URINARY TRACT DISORDERS Urinary tract Calculi : Urinary tract Calculi : -Calcified to varying degree -Calcified to varying degree uniform uniform laminated laminated -Radiolucent ( Xanthine and Uric acid) -Radiolucent ( Xanthine and Uric acid) - all stones are seen on CT and US - all stones are seen on CT and US

Shape : Shape : small : round or oval small : round or oval large : Staghorn calculi large : Staghorn calculi

Plain film or US ? Plain film or US ? Always carefully examine preliminary film of IVU Always carefully examine preliminary film of IVU Stones overly the bones may be obscured Stones overly the bones may be obscured

Stones by US Appearance ( echogenic + shadow ) Appearance ( echogenic + shadow ) Size >5mm Size >5mm Site Site calyces, pelvis and ureter or U.Bladder calyces, pelvis and ureter or U.Bladder

Stones by CT Native CT exquisitely sensitive Native CT exquisitely sensitive Sometimes ureteric stone need contrast Sometimes ureteric stone need contrast

Nephroclacinosis Medullary or cortical Medullary or cortical Focal or diffuse calcification of the renal paranchyma Focal or diffuse calcification of the renal paranchyma Hypercalcaemia, hypercalciurea : renal tubular acidosis and hyperparathyroidism Hypercalcaemia, hypercalciurea : renal tubular acidosis and hyperparathyroidism Normal calcium metabolism: Medullar sponge kidney or widespread papillary necrosis Normal calcium metabolism: Medullar sponge kidney or widespread papillary necrosis

Urinary tract Obstruction Dilatation of PCS and ureter. Dilatation of PCS and ureter. Degree Degree Level Level

US in Urinary Tract Obstruction Fluid collection in middle of central sinus Fluid collection in middle of central sinus Should be differentiated from cysts Should be differentiated from cysts Cortex ? Cortex ? Ureter ( proximal and distal parts seen) Ureter ( proximal and distal parts seen) Cause ? Stone, bladder mass, pelvic mass Cause ? Stone, bladder mass, pelvic mass

IVU in obstruction In some centers remains the primary imaging modality of acute ureteric colic. In some centers remains the primary imaging modality of acute ureteric colic. Plain film : calculus Plain film : calculus After 15 min of contrast injection : After 15 min of contrast injection : if urogram normal it rules out uretric colic as the cause of the pain if urogram normal it rules out uretric colic as the cause of the pain

If obstructed : If obstructed : dense nephrogram dense nephrogram delayed films delayed films obstruction can be intermittent obstruction can be intermittent

CT in urinary tract obstrcution - In Acute obstruciton ( CT KUB) - Other DD A. Appendicitis A. Appendicitis tumor tumor

Causes of obstruction May be at any level down to the urethra May be at any level down to the urethra Within the lumen Within the lumen In the wall In the wall Outside the wall Outside the wall

Causes within the lumen of the urinary tract Calculi Calculi Sloughed papilla Sloughed papilla Blood clot Blood clot

Causes arising in the wall Transitional cell carcinoma Transitional cell carcinoma On IVU: On IVU: in PCS appear as filling defec in PCS appear as filling defec in ureter ( filling defect or stricture) in ureter ( filling defect or stricture) On Ct : filling defect on urographic image On Ct : filling defect on urographic image Stricture ( infective, trauma) Stricture ( infective, trauma)

Congenital intrinsic PUJ obstruciton Peristalsis not transmitted Peristalsis not transmitted Age : usually in children and young adults Age : usually in children and young adults Diagnoses ? Dilated pelvis, normal ureter Diagnoses ? Dilated pelvis, normal ureter Should be differentiated from baggy pelvis Should be differentiated from baggy pelvis by giving diuretic during IVU by giving diuretic during IVU

Extrinsic causes of obstruction Best evaluated by CT : Tumors Best evaluated by CT : Tumors Retroperitoneal fibrosis; usually at the level of L4/5 Retroperitoneal fibrosis; usually at the level of L4/5

Questions?