Urinary Tract Radiological Investigations and Anatomy

• Intravenous urography

• Cysto-urethography

• Antegrade pyelography

• Retrograde pyelography

• Hysterosalpingography

• IONIZING RADIATIONIONIZING RADIATIONConventional (plain) radiography.

Contrast studies (X-Ray + Contrast)

Computed Tomography. Isotopic scanAngiography

• NONIONIZING RADIATIONNONIONIZING RADIATIONUS.

MRI.

KIDNEYS

URETERS

URINARY BLADDER

URETHRA

Conventional plain film of the abdomen is called a KUB (Kidneys, Ureters, Bladder)

Good evaluation of radio-opaque stones

This is KUB taken post intravenous contrast injection

KUB IVU

This is KUB taken post intravenous contrast injection

Also called IVP (intravenous pyelogram)Also called IVP (intravenous pyelogram)

Demonstrates both function and structure of the renal systemDemonstrates both function and structure of the renal system•Function ---Function --- FiltrationFiltration

•StructureStructure --- --- Contrast filled collecting systemContrast filled collecting system

Indications:Indications:•Urolithiasis / calculusUrolithiasis / calculus•PyelonephritisPyelonephritis•HydronephrosisHydronephrosis•TraumaTrauma•Tumour Tumour •Renal hypertensionRenal hypertension•Congenital abnormalityCongenital abnormality

Contra-Indications: (relative)Contra-Indications: (relative)•History of AllergyHistory of Allergy•AsthmaAsthma•Cardiovascular diseaseCardiovascular disease•Sickle cell diseaseSickle cell disease•Diabetes mellitusDiabetes mellitus

This is KUB taken post intravenous contrast injection

Renal Pelvis

Left Ureter

Urinary Bladder

• After IV injection,

sequential images are

taken in time order.

• Immediate post IV

• 5 min post IV

• 10 min post IV

This is KUB taken post intravenous contrast injection

Left Kidney

• Immediate post IV is nephrogram

Right Kidney

This is KUB taken post intravenous contrast injection

• 5 min post IV is nephrogram

This is KUB taken post intravenous contrast injection

• 10 min post IV is nephrogram

Renal Pelvis

Left Ureter

Urinary Bladder

Full Bladder20 min

KidneyKidney• Renal fasciaRenal fascia• HilumHilum• Renal sinusRenal sinus• Renal cortexRenal cortex

– Renal columnsRenal columns

• Renal medullaRenal medulla– Renal pyramidsRenal pyramids

• CalycesCalyces– Minor calycesMinor calyces– Major calycesMajor calyces– Renal pelvisRenal pelvis

Arterial

Venous Excretion

Non-contrast = Cortical

= Parenchymal

A 29 year old female patient presented to the emergency department complaining of acute sudden severe right flank pain radiated to the groin for 1 hour associated with hematuria.

•What is the likely diagnosis?•What investigation you will request?•What are the findings you expect to see?

Case one

Renal tract stone

Renal tract stone:

Renal tract stone

Renal tract stone:

Urinary tract stone

Case Two

A 36 year old male patient involved in road traffic accident. On examination patient is conscious oriented and in pain. Abdominal examination revealed diffuse guarding and tenderness.

What is the likely diagnosis?

What investigation you will request?

What are the findings you expect to see?

Case Three

A 54 years old female patient known case of diabetes and hypertension found to have high creatinine level.

What is the likely diagnosis?What investigation you will request?What are the findings you expect to see?

Hydronephrosis

Hydronephrosis

Case Four

A 49 years old male patient smoker for 30 years. Presented to primary health case with complaint of hematuria and weight loss. Patient denied history of flank or pelvic pain.

What is the likely diagnosis?What investigation you will request?What are the findings you expect to see?

Renal cell tumor

Renal cell tumor

Transitional cell tumor

Renal cysts

polycystic kidney disease

Horseshoe kidney

Cross Ectopic Kidney