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Radiological diagnostics of Urinary System

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Radiological diagnostics of Urinary System

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Radiological diagnostics of Urinary System

  1. 1. Radiological semioticsRadiological semiotics of diseases of urinaryof diseases of urinary and genital system.and genital system.
  2. 2. X-ray semiotics of urogenital system and mammary gland pathology Main syndrome at natural contrasting - opacity (intensive opacity). Morphological substratum (MSub) of the intensive opacity in the projection of pelvis, calices, ureter or urinary bladder - X-ray positive (opaque) concretion (stone). Plain radiogram
  3. 3. Plain radiogram. The opacity has a shape the same as intrarenal collecting system shape - coral-shaped stone. MSub of intensive opacity in the projection of kidney parenchyma - calcification of parenchyma, calcification of tumour or calcified echinococcus cyst.
  4. 4. MSub of intensive opacity in breast parenchyma - calcification of malignant tumour. MSub of round opacity in breast parenchyma - cyst, tumour (benign, malignant). MSub of irregular-shaped opacity in breast parenchyma - malignant tumour (cancer), excrescence of connective tissue (fibrous mastopathy), inflammatory infiltration. Mammograms
  5. 5. SponsoredSponsored Medical Lecture Notes –Medical Lecture Notes – All SubjectsAll Subjects USMLE Exam (America) –USMLE Exam (America) – PracticePractice
  6. 6. Main syndromes at artificial contrasting:Main syndromes at artificial contrasting: 1.1. Absence of kidney andAbsence of kidney and collecting systemcollecting system shadowshadow onon one sideone side -- absent kidneyabsent kidney ((aplasia, nephrectomyaplasia, nephrectomy),), non-non- functioning kidneyfunctioning kidney.. 2. Dislocation of kidney and2. Dislocation of kidney and collecting systemcollecting system shadowshadow -- congenitalcongenital dislocationdislocation ((lumbar orlumbar or pelvis distopia); nephroptosispelvis distopia); nephroptosis.. AtAt distopia ureter is shot.distopia ureter is shot. AtAt nephroptosis ureter has normalnephroptosis ureter has normal length but abnormal shape (it’s winding).length but abnormal shape (it’s winding). Intravenous urogram. Lumbar distopia of right kidney
  7. 7. 3. Double shadow of collecting system - complete or incomplete - kidney anomalies. Retrograde urogram. There are too intrarenal collecting systems and too ureters in both of sides - double-sided complete collecting system duplication Intravenous urogram. There are too collecting systems in the left kidney but too ureters are joined - incomplete collecting system duplication
  8. 8. 44.1..1. MSubMSub ofof inside round filling defectinside round filling defect:: -- tumourtumour in collecting system,in collecting system, mammarymammary ductduct, uterus cavity;, uterus cavity; -- X-ray negative (nonopaque)X-ray negative (nonopaque) stonestone in collecting systemin collecting system.. 4.2.4.2. MSubMSub ofof round filling defect alonground filling defect along the outlinethe outline –– tumourtumour oror cystcyst in surroundingin surrounding tissues that presses cavity –tissues that presses cavity – compressioncompression from outsidefrom outside.. Ductogram 4. Decreasing shadow (filling defect) of collecting system, mammary duct, uterus and uterine tube cavities.
  9. 9. 4.3.4.3. MSubMSub ofof linear fillinglinear filling defect indefect in upper part of ureterupper part of ureter -- additional vesseladditional vessel that pressesthat presses ureter.ureter. 4.4.4.4. MSubMSub ofof circulating filling defect incirculating filling defect in ureter,ureter, mammary ductmammary duct -- tumourtumour withwith infiltrative growth.infiltrative growth. 4.5. MSub of decreasing or absent shadow of uterine tube - obstruction of the tube by adhesions (scars) at chronic inflammation. Hysterosalpingogram
  10. 10. 5. Increasing shadow of collecting system or uterine tube. 5.1. Increasing uterine tube shadow - inflammatory fluid, pus, blood in tube - hydrosalpinx - often is combined with obstruction of tube (contrast medium does not go out the tube). 5.2. Increasing quantity of calyces - polycalycosis. There are a lot of cavities connected with collecting system (additional calyces) - spongy kidney (result of dysplasia).
  11. 11. 5.3.5.3. Increasing shadow of one calyx (Increasing shadow of one calyx (hydro-hydro- calycosis)calycosis) oror calices and pelvis (calices and pelvis (hydro-hydro- pyelocalycosis)pyelocalycosis) oror calices, pelvis and uretercalices, pelvis and ureter ((hydroureterpyelocalycosis)hydroureterpyelocalycosis) -- dilatation -dilatation - result ofresult of obstructionobstruction byby stone, tumour,stone, tumour, additional vesseladditional vessel oror stricture of ureterstricture of ureter.. The syndrome “increasing shadow” often is revealed in combination with syndrome “filling defect”. The dilatation also may be conditioned by hypotonia of collecting system at chronic pyelonephritis and by megaureter (congenital dilation).
  12. 12. 6. Increasing shadow of kidney. Enlargement of one kidney - tumour or cyst. Angiogram. Left kidney is enlarged. Its vessels are shifted by cyst
  13. 13. Enlargement of both of kidneys - polycystosis. The syndrome increasing shadow of kidney often is revealed at the same time with syndrome round filling defect along the outline of intrarenal collecting system. Intravenous urogram. Polycystosis
  14. 14. 7. Decreasing shadow of kidney – hypoplasia or sclerosis of parenchyma (contracted kidney). Angiogram. Hypoplasia of left kidney
  15. 15. 8. Deformation and displacement of uterus - anomalies, pressing from outside, shifting by fibrous adhesions at chronic inflammation (often - in combination with obstruction of tubes). Bicornate uterus Saddle-shaped uterus Uterus anomalies
  16. 16. CT- andCT- and MRI-MRI-semiotics of urogenital systemsemiotics of urogenital system and mammary gland pathologyand mammary gland pathology 1. Changes of shape, sizes, quantity, location of kidney.1. Changes of shape, sizes, quantity, location of kidney. CT-gram. Hypoplasia of right kidney due to hypoplasia of right renal artery MR-tomogram. Enlargement and deformation of right kidney due to tumor
  17. 17. 2.2. AtypicalAtypical (heterodense(heterodense oror heterointense)heterointense) focus in kidney,focus in kidney, breast, prostate gland, ovary parenchyma -breast, prostate gland, ovary parenchyma - massmass oror cavity;cavity; inin wall or cavity of uterus -wall or cavity of uterus - massmass.. TumourTumour -- homogeneoushomogeneous ((hypo-hypo- oror hyperdensehyperdense on CT-grams,on CT-grams, hypo-hypo- oror hyperintensehyperintense on MR-images);on MR-images); -- inhomogeneousinhomogeneous,, with regular or irregular contourswith regular or irregular contours.. Metastases may be found in kidney, as a rule - homogeneous with irregular contours. Metastases unlike tumour do not enlarge kidney!
  18. 18. Cyst always is seen as hypodense on CT-grams, hypointense on T1-weighted and hyperintense on T2-weighted MR- images, with regular contours. On MRI cyst often has hypo- or hyperintense outline (wall). Abscess as a rule is seen similar to cyst but with irregular contours. Echinococcus (hydatid) cysts very rarely are found in kidneys (unlike liver), may be inhomogeneous with hyperdense (on CT), hypointense (on MRI) outline conditioned by calcified wall.
  19. 19. 3.3. HyperdenseHyperdense (on CT)(on CT),, hypointensehypointense (on MRI)(on MRI) focus in calyx, pelvis,focus in calyx, pelvis, ureter, urinary bladderureter, urinary bladder -- stonestone.. CT-gram. Stone in the pelvisCT-gram. Stone in the pelvis of right kidneyof right kidney 44.. Changing collecting systemChanging collecting system cancan be visualized with MR-urographybe visualized with MR-urography (like(like X-ray urography but withoutX-ray urography but without using contrast medium)using contrast medium) oror withwith CT.CT.
  20. 20. Ultrasound semiotics of urogenital systemUltrasound semiotics of urogenital system and mammary gland pathologyand mammary gland pathology 1. Hypo- or hyperechoic focus in parenchyma of kidney,1. Hypo- or hyperechoic focus in parenchyma of kidney, prostate gland, ovary, breast; in wall or cavity of uterus –prostate gland, ovary, breast; in wall or cavity of uterus – tumour.tumour. MalignantMalignant tumor often istumor often is inhomogeneousinhomogeneous due todue to areas of necrosis or calcification.areas of necrosis or calcification. Metastasis (homogeneous),Metastasis (homogeneous), eechinococcus cystchinococcus cyst ((inhomogeneous)inhomogeneous) may be found in kidneymay be found in kidney.. Echogram of prostate. Heteroechoic focus - tumor Echogram of uterus. Inhomogeneous focus in cavity that grows from wall - tumor
  21. 21. 2. Hypoechoic focus in parenchyma of kidney, prostate, ovary, breast - abscess. 3. Anechoic focus (foci) with dorsal enhancement in parenchyma of kidney, prostate, ovary, breast – cyst (cysts). After cavity wall dorsal acoustic shadow often is visualized. Abscess has more irregular contours, thicker wall than cyst. Echograms of mammary glands: 1 - fluid in cavity, 2 - dorsal enhancement after fluid, 3 - dorsal acoustic shadow after wall of cavity 1 CystAbscess 2 3
  22. 22. 4. Hyperechoic focus in calyx, pelvis, urinary bladder - stone, tumor. After stone dorsal acoustic shadow always is seen. Echograms of urinary bladder Tumour Stones Echogram of kidney. Stone in collecting system 1 1 - dorsal acoustic shadow after stone, 2 - kidney collecting system, 3 - kidney parenchyma 3 2
  23. 23. 4. Increasing anechoic zone of kidney collecting system - hydropyelocalycosis or pyelocalycoectasia - dilation: -result of obstruction by stone, tumour, additional vessel or stricture of ureter; - hypotonia of collecting sys- tem at chronic pyelonephritis; - megaureter . The syndrome increasing anechoic zone often is found in combination with syndrome hyperechoic focus in collecting system. 1 2 3 1 - increasing calyces, 2 - stone in pelvis, 3 - kidney parenchyma
  24. 24. 5. Increasing quantity of calyces - polycalycosis - spongy kidney. 7. Decreasing kidney - hypoplasia, sclerosis of parenchyma. 6. Increasing kidney - tumour, cyst (cysts) - in combination with heteroechoic zone in parenchima. Contracted right kidney. It is smaller and more echoic than left kidney
  25. 25. Radionuclide semiotics of kidney pathology 1.Absence of RPH accumulation in kidney - absent or non-functioning kidney. 2. Diffuse decreased accumulation of RPH in kidney - total decreasing kidney function. At chronic glomerulonephritis, bilateral chronic pyelolonephritis, nephropathy both of kidneys are changed. At chronic one-sided pyelonephritis one kidney is changed.
  26. 26. 3. Changing shape, sizes of kidney. Right kidney is decreased and deformed, accumulation of RPH in it is decreased - contracted kidney Nephroscintigrams in posterior projection Kidneys are linked at one end by a band of tissue - horse-shoe kidney (anomaly). RPH accumulation in left kidney is decreased.
  27. 27. 4. Changing location of kidney - dystopia, nephroptosis. 5. Local decreased accumulation of RPH - “cold” area - mass, cavity. Nephroscintigrams in posterior projection
  28. 28. Segments (phases) of renograms: 1st - a sharp quick rise during 30 s after RPH injection (it represents function of kidney vessels) – vascular phase. 2nd - a slower rise in the next 3-5 min (it represents nephron accumulation of RPH) - secretion phase. 3d - a slow fall during the next 20 min (it represents excretion of RPH) - excretion phase. Renogram Dynamic scintigram 1 2 3 1 2 3
  29. 29. Types of pathological traces: 1 - obstructive - obstruction of urinary tract (3d phase is horizontal or rising). 2 - hypofunctional - minor or moderate decreasing of kidney function (2nd and 3d phases are changed). 3 - parenchymal - renal failure (2nd phase is absent and 3d phase is changed). 4 - anfunctional - considerable renal failure - contracted kidney (all of 3 phases are absent). 1 2 3 4

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