قراءة
عرض

Urinary system imaging

lecture (1)
5 TH stage
By
Dr. Firas Abdullah
Thiqar college of medicine

Aims of our lecture:

 To know the different radiological techniques used in
urinary tract
 To know different renal pathologies.
 Urinary bladder diseases
 Prostate and urethra disease
 Scrotal and testicular disorders
 Female genital organs imaging

I) Radiological techniques used in urinary

tract imaging:
 Ultrasonography
 Urography
 CT scan
 MRI
 Radionuclide scanning
 Special techniques:
o Retrograde and antegrade pyelography
o Voiding cystourethrogram (micturating cystogram ) and videourodynamics
o Urethrography
o Renal arteriography.

Ultrasonography:

 Investigate patients with symptoms thought to arise
from the urinary tract.
 Demonstrate the size of the kidneys and exclude
hydronephrosis in patients with renal failure.
 Diagnose hydronephrosis , renal tumours, abscesses
and cysts including polycystic disease.
 Assess and follow -up renal size and scarring in
children with urinary tract infections.
 Assess the bladder and prostate .

❑ The normal adult renal length, measured by

ultrasound, is 9 – 12 cm.
❑ Renal length varies with age, being maximal in
the young adult.
❑ There may be a difference between the two
kidneys , normally less than 1.5 cm.
❑ A kidney with a bifid collecting system is usually
1 – 2 cm larger than a kidney with a single
pelvicaliceal system.

Causes of small kidney

Causes of large kidneys

Urography:

Indications :
 When detailed demonstration of the
pelvicaliceal system and ureters are required
 Suspected ureteric injury, e.g. following pelvic
surgery or trauma
 Assessment of acute ureteric colic

Intravenou s (Excretory ) Urography

Preliminary
Immediate Compre ssio n
5 min u tes Release Post -mictu ration

1. Check the Kidneys: outline, size, site

2. Check the calyces: cupped
3. Check renal pelvis and ureter
4. Check the bladder

Causes of calyceal dilatation:

A: Due to obstruction
1. Within the lumen:
I. calculus
II. blood clot
III. sloughed papilla
2. Within the wall of the collecting system
I. intrinsic pelviureteric junction obstruction
II. transitional cell tumour
III. infective stricture (e.g. tuberculosis or schistosomiasis )
3. Extrinsic compression
I. retroperitoneal fibrosis
II. pelvic tumour, e.g. cervical, ovarian or rectal carcinoma
III. aberrant renal artery or retrocaval ureter
B) Due to pap illary atrophy or destruction:
1. Reflux nephropathy
2. Papillary necrosis
3. Tuberculosis

Indication of CT urography

 Investigation of renal calculi
 Investigation of haematuria
 Characterization of a renal mass
 Staging and follow -up of renal carcinoma
 To delineate renal vascular anatomy (e.g.
suspected renal artery stenosis or prior to live
related kidney donation)
 To diagnose or exclude renal trauma

CT urography

CT urography

MRI

MRI

MRA

Radionuclide examination

Voiding cystourethrogram ( micturating cystogram )

Retrograde urethrogram

Urinary calculi

Nephrocalcinosis

 Deposition of calcium salts in the
medulla or cortex of the kidney.

Medullary Nephrocalcinosis

Congenital intrinsic pelviureteric junction (PUJ) obstruction
 In this disorder, peristalsis is not transmitted across the
pelviureteric junction.
 Childern and young adult
 Dilatation of the pelvis and calices, with an abrupt
change in caliber at the pelviureteric junction
 the ureter is either narrow or normal in size .

Renal parenchymal masses

 In adults, the most common malignant tumour is
renal cell carcinoma, whereas in young children
the common neoplasm is Wilms’ tumour.
 Other masses: renal abscess, benign tumour
( oncocytoma or angiomyolipoma ), hydatid cyst ,
and metastasis.
 Renal cysts
 ‘renal pseudotumour ’ or column of Bertin

Multiple renal masses include :

• Multiple simple cysts
• Polycystic disease
• Malignant lymphoma
• Metastases
• Inflammatory masses.

Thank you


رفعت المحاضرة من قبل: Mubark Wilkins
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