IMAGING

Dr Bashir BnYunus

SURGERY RESIDENT

CXR

ABDOMINAL X RAY

INTRAVENOUS UROGRAM(IVU)

Indications• To see the anatomy and physiology of urinary system

• Trauma

• Calculi- renal, ureteric, bladder

• Congenital anomalies- ectopic kidney, horseshoe kidney, renal agenesis

• Infective pathology

• Renal tumour

• Unknown Haematuria

• Renal hypertension

• Bladder pathology- diverticula, fistula

• Vesico ureteric reflux

3/9/2015 13

Contraindications:

• Hypersensitivity to iodinated CM

• Renal insufficency

• Hepato renal syndrome

• Thyrotoxicosis,

• Pregnancy, (Allow 28 days from childbirth)

3/9/2015 14

Films • Preliminary film:

Supine, full length AP ofabdomen in inspiration.

Position

To demonstrate bowelpreparation, check exposurefactor, and location ofradiopaque stones or anyradiopaque artifacts.

3/9/2015 15

Films • 0 MIN :

AP of the renal areas.

After injection of contrast

Aims to show the nephrogram

3/9/2015 16

• 5-min film: excretion phase AP of renal areas.

To determine if excretion is symmetrical

3/9/2015 17

• 15 min film:

Supine full length AP

There is usually adequate distension of the pelvicalycealsystems with opaque urine by this time.

Outlines the ureters

3/9/2015 18

• Release film (full bladder) : coned view of bladder area

• Taken to show the bladder. If this film is satisfactory, the pt is asked to empty the bladder.

3/9/2015 19

• After micturition film:

• Main aim of films is to

Assess bladder emptying

To demonstrate return of dilated upper

tracts with relief of bladder pressure.

Aid diagnosis of VJ calculi

Dx of bladder tumors

Demonstrate urethral diverticulum.

Residual vol of urine.

3/9/2015 20

IVU

RUG

• INDICATIONS

Urethral stricture.

Urethral tear.

Congenital abnormalities.

Periurethral / prostatic abscess.

Fistula / false passages.

• CONTRAST MEDIUM

Urograffin 60%.

Pre warming the contrast helps to prevent external urethral sphincter spasms

• EQUIPMENT

Tilting radiography table.

Fluroscopy / spot film device.

Foley catheter no 8 / knutsson`s clamp.

• PREPARATION

Patient micturates prior to the procedure

• TECHNIQUE

Preliminary film – coned supine PA view of bladder base and urethra.

In supine position penile clamp is applied or tip of the catheter is inserted so that the

balloon lies on the fossa navicularis

Balloon is inflated with 1 – 2 ml of water.

Contrast medium is injected under fluoroscopic control.

• FILMING

30* left anterior oblique.

Supine PA.

30* right anterior oblique.

• COMPLICATIONS

Contrast reaction ( due to absorption through bladder mucosa )

UTI

Urethral trauma.

Intravasation of contrast – due to use of excessive pressure in stricture.

MCUG

CHILDREN

• Voiding difficulties.• Vesico ureteric reflux.• Posterior urethral valve.• Baseline study prior to urinary tract surgery.

ADULTS• Functional disorders of bladder & urethra.• Suspected vesicovaginal / vesicocolic fistula.• Suspected bladder / urethral trauma.• Urethral diverticula

• COMPICATIONS

Contrast reaction.

Contrast induced cystitis.

UTI.

Catheter trauma.

Bladder perforation – overfilling.

Retention of a foley catheter.

Catheterisation of vagina / ectopic ureter.

• CONTRAINDICATIONS

Acute UTI.

• AFTERCARE

Warned – of rare dysuria , retention.

Reflux - Antibiotcs.

Posterior urethral valves

Congenital thick folds of mucous membrane located in the posterior urethra

(prostatic + membranous) distal to the verumontanum.

Most common cause of severe obstructive uropathy in children.

Almost exclusively in males.

Now rare for them to present with severe UTI and septicaemia -diagnosis is

generally made in early infancy and antenatal period.

Types

Type I:

Most common.

Two folds extend anteroinferiorly from caudal aspect of verumontanum often

fusing anteriorly at a lower level.

Type II:

No longer considered a valve.

Hypertrophic band of muscle running from ureteric orifice to verumontanum along

postero lateral urethral wall.

Type III:

Circular diaphragm with a central or eccentric narrow aperture in membranous urethra.

Fusiform dilatation & elongation of proximal posterior urethrapersisting throught voiding

Transverse/curvilinear filling defect in posterior urethra

MCU – Lateral view.

Grading of VUR

• Grade 1 : reflux limited to ureter

• Grade 2 : reflux into renal pelvis

• Grade 3 : mild dilatation of ureter

and pelvicalyceal system.

• Grade 4 : tortuous ureter with

moderate dilatation, blunting of

fornicies but preserved papillary

impressions.

• Grade 5 : tortuous ureter with

severe dilatation of ureter and

pelvicalyceal system, loss of

fornicies and papillary impressions

Barium swallow

Mass in mid oesophagus-shouldering and irregular shadow

D/D-carcinoma; mass out oesophagus e.g.mediastinal mass

Confirmation-oesophagoscopyand biopsy and rule out bronchus invasion

RAT TAIL APPEARANCE

Hugely dilated oesophagus with narrow lower end rat tail appearance)

D/D-Achalasia cardia, carcinoma lower end oesophagus , stricture

Confirmation-oesophagoscopy and manometry

Biopsy and follow up

Barium meal

Hugely dilated oesophagus with narrow lower end rat tail appearance)

D/D-Achalasia cardia, carcinoma lower end oesophagus , stricture

Confirmation-oesophagoscopy and manometry

Biopsy and follow up

CT SCAN

QUESTIONS