Paediatric Urinary Tract Anomalies, Hydronephrosis, and Vesicoureteral Reflux — WACS Viva & Clinical Scenarios (Paediatric Radiology)

Exam-style paediatric urinary tract anomalies, hydronephrosis, and vesicoureteral reflux viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A 3-day-old male neonate presents with a distended abdomen, poor urinary stream, and elevated serum creatinine. Renal and pelvic ultrasound demonstrates bilateral hydroureteronephrosis, a thick-walled trabeculated urinary bladder, and dilatation of the posterior urethra. Detail the immediate fluoroscopic investigation of choice, protocol technicalities to minimize radiation dose, and pathognomonic diagnostic features confirming posterior urethral valves.
• SCENARIO 2: A 2-year-old female presents with recurrent febrile urinary tract infections. Ultrasound reveals a complete duplex collecting system on the right, with severe cystic dilatation of the upper pole moiety and a smooth, thin-walled intravesical cystic mass at the bladder base. Explain the anatomical rule governing this pathology, the characteristic imaging findings across ultrasound and micturating cystourethrography, and the distinct complications affecting the upper versus lower renal moieties.
• SCENARIO 3: A 4-month-old infant is evaluated for persistent severe unilateral left hydronephrosis detected antenatally. Ultrasound demonstrates marked ballooning of the extrarenal pelvis with caliceal dilatation and an abrupt cutoff at the pelviureteric junction without ureteric dilatation. Describe the standardized nuclear medicine diuretic renography protocol, quantitative parameters, and renogram curve criteria used to establish fixed mechanical pelviureteric junction obstruction.
• SCENARIO 4: A 3-year-old boy presents for fluoroscopic voiding cystourethrography following an episode of culture-proven acute pyelonephritis. Detail the International Reflux Study grading classification for vesicoureteral reflux from Grade I through Grade V, and explain the imaging protocol and scintigraphic findings on Technetium-99m DMSA used to confirm permanent reflux nephropathy.
• SCENARIO 5: Contrast the sonographic, functional, and contralateral structural associations of Multicystic Dysplastic Kidney (MCDK) with Autosomal Recessive Polycystic Kidney Disease (ARPKD) in a neonate, including essential imaging evaluations for extrarenal manifestations.