contrast radiography

1. CONTRAST
RADIOGRAPHY OF
BLADDER AND
URETHRA
Dr. Pavulraj.S
M.V.Sc., (Veterinary Pathologist)
Research fellow
National Research Centre of
Equines, India
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist, Research Fellow, NRCE,
India

2. CONTRAST
RADIOGRAPHY OF
BLADDER
• It is a simple, fast, inexpensive
technique
• Provide valuable diagnostic and
prognostic information about bladder
disease
• Clinical indications - dysuria,
pollakiuria, haematuria
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

3. Dog
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

4. Cat
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

5. Cystographic technique
• Withheld food for 24 hrs
• Enema given preceding cystography
• All catheters should be sterilized
• Bladder is catheterized
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

6. Contrast media
• Negative contrast media – CO2,
Nitrous oxide
• Positive contrast media – water
soluble organic iodides 20% - 10 ml
per Kg body weight.
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

7. Views
• Lateral
• Ventral left dorsal right
• Ventral right dorsal left
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

8. Procedure
• Positive contrast cytography is performed by
injecting 20% organic iodides solution in to bladder by
urethral catheter
• Double contrast cytography is performed by injecting
a small volume of undiluted +ve contrast medium in to
a empty bladder
Dose – 1 ml for cat, 3 ml for dog. Followed by
bladder distention with –ve contrast medium
• Positive and double contrast procedure is useful than
negative contrast cytography
• Double contrast cytography is superior for assessing
bladder wall lesions and intraluminal filling defects.
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

9. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

10. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

11. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

12. Radiographic signs
• Irregular mucosal border
• Intramural thickening filling defects
• Extravasation patterns
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

13. Mucosal changes
• Metaplastic, neoplastic, non-
neoplastic proliferations.
• Appears as a irregular outline along
inside of bladder surface. Ulcers can
be identified with a double contrast
cystography
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

14. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

15. Bladder wall thickening
• Normal thickness – 1 mm
• Can use double contrast cytography
• Thickening may be due to
Cellular infiltrations
Fibrous tissue proliferation
Hemorrhage
Trauma
Neoplasia
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

16. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

17. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

18. Filling defects
• Any thing occupying space with in the
bladder alter normal filling. Defect
area appear as radiolucent
surrounded by +ve contrast medium.
• Size, shape, border, position with in
the bladder and attachment to the
bladder should be examined.
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

19. • Free luminal filling defect
Air bubbles
Calculi
Blood clots
• Attached luminal filling defect
Neoplasia
Polyps
Blood clots
Haemotoma
Adherent calculi
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

20. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

21. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

22. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

23. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

24. Contrast extravasation
patterns from the urinary
bladder
• Traumatic bladder diverticula's
• Urachal anomalies – urachal
diverticulum's
• Extravasations to peritoneal cavity
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

25. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

26. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

27. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

28. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

29. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

30. Pitfalls with cystographic
interpretation
• Changes mimic actual pathologic changes
• Artifacts – created during cystographic procedures
Air bubbles
Small -calculi or small luminal filling defects
Large – bladder wall thickening
Multiple – honey comb appearance
• Pseudo filling defects
Mistaken as bladder neoplasia
It may due to inadequate bladder distension and
external pressure from abdominal structures.
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

31. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

32. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

33. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

34. Contrast radiography of
urethra
• Conduit for urine from bladder
• Female - shorter and wider
• Dog – 3 parts
• Cat - 2 parts
• Contrast radiography used in all
urethral diseases
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

35. Contrast urethrography
• Water soluble organic iodides 15 % used.
• Balloon tipped catheter used. It is
inserted and balloon inflated to prevent
reflux of contrast medium
• 10 – 15 ml in dogs. 5-10 ml in cats
• Radiographic exposure should be done at
the last 2-3 ml of contrast medium
injection
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

36. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

37. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

38. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

39. Views
• Lateral
• Right and left ventro-dorsal oblique
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

40. Female animals
• Difficult
• Balloon tipped catheter inserted into
urethra then balloon inflated and contrast
injected then exposure made during
injection
Vaginocystourethrography
Balloon tipped catheter placed in
vestibule and inflated to occlude the
outflow. +ve contrast medium is injected.
Vagina fills first and then urethra fills.
But it need general anesthesia
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

41. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

42. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

43. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

44. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

45. Radiographic signs
Filling defects
1. Intraluminal
Air bubbles – round, smooth
margin
Urethral calculi – irregular
margin, blurred margin
Blood clots – irregular, poorly
defined margin
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

46. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

47. 2. Intramural filling
defects
Due to neoplasm, inflammation
Irregularity of mucosal surface
Widening or narrowing of lumen
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

48. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

49. Extramural filling defects
• Due to compression by masses
surround the urethra
• Prostate hyperplasia
• Neoplasm
Mucosal surface will be smooth
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

50. Extra vasation of
contrast medium
• Urethral rent near bladder neck –
peritoneal cavity
• Urethrocavernous reflux – systemic
venous circulation
• Os penis fracture
• Poor catheter manipulation
Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

51. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

52. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist,

53. Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist, Research
Fellow, NRCE, India