  * Idiopathic, older men (> 45 yrs old)
+====== Prostate ======
+===== Anatomy =====
+  * U/S → hyperechoic central gland = transitional + central zones
+  * Transition zone (5%): periurethral → BPH
+  * Central zone (25%): ejaculatory ducts
+  * Peripheral zone (75%): carcinoma (> 80%); hypoechoic
+===== BPH =====
+  * periurethral transitional zone; enlarged, lobulated gland; cystic degeneration; Ca2+; elevation of bladder base; bladder wall thickening and trabeculation
+===== Prostatic Cysts =====
+  * Midline:
+    * Mullerian duct: larger; extend superiorly
+    * Utricular cyst: smaller; communicate with urethra; ↑ hypospadias
+    * Ejaculatory duct cyst: acquired; due to obstruction
+  * Eccentric:
+    * Cystic prostatitis/ carcinoma
+    * Cystic BPH
+  * DDX = seminal vesicle cysts → unilateral; ↑ ipsilateral renal agenesis (= Zinner syndrome) > cystic renal disease (APKD), renal ectopia, duplication, ectopic renal insertion
+===== Prostate Carcinoma =====
+  * Clinical: # 2 male CA; enlarged gland with nodules; periprostatic stranding; regional nodes; direct extension to seminal vesicles, bladder; mets to axial skeleton
+  * Radiographic: hypoechoic; ↓ T2 lesions in peripheral gland (DDX = prostatitis; fibrosis; hemorrhage)
+==== Staging ====
+  * Stage A: nonpalpable
+  * Stage B: confined to prostate
+  * Stage C: capsular involvement
+    * 1: invasion
+    * 2: penetration
+    * 3: seminal vesicles
+  * Stage D: metastases
+    * D1: pelvic LN
+    * D2: bone; distant LN
+  * Treatment: Stage A/B → radical prostatectomy +/- XRT; Stage C/D → hormone therapy +/- XRT
+====== Peritoneal Cavity, Vessels, and Nodes ======
+===== Fluid in peritoneal cavity =====
+  * Ascites: serous; due to CHF, cirrhosis, hypoproteinemia, venous obstruction; accumulates in greater peritoneal space; density = 10-15 HU
+  * Exudative ascites: pancreattis → accumulates within lesser sac; peritonitis; bowel perforation
+  * Hemoperitoneum: density > 30 HU; “sentinel bleed” → accumulates at site of hemorrhage
+  * Pseudomyxoma peritonei: due to appendiceal mucocele or mucinous cystadenocarcinoma of the ovary (> urachal/ endometrial CA); peritoneum filled with gelatinous mucin; Ca2+
+===== Pneumoperitoneum =====
+  * due to bowel perforation, pneumothorax, or mechanical ventilation
+===== Peritoneal tumors =====
+  * Peritoneal carcinomatosis:
+    * Etiologies: ovarian, pancreatic, gastric, and colon carcinoma
+    * Radiographic: malignant ascites; tumor nodules/ Ca2+ → bowel wall nodularity; mesentery; “omental cake”; pouch of Douglas (“Blumer’s shelf); adnexa/ ovaries (Krukenberg tumor)
+  * Peritoneal (cystic) mesothelioma: 20-40% in abdomen; ↑ women 30-40 years; irregular thickening of peritoneal surfaces; multilocular cysts; ascites; bowel compression without obstruction
+  * Mesenteric lipodystrophy (= retractile mesenteritis): fat-density mass with tethering/ kinking/ angulation of adherent bowel loops
+===== Abscess =====
+  * Clinical: complications of trauma or surgery; pancreatitis; bowel perforation; commonly located within pelvis, subhepatic and subphrenic spaces
+  * Radiographic: loculated fluid collection; thickened walls; gas; thickening of fascia; obliteration of fat planes; ascites; pleural effusions
+===== DDx for cystic abdominal masses =====
+  * Abscess
+  * Loculated ascites
+  * Pancreatic pseudocyst
+  * Ovarian cyst/ tumor
+  * Cystic teratoma: fat, water, Ca<sup>2+</sup>
+  * Enteric duplication cysts: lined by GI mucosa
+  * Lymphocele: complication of surgery / trauma
+  * Cystic lymphangioma: mesenteric / omental
+===== DDx for pelvic cystic masses =====
+  * Ectopic pregnancy: adnexal/ tubal ring
+  * TOA: tubo-ovarian abscess
+  * Endometrioma
+  * Ovarian neoplasms
+  * Ovarian cysts
+  * Extra-GU origin: abscess; urinoma; duplication/ mesenteric cyst; etc.
+===== Lymph nodes =====
+  * Pathology: lymphadenopathy: > 10 mm in abdomen and pelvis; > 6 mm in retrocrural and porta hepatis regions
+  * Hodgkin’s lymphoma: 40% of total; contiguous spread
+  * Non-Hodgkin’s lymphoma: 60% of total; noncontiguous spread; ↑ GI involvement
+===== DDx for hypodense intra-abdominal/ retroperitoneal LAD =====
+  * Infection: MAI > TB (↑ AIDS), histoplasmosis
+  * Whipple’s disease: glycogen deposition
+  * Tumors: lymphoma (post-therapy); nonseminomatous testicular CA; mucinous adenoCA (rare)
+===== Trauma =====
+  * Hemoperitoneum: density (30-45) HU; (60-80) HU → active bleeding (> 100 HU with contrast); “sentinel clot” → adjacent to injured organ (> 60 HU); free intraperitoneal contrast → bowel/ bladder perforation
+  * Pneumoperitoneum: perforated viscous; PTX; mechanical ventilation; post-op
+  * Subcapsular hematomas: crescentic → flatten parenchyma
+  * Lacerations: jagged, linear low density areas
+  * Intraparenchymal hematomas: rounded, low density areas
+====== Retroperitoneum ======
+===== Retroperitoneal fibrosis =====
+  * ST-encasement of retroperitoneal vessels/ ureters without anterior displacement (DDX = lymphoma); prominent enhancement
+  * Drugs: methylsergide; hydralazine
+  * Lymphoma
+  * Metastases: lung; breast; carcinoid
+  * Other: AAA; trauma; surgery; instrumentation
+  * Ormond’s disease: idiopathic
+===== DDx for retroperitoneal masses =====
+==== Malignant ====
+  * MFH (#1)
+  * Liposarcoma (#2)
+  * Other: leiomyosarcoma; metastases; RCC/ adrenal extension
+==== Benign ====
+  * XGP
+  * Neural tumors
+  * Lymphangioma; hamangioma; lipoma
+  * Teratoma (dermoid)
+===== Retroperitoneal Fibrosis =====
+  * Associated w/
+    * aortic aneurysms
+    * inflammatory bowel dz
+    * urinomas
+    * retroperitoneal hematomas
+    * aortic and iliac graft procedures
+    * infections
+    * ergot alkaloids
+    * sclerosing cholangitis
+    * fibrosing mediastinitis
+===== Waterhouse-Friderichsen syndrome =====
+  * massive, usually bilateral, hemorrhage into the adrenal glands caused by fulminant meningococcemia
+===== Low-density Retroperitoneal Nodes =====
+  * Neoplastic
+    * Testicular (particularly teratocarcinoma)
+    * Epidermoid carcinoma of GU tract
+    * Lymphoma
+    * Leiomyosarcoma
+  * Infectious
+    * Whipple's Dz
+    * MAI