Urinary Tract Radiological Investigations and Anatomy

1. Urinary Tract Radiological Investigations and Anatomy MEDICAL IMAGING & RADIOLOGY DEPARTMENT

2. IMAGING MODALITIES • IONIZING RADIATION Conventional (plain) radiography. Contrast studies (X-Ray + Contrast) Computed Tomography. Isotopic scan Angiography • NONIONIZING RADIATION US. MRI. • Intravenous urography • Cysto-urethography • Antegrade pyelography • Retrograde pyelography • Hysterosalpingography

3. KUB Conventional plain film of the abdomen is called a KUB (Kidneys, Ureters, Bladder) KIDNEYS URETERS URINARY BLADDER URETHRA Good evaluation of radio-opaque stones

4. IVU KUB IVU This is KUB taken post intravenous contrast injection

5. IVU • Also called IVP (intravenous pyelogram) • Demonstrates both function and structure of the renal system • Function --- Filtration • Structure --- Contrast filled collecting system This is KUB taken post intravenous contrast injection • Indications: • Urolithiasis / calculus • Pyelonephritis • Hydronephrosis • Trauma • Tumour • Renal hypertension • Congenital abnormality • Contra-Indications: (relative) • History of Allergy • Asthma • Cardiovascular disease • Sickle cell disease • Diabetes mellitus

6. IVU This is KUB taken post intravenous contrast injection Renal Pelvis • After IV injection, sequential images are taken in time order. • Immediate post IV • 5 min post IV • 10 min post IV Left Ureter Urinary Bladder

7. IVU • Immediate post IV is nephrogram This is KUB taken post intravenous contrast injection Left Kidney Right Kidney

8. IVU • 5 min post IV is nephrogram This is KUB taken post intravenous contrast injection

9. IVU • 10 min post IV is nephrogram This is KUB taken post intravenous contrast injection Renal Pelvis Left Ureter Full Bladder 20 min Urinary Bladder

10. Kidney Renal fascia Hilum Renal sinus Renal cortex Renal columns Renal medulla Renal pyramids Calyces Minor calyces Major calyces Renal pelvis

11. COMPUTED TOMOGRAPHY Non-contrast Arterial = Cortical Venous = Parenchymal Excretion

12. RENALUS

15. RENAL MRI

16. Case one 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?

17. Renal tract stone

18. Renal tract stone:

19. Renal tract stone

20. Renal tract stone:

21. Urinary tract stone

22. 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?

25. 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?

26. Hydronephrosis

27. Hydronephrosis

28. 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?

29. Renal cell tumor

30. Renal cell tumor

31. Transitional cell tumor

32. Renal cysts

33. polycystic kidney disease

34. Horseshoe kidney

35. Cross Ectopic Kidney

36. THANK YOU