Urinary Tract Radiological Investigations and Anatomy MEDICAL IMAGING & RADIOLOGY DEPARTMENT

IMAGING MODALITIES IONIZING RADIATION NONIONIZING 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

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

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

This is KUB taken post intravenous contrast injection IVU This is KUB taken post intravenous contrast injection Also called IVP (intravenous pyelogram) Demonstrates both function and structure of the renal system Function --- Filtration Structure --- Contrast filled collecting system 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

This is KUB taken post intravenous contrast injection 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

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

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

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

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

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

RENALUS

RENAL MRI

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?

Renal tract stone

Renal tract stone:

Renal tract stone

Renal tract stone:

Urinary tract stone

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?

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?

Hydronephrosis

Hydronephrosis

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?

Renal cell tumor

Renal cell tumor

Transitional cell tumor

Renal cysts

polycystic kidney disease

Horseshoe kidney

Cross Ectopic Kidney

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