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1. Radio anatomy
of
Kidney, Ureter and
Urinary bladder
Presented by
Capt Alauddin
MD residency phase A
Dept of Radiologyand Imaging

2. •Radio anatomy means study of
anatomy through the use of
radiographic films.
•The density differences in
radiograph have to be described in
terms of anatomical structures.
Radio anatomy

3. Objective :
To identify the Kidney,
ureter and urinary
bladder in different
imaging modalities.

4. Kidney
 Retroperitonial organs
that maintain electrolyte
balance and function for
waste excretion.
 location – T-12 to L-3
vertebra
Rt kidney is slightly
lower than the left kidney
Long axis is directed
downward and laterally

5. Kidneys have
2 poles: Upper and lower
2 borders : Medial and lateral
2 surfaces : Ant and post

6. Capsules of kidney:
-Fibrous capsule :
Covers the kidney
-Perirenal fat: Layer of
fat surrounding the
fibrous capsule
-Renal fascia of Gerota:
Fibroareolar tissue
surrounding the kidney
and perirenal fat.
-Pararenal fat: Fat that
surrounds renal fascia

8. Internal structures
Cortex: 2 parts: Cortical arch and renal
collumn ( Collumn of Bartin).
Medulla : About 10 conical masses called
renal pyramids , the apices of which indent
the minor calyces and bases are covered by
cortical arches.

9. Contents of Cortex & Medulla:

10. Development of Kidney:
Permanent kidney has 2 parts-
A. Collecting system- It develops from ureteric bud
which is an outgrowth of mesonephric duct.
B. Excretory system- It develops from metanephric
mesoderm.

11. Development of Kidney(cont)
9 th wk
of dev

12. Ureters
Connects the renal pelvis to the
bladder and is 25–30 cm long.
• Diameter : About 3 mm
•3 Functionally narrow
regions:
-Junction of renal pelvis with
ureter
-As the ureter crosses bony
pelvic brim
-Intravesical ureter -about 2 cm
and it runs obliquely through
the muscular bladder wall
where it has a valve like action

13. 3 ‘functionally’ narrow regions of ureter:

14. Urinary bladder
Pyramidal muscular
organ specially
when empty.
-The urine produced
by kidney is
temporarily stored
in urinary bladder
till it is cleared to
the exterior through
the urethra.

15. Imaging modalities for
KUB:
•Plain X ray
•USG
•IVU
•CT scan
•MRI
•Renal angiography

16. In plain X ray:
Only renal outline is
seen. The renal edge
may be visible, outlined
by the surrounding
perirenal fat.
Renal size is 3and ½
vertebral bodies in
height. Left kidney is
usually larger(<2 cm).
Bowel preparation is
needed to reduce
confusing gas shadows
of stomach and

17. Plain X ray KUB (cont):
The hilum of left
kidney is closely
approximate with
the tip of left L1
transeverse
process
And hilum of right
kidney is closely
approximate with
the tip of right L2
transeverse

18. Ureter in plain x ray:
-not visible in normal
cases.
-its course is carefully
observed over the tip
of transeverse
processes of L2-L5
vertebrae and
anterior to SI joint
specially when
looking for radio
opaque calculi .

19. Urinary bladder
in plain X ray:
May be identified
specially when full
as a round soft
tissue density
surrounded by a
lucent line of
perivesical fat. It
should be smooth
and symetrical.

20. USG: -Allows multiplanar evaluation of renal anatomy.
Assessment of size, parenchyma, the pelvicalyceal
system can be readily performed.
-Cortex of the kidneys are less echogenic compared
to liver parenchyma . Renal pyramids are relatively
hypoechoic than cortex.
-Outline: smooth
-Cortical thickness: uniform
- Renal sinus contains fat so those are echogenic.

21. Ureter : Proximal and
distal ureter is seen
when dilated .
Urinary bladder: The
bladder wall is best
assessed with this
modality - it should not
exceed 3-5 mm in
thickness.
USG: (Cont)

22. IVU:
Indications
1. Haematuria
2. Renal colic
3. Recurrent UTI
4. Loin pain
5. Suspected UT
pathology.
Contraindications :
Patients with contrast
medium allergies or with
impaired renal function.

23. Contrast medium:
Low osmolar contrast
material (LOCM) 300–370
mg/ml
Adult dose 50–100 ml.
Paediatric dose 1 ml kg–1

24. Preliminary images:
-Supine, full-length
anterior posterior (AP)
view of the abdomen, in
inspiration , before the
start of procedure of
IVU.

25. After giving IV contrast ,
these images are taken:
1. Immediate film. shows the
nephrogram phase where
the renal parenchyma is
opacified by contrast
medium.
2. 5-min film : This film
gives an initial
assessment of pathology
like obstruction before
applying compression
3. 10-min film: Shows the
pelvicalyceal system
which is opacified due to
urine containing contrast.

26. 4. Release film: To
assess the ureters.
5. After micturition
film: For assessment
of urinary bladder
emptying, tumour
,ureterovesical
junction calculi and
also urethral
diverticulum(Female)

27. Dromedary hump/splenic hump is a prominence of
lateral border of left kidney.
It is a normal variant due to close proximity of
spleen.

28. CT:
Kidneys are isodense to liver before contrast.
Hyperdense to liver post contrast.
Collecting system visualized after 120 sec of
applying contrast.
Ureter : May be identified before contrast, well
visualized 120 s after giving contrast .

29. MRI:
Dependent on state of hydration.
Cortex of higher signal intensity (SI) on T1W
image (corticomeduallary junction may be seen)
In T2w image , cortex is of lower signal
intensity.
Ureter : Hyperintense on T2W image
T1 W T2 W

30. Renal vasculatures:
Renal arteries branch from the bdominal aorta
laterally between L1 and L2
-Rt renal artery passes posterior to the IVC
Renal vein drain into the inferior venacava. Renal
veins lie anterior to arteries.

32. Vascular Renal segments:

33. •Renal angiography:
•Allows assessment of
vascular and other
lesions of the kidneys,
but is primarily used to
facilitate interventional
procedures such as
renal artery
angioplasty or stent
placement .

34. Common anomalies of the kidneys:
Anomaly
1.Renal agenesis
2.Pelvic kidney
3. Horseshoe kidney

35. 4. Pancake’ (discoid) kidney (Fused
completely)
5. Crossed fused ectopia
Common anomalies of the
kidneys: (cont)

36. References:
1.Anatomy for Diagnostic Imaging, Stephanie Ryan
FRCSI FFR(RCSI) Consultant Paediatric
Radiologist, Children’s University Hospital, Temple
Street, Dublin, Ireland
2.Weir & Abrahams’ Imaging Atlas of Human
Anatomy
3.TEXTBOOK OF Radiology and imaging by DAVID
SUTTON MD, FRcB FRcR, DMRD, FCan.AR
(Hon)
4.CHAPMAN AND NAKIELNY’S GUIDE TO
RADIOLOGICAL PROCEDURE
5. Radiopedia.org