Renal system seminar pdf - كتابة الطلاب

Fifth stage

Radiology

عملي

.د

محمد ميسر

9/12/2015

Renal system seminar

Slide1  Renal system seminar.

Slide2  normal KUB  may come in the exam.

Slide3  Renal stones:



85% of stones are radio-opaque (use KUB).



15% of stones are radio-lucent (use US or CT).



In the renal rejoin



renal stone.



Outside the renal rejoin



ureteric stone.



Pelvic rejoin



bladder stone or phlebolith (round, radiolucent center).

Slide4  first photo (KUB show renal stone) second photo (KUB show ureteric stone).

Slide5  first photo (KUB show renal stone) second photo (KUB show ureteric stone).

Slide6  Calcification of the urinary bladder wall (due to schistosomiasis).

Slide7  CT scan:

Coronal view show  double J catheter + ureteric stone + schistosomiasis.

Axial view show  schistosomiasis.

Slide8  bladder exstrophy:

Radiographic appearance in bladder exstrophy. It describes wide midline separation of the
pubic bones.

Bladder exstrophy (also known as ectopia vesicae) refers to a herniation of the urinary
bladder through an anterior abdominal wall defect. The severity of these defects is widely
variable.

Slide9  bladder exstrophy.

Slide10  Normal CT scan of abdomen:



Plans or views



axial, coronal, sagittal.



Black (hypodense), white (hyperdense).



Opaque and lucent stones appear hyperdense in CT.



Types



plane CT (without contrast) and contrast CT.



Oral contrast



use gastrographine and the stomach appears white.



IV contrast



the vessels appear white.

Slide11  contrast CT with oral and IV contrast.

Slide12  CT scan stones in kidneys.

Slide13 

First photo:



Plane CT scan / stone and hydronephrosis in the right kidney, left kidney is normal
(black area in the center is fat).



Note: dilated cortex = cyst // dilated pelvis = hydronephrosis (according to the
density we can differentiate between fluid, soft tissue, mass).

Second photo:



CT scan with contrast / Stone + hydronephrosis.

Slide14  Stage horn calculus / KUB films / radio opaque stones.

Slide15 

First photo:



KUB study.



Stag horn stone.



Note: IVU study give the same image but not stone, it could be PUJ obstruction.

Second photo:



Stone in the bladder.



Bilateral stag horn stone.

Slide16  procedure of IVU study.

Slide17  Normal IVU series.

Slide18 

First photo: IVU study, left ureteric stone.

Second photo: IVU study, bilateral hydronephrosis.

Slide19  Hydronephrosis + filling defect (stone which causing partial obstruction because
lower ureter appear).

Slide20  Bilateral HU + HN, the cause:



Exclude bilateral stone.



Exclude bladder tumor.



Exclude reflux.



If all causes are no



then it is megaureter.

Slide21  only left hydronephrosis, right kidney (other pathology .)غير مطلوبة

Slide22 

RT sided PUJ stenosis & obstruction with RT sided HN

Slide23  nothing.

Slide24  Uretrocele (cobra head shape) distal both sided ureteric ends with dilated both
ureters

Slide25 



First photo: uretrocele.



Second photo: copra head + hydroureter + hydronephrosis (bilateral).

Slide26  megacalyces ( .)غير مطلوب

Slide27  megaureter.

Slide28  right side (hydronephrosis), left side (polycystic kidney  spider leg appearance
of the kidny).

Slide29  Absent kidney ((DDx  agenesis, nephropathy lead to renal failure,
nephrectomy)).

Slide30  absent right kidney.

Slide31  Duplication of the renal system.

Slide32  Duplication of the renal system.

Slide33  horse shoe kidney with hydronephrosis.

Slide34 

First photo: not important.

Second photo: crossed ectopia / right kidney in the left side and the right ureter is inserted
in the right side of bladder.

Slide35  Hydronephrosis + hydroureter + neurogenic bladder (irregular shape of the
bladder called christmas tree sign).

Slide36 



IVU show filling defect in the bladder which could be stone, tumor or BPH and we can
differentiate between them by clinical picture.



In male



BPH lead to filling defect in the base on bladder.



In female



uterus compress the bladder from above.

Slide37  BPH with elevated bladder base.

Slide38  irregular large felling defect  tumor.

Slide39 

Renal cell ca destruction & missing of the normal appearance of the RT PCS.

Note: pelvi-calyceal system  could be stretched (polycystic kidney) or destroyed (tumor).

Slide40  US show hypoechoic lesion at the parenchyma  it is tumor (RCC most
common).

Slide41 

Contrast CT scan showing soft tissue mass, hypodense, from the parenchyma, in the left
kidney, the mass take the contrast.



Large mass from parenchyma



tumor (vascular tumor if take the contrast).



Cyst



same picture but the density differ.

Slide42  contrast CT scan, showing hypodense mass mixed or complex (contain both soft
tissue and fluid) this is tumor with necrosis and degeneration.

Slide43  Wilms tumor.

Slide44  soft tissue shadow involve hemiabdomen in the left side, DDx:



Splenomegaly.



Tumor



renal (Wilms), adrenal (neuroblastoma), muscle (rhadbomyosarcoma).

Note: in the right side there is bowel .مدفوعة

Slide45  Normal US of the renal system.

Slide46  normal kidney US .قد يأتي باالمتحان

Slide47  US showing hydronephrosis.

Slide48 

Simple renal cyst with acoustic enhancement.

Slide49 

Polycystic renal disease in ultrasound demonstrate numerous cysts seen in

cortex & medulla.

Slide50  Polycystic renal disese in CT scan diffuse liver & kidney affection.

Slide51 

First photo: not important.

Second photo: Multicystic dysplastic kidney:
  1.hypoechoic cysts of variable sizes and shapes,
  2.interfaces between cysts,
  3.absence of an identifiable renal sinus,
  4.lack of communication between cysts on sonograms,
  5. minimal surrounding parenchyma

Slide52 

Renal stones (white echogenic stones with reflections).

Note: No acoustic show = no stone // calcifications not have acoustic shadow.

Slide53  First photo = stone in the urethrovesical junction.

Slide54  US showing hypoechoic irregular mass in the bladder (mostly TCC).