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8/14/2017
1
Dr. Russell Tucker, DACVR
Brief Review with tips &Case Based Illustrations
K9 Kidneys:
Rt @ T13-L1
Lt @ L2-L4
Kidney location
& visualization
K9 Kidneys:
Rt @ T13-L1
Lt @ L2-L4
Size = 2.5 - 3.0 x L2 Size = 2.4 - 3.0 x L2
L2
Kidney visualization
Kidney visualization
8/14/2017
2
Superimposed -
but not in contactRt & Lt kidneys superimposed
IV iodinated contrast (15min)
880mg I/kg
(400mg I/lb)
give as bolus
Opacification of kidneys,ureters & urinary bladder
+flank band compression
Ectopic ureter
w/ air in bladder to help
visualize the entrance
7 year old M/C miniature schnauzer
Previous history of urinary blockage
a) Bladder stonesb) Kidney stonesc) Urethral stonesd) All of above
7 year old M/C miniature schnauzer
Previous history of urinary blockage
a) Bladder stonesb) Kidney stonesc) Urethral stonesd) All of above
8/14/2017
3
7 year old M/C miniature schnauzer
Previous history of urinary blockage
Renal Calculi
Urethral Calculi~ pull legs forward* evaluate entire urinary system
8 year old FS mix
Recurrent UTI’s
feces over both kidneys…
8 year old FS mix K9
Recurrent UTI’sEnema to clean out colon 8 year old FS mix K9
Recurrent UTI’s Barium painted on nipple
positive contrast
negative contrast
double contrast
5 - 10 cc/kg (cats ½ volume)
2 - 5 cc/lb
Palpate while distending bladder!
Bone/water Liver/water Fat/water Air/air
Bone/fat Liver/fat Fat/fat Water/water
8/14/2017
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center squares identical, but look different gray shades
in the different surrounding backgrounds
Horizontal beam
Fluoroscopy exam: ruptured bladder
Deflated bladder on US
Requires positive contrast to visualize
Retrograde urethrography
Normograde urethrography
Dose dependent on sizeHelpful to have bladder distended
1. Uniform kidney
opacification
2. Diverticula & renal
pelvis excretion
3. Proximal ureters
peristalsis of ureters
Normal “nephrogram”
1
2
3
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Uniform enhancement
1. nephrogram phase
~ symmetric kidneys
Ureter opacification
2. pyleogram phase
+/- compression band occlusion
Bladder filling
3. clearance phase
compression applied:
- left & right ureters
0 - 10 min
10 - 20 min
30 - 45 min
Early phase Collection phase
Ureter entering trigone
Clean out colon before IVP performed! LR
Severe hydronephrosis & hydroureter
LRSevere hydronephrosis & hydroureter!
Transverse at bladder
Dorsal reconstruction
Sagittal reconstruction
8/14/2017
6
2 year old M/C miniature poodle
Dribbling urine for 1 year, especially when sleeping or relaxed
Legs forward
Dribbling urine for 1 year, especially when sleeping or relaxed
2 year old M/C miniature poodle
left right
L KidR Kid
Nuclear ScintigraphyTc-99m attached to agent filtered by kidneys
Dynamic acquisition (0- 3mins)create composite image:
Dark = TC-99m accumulation
Rt kidney >>> Lt kidney
Dorsal view
2 year old M/C miniature poodle
Dribbling urine for 1 year, especially when sleeping or relaxed
RK
LK
Bladder
CT 3-D volume recon
2 year old M/C miniature poodle
Dribbling urine for 1 year, especially when sleeping or relaxed
Misshapen left kidney-hydronephrosis
2 year old M/C miniature poodle
Dribbling urine for 1 year, especially when sleeping or relaxed
Left hydroureter
Misshapen left kidney-hydronephrosis
2 year old M/C miniature poodle
Dribbling urine for 1 year, especially when sleeping or relaxed
Left hydroureter
Left ectopic ureter
Misshapen left kidney-hydronephrosis
8/14/2017
7
10 year old F/S DSH
Straining to urinate
10 year old F/S DSH
Straining to urinate
Enlarged right kidney
10 year old F/S DSH
Straining to urinate
Enlarged right kidney
? Ureter stone obstruction
10 year old F/S DSH
Straining to urinate
Enlarged right kidney
a) Ultrasoundb) Excretory urographyc) Exploratory surgeryd) Renal biopsy or FNA
10 year old F/S DSH
Straining to urinate
Enlarged right kidney
a) Renal ultrasoundb) Excretory urographyc) Exploratory surgeryd) Renal biopsy or FNA
10 year old F/S DSH
Straining to urinateright kidney & ureter