2. Structure and function of urinary system.
Ascending Urography
-
Retrograde/Cystoscopic
Descending Urography
-
Excretory/Intravenous
3. Timed series of radiographic
images of urinary system after
administration of IV contrast.
4. Suspected urinary tract pathology.
Repeated infections -focus, damage
Heamaturia
Investigation of hypertension not
controlled by medication in young
adults.
Renal colic.
Trauma.
5. General contra indications to contrast
agents.
Diabetes,
Thyrotoxicosis,
Pregnancy
Raised urea creat. urography unlikely to
be successful.
Metformin therapy
6. Bowel prep.
Basic psychological preparation with
reassurance & explanation of technique
Bladder emptied immediately before exam.
Hx of Previous I.V.U.
Previous experience of iodinated
contrast media.
Abdominal surgery, Allergies, drugs Hx.
7. Ionic or HOCM eg urograffin used.
Iodine is main element which imparts
radio-opacity.
300mg I/kg body wt. 15-25 gm of iodine
given. 20ml of 76% urograffin
Greatest single predictor of contrast
reaction is previous reaction to contrast
8. MILD & TRANSIENT – NO Rx REQUIRED:
-nausea,vomiting,sensation of heat, tingling,
metallic taste,pain in arm,deire to urinate.
ANTI-HISTAMINE & STEROID Rx:
-Skin rashes;urticaria ,diffuse erythema.
Angioneurotic edema,pruritis,sneezing&rhinorrhea
ADRENALINE,AMINOPHYLLINE or SALBUTAMOL,O2
& STEROIDS Rx:
-Broncho spasm and layryngeal edema particularly
due to meglumine.
12. Compression banding:
Aim to produce better PC distension
C/I: Recent abd surgery.
Renal trauma.
Large abd mass.
Obstruction.
If 5min film shows adequate
distension.
13.
14.
15. End of Injection, A.P. of the renal areas to show the nephrogram, i.e. the
renal parenchyma opacified by the contrast medium in the renal tubules.
16.
17.
18. Value of fluoroscopy. Fluoroscopic spot images demonstrate the entire
luminal surface of the ureters.
19. On a radiograph obtained during bladder filling, the contrast material is
smoothly defined and the bladder wall has become less evident. A normal
uterine impression on the superior margin is noted
20. Post Micturition film to demonstrate the bladder emptying success, and the
return of the previously distended lower ends of ureters to normal.
21.
22. Area: supra-renal - below symphysis.
Assessment of Bones, stones, masses &
gases.
Oblique view helpful when pt symptomatic
but no cause seen on KUB.
23. Urethral calculus in pt with hx of severe right flank pain.Collimated Radiograph shows
calcification centered behind symphysis . CT helped confirm presence of urethral
calculus.This case shows importance of full coverage of anatomic structures at KUB.
25. Rt post oblique radiograph of pelvis shows 6mm ureteral calculus now projected onto
iliac bone.urogram (not shown)helped confirm rt ureteral obstruction 2ndry to the
stone. This case shows how a calculus can be obscured by the complex sacral anatomy.
26.
27. The plain KUB
shows lumbar
spondylosis
with marked
scoliosis and
obvious
asymmetrical
thickness of
the lateral
abdominal wall
musculatures.
28. AP radiograph of pelvis shows parasymphyseal bone fragment along left
pubis ,mild p. symphysis diastasis, &transverse fracture of rt transverse
process .irregularity of rt SI joint space, suggestive of fracture.
30. 50yrs female,
known diabetic
presented with
lethargy, fever
with chills and
rigors. Urine
examination
shows multiple
pus cells and
ESR is
elevatedabnor
mal gas in the
left renal
region
31. Another patient
aged 45yr with
similar history
and marked
suprapubic
tendernessKUB
radiograph
showing air with
in the bladder
32. KIDNEYS: visualised if peri-renal fat.
GUT GASES: may over lap.
Change in shape & location
displaced by compression.
CALCIFICATION OVER RENAL AREA:
-True lat/ips-ilateral post oblique views.
-Displacement with ins/exp/upright films.
35. On a scout image
obtained before
excretory urography,
a calculus fills nearly
the entirety of a
bifid right renal
collecting system,
giving it a branched
appearance that
resembles the
antlers of a stag.
36. Plain radiograph of
the abdomen
demonstrates
extensive
calcification in the
left kidney, which
was nonfunctional
(the putty kidney),
consistent with
autonephrectomy
from tuberculosis.
37. URETERS: not visualized.
OPACITIES:
-Intra-Luminal: ureteral stones.
-Intra-mural: schistosomiasis.
GAS SHADOWS: conform to shape of ureter.
EXTRA-URETERAL CALCIFICATION:
-mesenteric LN(mobile)
-phleboliths, calcification in arteries.
39. Contrast in glomeruli & tubules.(1-3min)
Four phases:
SPONTANEOUS: Non-opacified, outlined by
RP fat on plain film.
VASCULAR: Opacification of intra-renal
blood vessels.
TOTAL BODY: “ of pre and retro renal soft
tissue + vascular nephrogram
INTRA-TUBULAR:” of intra-renal tubules.
42. Size - Normal range-height of three vertebra.
Enlarged kidneys suggest
-polycystic disease
-acute pyelo or glomerulonephritis
Small kidneys imply chronic disease.
Shape –Cysts & tumors may cause distortion.
Orientation - disorientation may be
-intrinsic, e.g. horseshoe kidney, or
-extrinsic, i.e. pressure effect of other organs
45. On a 10-minute
image, no pyelogram
is evident. The
nephrograms are
persistent, and the
kidneys are smaller.
With this imaging
sequence alteration,
the patient should be
evaluated
immediately for the
development of
hypotension related
to the procedure or
as a reaction to
contrast material
administration.
47. Image obtained
at 80 minutes
shows a
persistent, very
dense right
nephrogram, a
typical finding
in acute high-
grade
obstruction. A
2-mm stone
was discovered
at the right
ureterovesical
junction.
48. Enlarged kidneys in a
young patient with
early, asymmetric
findings of autosomal
dominant polycystic
kidney disease.
Nephrotomogram
shows enlarged
kidneys, the left
more so than the
right. Note the
multiple parenchymal
defects (“Swiss
cheese”
nephrogram).
49. Right renal
artery
stenosis for
evaluation of
renovascular
hypertension
shows a small
right kidney
with
decreased
nephrographic
density and
temporal
asymmetry of
filling of the
right
collecting
system
compared
with the left
51. Opacification of pelvicalceal system &bladder
Filling defects include:
stone,tcc,blood clots,papillary necrosis
with sloughing of infarcted papilla.
Strictures due to :
-Post inflammation,previous stone impaction
-Post infection,TB, Shistosomiasis
-Cancer, intrinsic-tcc
extrinsic-cevical ca
53. Common findings in bladder:
-Filling defects , tumors
-Trabeculated , thick walled bladder.
54.
55.
56.
57. different patterns of excavation that can be seen with papillary necrosis:
normal (A), central excavation with ball-on-tee appearance (B), forniceal
excavation (C), lobster claw appearance (D), signet ring appearance (E), and
sloughed papilla with clubbed calix (F).
61. Delayed tomographic
image from excretory
urography shows
caliceal crescents
(arrowheads)
surrounding the
dilated collecting
system. Contrast
material pools
dependently
Notas del editor
the drug metformin has been required to stop 48 hours pre and post procedure, as it known to cause a reaction with the contrast agent. However the newest guidelines published by the Royal College of Radiologists suggests this is not as important for patients having <100mls of contrast, who have a normal renal function. If renal impairment is found before administration of the contrast, metformin should be stopped 48 hours before and after the procedure.[2]
No universally accepted sequence it is tailored and modified to answer clinical queries.
No universally accepted sequence it is tailored and modified to answer clinical queries.
15 Minute film(On release if compression has been applied) to demonstrate the pelvicalyceal systems and the ureters.