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Urinary Tract

Urinary Tract. Dr. Nasr A. Mohammed FIBMS. Imaging techniques. Basic examinations -Ultrasound. -Intravenous Urography IVU. -Computed Tomography CT. -Radionuclide examination. Other investigations.

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Urinary Tract

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  1. Urinary Tract Dr. Nasr A. Mohammed FIBMS

  2. Imaging techniques • Basic examinations -Ultrasound. -Intravenous Urography IVU. -Computed Tomography CT. -Radionuclide examination.

  3. Other investigations investigations limited to selected patients • Magnetic Resonance Imaging MRI. • Arteriography. • Direct puncture of collecting system • Catheterization.

  4. Type of information they provide -Anatomical • US • CT • MRI -Functional Radionuclide -both • IVU

  5. ULTRASOUND • Is the first line investigation Non invasive , no radiation, no contarst….. • The main uses of ultrasound : renal symptoms renal size hydronephrosis renal masses bladder and prostate

  6. Normal renal Ultrasound • Outline …….smooth • Renal paranchyma • Renal sinus ..cental part • Renal pyramids • Size …… difference <1.5 cm

  7. Small kindeys • Unilateral but may be bilateral : chronic infection ( including TB) obstructive atrophy RAS Hypoplastic • Always bilateral : Chronic glomerulonephritis Hypertensive nephropathy DM, collagen vascular disease

  8. Enlarged kidneys • May be unilateral or bilateral : • bifid collecting system renal mass hydronephrosis lymphoma ( masses or just enlargement) renal vein thromboses • Always unilateral …….compensatory hypertophy • Always bilateral : PCK (polycystic disease) AGN (acute glomerulonephritis) amyloidosis

  9. Ureters ……..usually not visualized • Urinary bladder examined in distended state ….thin walls following micturition….. For residual vol.

  10. Urography • Use of IV iodinated contrast IVUCT Urography Details of PCS Renal calculi detection (all types) Ureteric injury Hematuria Acute ureteric colic Renal mass Staging and follow up of CA Renal vascular anatomy renal trauma

  11. Intravenous urogram • Plain film ; identify calcification: -stone -diffuse or focal nephroclacinosis • After contrast injection : -Kidneys position ( mormally left higher than Right) outline : indentation : fetal lobulation , scar bulge : mass or cyst renal length …… 10-16 cm

  12. - Calices : distribution (distributed and symmetrical ) shape : normal …. Cupped dilatation…….clubbed ( from obstruction or destruction )

  13. Renal plevis and ureters : shape : funnel shaped dilatation : -obstruction filling defect : calculi, blood clot , tumor …. stricture : PUJ, tumor , infection compression : LN pelvic mass - reflux - normal variant

  14. Bladder • Outline : central and smooth • Indentation ( smooth indentation by prostate or uterus ) • after voiding should be empty .

  15. CT urography • CT KUB : before contrast for detection of calcification • Contrast : • early …. Cortical phase • then …..nephrogram • delay… urographic phase

  16. MRI • Indication : for selected patient as :- renal artery stenosis tumor extension to IVC • Disadvantage : calcification is not visible on MRI

  17. Radionuclide examination • Renogram ( DTPA ) • Renal morphology (DMSA scan) • Voiding cystography

  18. Special techniques • Retrograde and antegradepyelography • Micturatingcystogram • Urethrography • Renal arteriography

  19. Questions?

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