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Scout Film
Nephrogram Phase
Kidney
Size 11-13cm
Shape: bean shaped
Contour: smooth
Thickness of cortex: uniform
Axis: tilted
Superior pole closer to mid line
Collecting System
Calyces
Limitations
Contrast complications
Disadvantages May aggravate an existing urinary tract
infection or triggering one from the
catheterization
Labor and time intensive – it may take up
to 6 hours to complete in the severe
Utility/Indications
obstruction
It requires placement of an intravenous
Children with urinary tract infections
line
Reflux is detected if contrast is seen to
Requires a bowel preparation for optimal
flow in retrograde fashion up the ureters
results
from the bladder
Involves intravenous injection of
Pelvic trauma where rupture of the
potentially allergic and mildly nephrotoxic
bladder or urethra is suspected
contrast
o If the bladder is ruptured,
Retrograde Pyelogram extravasations of contrast will be
seen outside the bladder in the
pelvis or abdomen
• Like IVP, retrograde pyelography relies on
o If urethra is ruptured, there is
contrast medium to produce detailed x-ray extravasations into the perineum
images of the urinary tract
How it is done…
Images of the urinary tract
Avoiding cystourethrogam is performed by
Indications inserting a catheter into the urethra
Contrast material is then instilled into the
Commonly performed when IVP produces bladder through the catheter
an inadequate picture. Useful to study x-rays are taken before, during and after
urinary tract obstruction when further filling of the bladder
calcification of nature of utreteral when the bladder is full, the catheter is
obstruction is required removed
It also complements cytoscopy while while the patient voids, additional x-rays
investigating a patient with hematuria or are taken
recurrent or suspected cancer
Detects small lesions in the collecting
system. E.g. transitional cell carcinoma
• Hematuria
• Local staging of cancer to allow definitive
surgical management if needed
• Renal artery and vein evaluation
Disadvantages
Utility
Radiographic findings
a classic appearance known as the “cobra
head deformity” and resembles a snake’s
head bulging into the bladder
often best detected on IVP
Disadvantages
Case 2
• Expensive
• Limited availability
• MRI has limited applicability for urinary
tract since the non-specificity of its signals
makes it ineffective in detecting
calcifications and bladder abnormalities
• Patients with pacemakers, aneurysm clips,
ear implants, and metallic pieces in vital
body locations cannot be imaged safely.
Normal IVP
Case 3
Renal Agenesis
Case 1
when the ureteric bud fails to reach the
metanephric blastema, there is no
induction of nephron development
associated ipsilateral abnormalities are
almost always present ans include
absence of ureter, hemitrigone, or vas
deferens, seminal vesicle cyst, or
Muellerian abnormalities such as
unicornate uterus
absence of the ipsilateral adrenal gland is
seen in 10 % of these patients
incidence of renal agenesis is one per
1000 live births, 75 % of which are male
Case 4
Horseshoe Kidney
occurs in one of every 400 livebirths
most common renal anomaly
Multicystic Dysplastic Kidney (MCDK) males are twice as likely to have the
occurs as a result of inadequate induction anomaly as females
of maturation of the metanephric associations include UPJ obstruction,
blastema by the ureteric bud duplication anomalies and stone formation
due to abnormal kidney geometry and
2 Types urine stasis
a. Pelvoinfundibular MCDK- randomly
distributed, non-communicating cysts Pelvic Kidney
replace normal renal parenchyma, the
kidney is not functional and an atretic
ureter is often present
b. Hydronephrotic MCDK- representing a
severe inutero form of UPJ obstruction
Case 1
Case 6
density cysts
(>20 HU), non-
enhancing
III M Renal-sparing
ultiloculated, suregery
hemorrhagic,
dense
calcifications,
nonenhancing
solid
component
IV Marginal Radical
irregularity, nephrectomy
enhancing
solid
component
Bosniak I Lesions
simple fluid with imperceptibly thin walls
and no septations, calcifications, or
enhancement
on CT, simple fluid possesses an
attenuation at or around 0 HU
Bosniak II Cyst
Renal Cysts
50 % of the population older than 50 years
the cyst shows high signal on T1 and T2-
most are asymptomatic, though a large
weighted images suggesting it is more
cyst can cause discomfort and
complex perhaps from hemorrhage or
hypertension
from proteinaceous contents
a ruptured cysts may result in hematuria,
an infected cyst results in fever Bosniak II Lesions
both infected cysts and hemorrhagic cysts
are non-simple by imaging
Bosniak IV Cyst
Case 2
Case 3
Case 1
Case 5
Case 3
Differential Diagnosis
Cystitis
an inflammation of part or the entire
urinary bladder wall contrast enhanced CT of pelvis shows a
common causes include: small diverticulum projecting from the left
-infection- E.coli, klebsiella, pseudomonas, lateral wall of the bladder (arrow)
schistosomiasis, also viral and fungal cause
-irritative or mechanical (such as an Cystocele
indwelling catheter or a stone)
-toxic (cyclophophamide)
-radiation
-allergic
CECT of the pelvis
an indwelling nephroureterical stent sits in
the bladder
this patient received pelvic radiation for a
non-bladder malignancy. This resulted in
bladder wall thickening and obstruction of
the left ureter at the ureteral orifice into
the bladder causing left-sided
hydronephrosis and thus requiring
stenting
as focal herniations of the urothelium and
note bladder wall thickening in the left submucosa cystoceles
lateral bladder wall from radiation induced usually occur in the setting of chronic
cystitis elevation of intravesical pressure
a mass like lesion in the dependent they tend to occur next to ureteral orifices,
portion of the bladder may represent a and occur where small outpouchings of
mass (arrows). However, this patient mucosa evaginate between hypertrophied
presented with gross hematuria which detrusor muscle bundles, but do not
resolved following irrigation extend past the bladder wall
differential diagnosis: bladder or prostate cystoceles constitute an important cause
mass of urinary stasis, ureteral obstruction, and
vesicoureteral reflux
Bladder Diverticula
Bladder Fistulas
Case 6
Emphysematous Cystitis
a rare form of bacterial cystitis that occurs
in patients with poorly controlled diabetes
E. coli is the most common pathogen and
urinary stasis is a common feature