Radiology of urinary system Dr. Sameer Abdul Lateef

THE URINARY SYSTEM Urinary calculi Common in middle age . High prevalence in tropical countries due to dehydration . Any lesion cause urinary stasis , predispose to stone formation (congenital or aquired lesion ). Metabolic disorder producing hypercalcaemia or hypercalcuria (specially hyperparathyroidism ) are responsible for stone formation .

TYPES OF URINARY STONE 1- Radio-opaque stones --- more frequent , consist of Ca. oxalate Ca. phosphate Ca. carbonate Ammon. & Mg. phosphate Urate 2- Semi radio-opaque -- cystine stone. 3- Radio-lucent stones –pure uric acid , xanthine

Urinary stones A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Nephrolithiasis is the medical term for kidney stones. Symptoms of a kidney stone include flank pain (which can be quite severe) and blood in the urine (hematuria). Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. Dehydration is a major risk factor for kidney stone formation. People with certain medical conditions, such as gout, and those who take certain medications or supplements are at risk for kidney stones. Dietary and hereditary factors are also related to stone formation. .

Renal Calculi Called nephrolithiasis or urolithiasis Most commonly develop in the renal pelvis but can be anywhere in the urinary tract Vary in size –from very large to tiny Can be one stone or many stones May stay in kidney or travel into the ureter Can damage the urinary tract May cause hydronephrosis More common in white males 30-50 years of age

radio-opaque stones)) KUB 1- Localization of stone in the kidney , in ureter or in the bladder. 2- Number of stones. 3- Soft tissue shadow of enlarged kid.

Renal stone

Ureteric stone (oval shape or elongated

spiky or lamellate)) Vesical stone

Stag horn calculus (large radio-opaque stone casting the shape of pelvi-calyceal system

Calcified lesions other than stones

Radiological appearance: Plain film Localization in the kidney Radiological appearance: Plain film Localization in the kidney. Scoliosis in severe pain. IVU : Is not used in acute stage , if so compression is not applied . If obstruction is present 1- The kidney increases in size. 2- Delayed excretion of contrast . 3- Persistent nephrogram. 4- Dilatation of ureter down to the site of obstruction . 5- Delayed film up to 24 hrs. to see the site of obstruction. 6- In the kidney lead to hydronephrosis . In the ureter lead to hydroureter .

Stones and hydronephrosis

Radio lucent stone

Ultrasound

Hydronephrosis

Dense persistent nephrogram

Nephrocalcinosis Deposition of calcium with in the renal substance( renal tubules ) in form of small rounded , clusters or less frequently by speckles , it should be differentiated from calcified pathology like Tb. The changes seen in plain film. IVU shows no obstruction. nephrocalcinosis

Urinary Infection * May be unilateral or bilateral . * Age incidence : childhood and early adult life ,rarely after 40 years . * The kidney reduced in size and shows coarse focal scarring with adjoining areas of normal hypertrophied renal tissues . IVU shows : 1- reduction of kidney size . 2-Irreqular out-line . 3-Decreased renal thickness . 4-Calyceal deformity. 5-Disturbed inter-papillary line . 6-Reflux. 7-Evididence of CRF.

Urinary Infection Acute pyelonephritis : IVU may show : 1- Normal urogram. 2- Increased size of kidney . 3- Delayed excretion . Chronic pyelonephritis ( reflux nephropathy ): * Common cause of death from renal failure and hypertension . *Caused by infection or vesico-ureteric reflux during childhood . * It’s the end result of chronic bacterial infection of renal substance .

Renal Tuberculosis (Tb. Pyelonepritis ) *Almost secondary to Tb infection every where. * Tb. Bacilli reach the kidney via blood and develop tubercles in renal cortex . Tb. Foci enlarged and coalesce , and Tb. Bacilli via tubules form medullary lesions and papillary involvement . *Ulceration of renal pelvis produce urinary symptoms . *Extension along ureters to the bladder , prostate , seminal vesicles , vas deference and epididymus . * In early stage , when the disease confined to cortex and medulla , IVU is normal . * Normal urogram dose not exclude Tb.

Renal Tuberculosis (Tb. Pyelonepritis ) Plain film show : 1- Calcification , common , varies in extent from few minute areas to complete cast ( auto-nephrectomy ) . 2- Scarring and fibrosis produce irregular out-line of kidney . 3-Abscess may produce local bulge . 4-ureteric obstruction may produce large kidney .

IVU : 1- Loss of definition of minor calyces . 2- May simulate ch. Pyelonephritis . 3-Calyceal stricture cause narrowing of calyces with proximal dilatation or complete cut off of affected calyces . 4-Ureteric Tb. Produce irregular areas of narrowing and dilatation and tortuous and rigid appearance . 5- uretral obstruction produce hydronephrosis

Urinary Schistomiasis * Infestation by Schist. Haematobium. *The ova deposited into sub-mucosa of urinary bladder and to less extent at the wall of ureters . *The ova calcify and excrete toxin producing necrosis of tissue lead to granulomatous tubercles and extensive fibrosis . *Calcification is very common and important diagnostic findings. Very common in bladder ,less frequent in lower ureters ,but in advanced case involve the whole length of ureter . *The appearance depends on degree of fullness of bladder ; thin linear opacity outlining bladder wall. Empty bladder shows crowded linear opacities with calcified plaques.

IVU: Early stage –cobble stone Later filling defects due to graneulomatos papilloma Carcinoma is important complication Ureters : dilated and tortuous In early stage hydroureter and hydronephrosis + reflux

Quiz Answer one of the followings: 1- ureterocele Quiz Answer one of the followings: 1- ureterocele. 2- IVU findings of horse shoe .kidney