10 Intravenous Pyelography Largely replaced by USml of contrast is injected intravenouslyCarried via blood to the kidneys, passes through the glomerular filtrate collecting systemsMain indications:Detailed demonstration of PCS and uretersAcute ureteric colicInvestigation of renal calculiInvestigation of hematuria
11 Identify all calcifications !!! First step: Plain filmLook at renal contourIdentify all calcifications !!!Urinary calculi (kidney,ureter,bladder)NephrocalcinosisProstatic calcification
16 Kidneys: position , length , contours Calices: should be symmetrical, cup-shaped.If dilated club-shaped (due to obstruction or destruction of papilla)Renal pelvis and ureters: normal pelvis is funnel-shaped, ureters are seen in only part of their length due to peristaltism.Bladder: centrally located, smooth outline, should be empty after micturition
18 Computed Tomography Indications: To characterize renal masses and stage tumorsTo diagnose or exclude renal traumaTo demonstrate stonesTo assess acute ureteric colicTo delineate renal vascular anatomy
19 Normal Findings Renal sinus ; low attenuation in the center There should not be any calcificationUreters are seen as dots in cross section lying on the psoas musclesBladder has a smooth outline, thin wall, anechoic urine.Axial images may be reformatted in the coronal and sagittal planes
23 Voiding Cystourethrogram Bladder is filled with contrast medium through a catheter and films are taken during voidingObserved fluoroscopically to identify reflux of contrast medium from bladder to upper UT.Risk of urinary tract infection, chronic pyelonephritis and renal scarring is increased in VUR.
24 Grading of VUR Grade 1 reflux of urine only into the ureter Grade 2 reflux into the pelvis and calices, no dilatationGrade 3 mild to moderate dilatation of the ureters and renal pelvisGrade 4 moderate dilatation and tortuosity of the ureters,pelvis,calicesGrade 5 gross dilatation and tortuosity of the ureters,pelvis and calices
29 Urinary CalculiMost calculi are calcified and can be seen as radiodense on plain x-ray.Only pure uric acid and xanthine stones are radiolucent on plain radiography, and they can be identified at CT or US.US ; hyperechoic with posterior acoustic shadowingCT ; hyperdense
33 Urinary Tract Obstruction The main feature is dilatation of the pelvicaliceal system and uretersMain causes :CalculiBlood clotSloughed papillaTumorsUS, IVP and CT
34 US : dilatation of PCS is seen as multiloculate fluid collection in the central echo complex (caused by pooling of urine within the distended pelvis and calices). Proximal ureteric dilatation can also be demonstrated but overlying bowel gas obscures dilatation of the mid and distal ureter.
39 Renal Parencymal Masses Causes: cyst, benign tumor (angiomyolipoma), renal cell carcinoma, metastases, abscessUSusually renal masses are first detected by US.Cystic versus SolidSimple cyst: common in elderly, solitary or multiple, unilocular or septated. Acoustic enhancement.
42 Renal Cell CarcinomaRCCs account for 86% of all primary renal parenchymal tumors.On US; solid tumorsMay be iso, hypo or hyperechoic.When a tumor is demonstrated, extension into the renal vein and inferior vena cava should be assessed.
43 CT Useful for diagnosis and staging of renal tumors Shows local direct spread, enlargement of lymph nodes, liver or other organ metastases, renal vein and IVC involvement.
46 Urothelial tumors are seen as filling defects in the renal pelvis and ureters Filling defects in the collecting system: calculi, blood clot, tumorThey may obstruct the ureter and cause hyrdonephrosis.
51 Ectopic Kidney During fetal development kidneys ascend in the abdomen Ectopic kidney results when this ascent is haltedIn some cases kidneys lie on the same side and are fused (crossed fused ectopia)
52 Horseshoe KidneyThe kidneys may fail to seperate, giving rise to a horseshoe kidneyLower poles are fused by parenchyma or fibrous tissue
55 Bladder Tumor Most frequent site for neoplasms of the urinary tract On US; bladder tumors are seen as soft tissue masses protruding into the bladder.IVP; filling defect in the bladderOn CT and MRI; soft tissue mass projecting from the bladder wall
63 Prostate ImagingProstatic enlargement : benign prostatic hypertrophy, prostatic carcinomaProstatic ultrasound; transducer introduced into the rectumTRUS guided biopsyMRI ; tumor is seen mostly in the peripheral zone as hypointense on T2
67 Scrotal Swelling US, Color Doppler US, MRI Testicular tumor, orchitis-epididymo-orchitis, testicular torsion, hydroceleDoppler ; used in acute scrotum; to differentiate between epididiymo-orchitis and testicular torsionEpididiymo-orchitis ; medical treatmentTorsion ; surgery