1. Infections of the urinary tract Lecture 3

2. Acute pyelonephrites
its due to bacterial infection entering via the urethra.
precipitating factors include:
1.urinary obstruction .
2.duplex system.
3.diabetes mellitus.
The IVU is normal even during the acute attack .
In very sever cases ,the caliceal system is compressed by the swelling of the renal substance.
Poor concentration of contrast .
US shows enlarged hypoechoic kidney due to cortical oedema.
In CT may reveal patchy diminished density.

3. Renal & Perinephric abscess
They are difficult to seen on IVU since it may cause poor visualization of the kid. either due to pre-existing hydronephrosis or calculus disease. US & CT are the modalities of choice in diagnosis. US findings: 1.complex mass (cyst & solid) 2.thick wall. 3.contain internal septation CT findings: 1.thick wall cyst. 2.enhancement of the wall after IV contrast . 3.underlying cause of obstruction may be seen.

5. Pyonephrosis
Occur only in obstructed PC system . US is more sensitive imaging modality , it shows multiple echoes within the urine due to infected debris. IVU shows poor function of the kidney

7. Tuberculosis
Urinary TB follow blood born spread of mycobacterium tuberculosis , usually from focus of infection in the lung ,
The bacilli infect the renal cortex , most foci heal but one or more may form abscess ,these ulcerate into renal pelvis & spread to other portions of urinary & genital systems .

8. At early stage US &IVP may be normal .
Late stages of renal TB (radiographic finding):
1.cortical calcification (common & irregular).
2.irregular calyx ,later contrast filled cavity near the calyx.
3.strictures of portions of PCS and ureter.
4. if the obstruction severe ,total destruction of the kid. may take place (shrunken calcified non functioning kid.)
5.UB become thick wall & contracted .

11. Chronic pyelonephritis
It occur due to reflux of infected urine from the UB to kid.
Radiological features :
1-local reduction in cortical thickness.
2- dilatation of calyx in the scar area.
3-.small size kid.
4-Dilatation of collection system.

13. Vesico –uretric reflux (VUR)
the usual cause of reflux is congenital abnormality
of the UV junction ,with shorter than normal
intramural section of ureter .
VUR demonstrate at micturating cystography
Grading of VUR :
1.Grade 1 reflux into the ureter alone.
2.Grade 2 reflux into ureter & pelvis

14. Vesico –uretric reflux (VUR)
3.Grade 3 : reflux into ureter & pelvis with mild
dilatation
4.Grade 4 : reflux into ureter & pelvis with
moderate dilatation.
5.Grade 5 : reflux into ureter & pelvis with
obliteration of the papilla with gross dilatation
and tortusity of ureter.

17. Renal trauma injuries to the kid. usually the result of a direct
blow to the loin .
loin pain & haematuria are the major presenting
features .
IVU & CT are the main imaging modalities .
The aims of imaging :
1.assess renal function .
2-ensure the normality of opposite kid.
3-demonstrate injury to other abdominal organ .

18. Classification of renal trauma:
1.Contusion or cortical laceration not extend into
PCS.
2.Cortical laceration extending into PCS.
3.Renal pedicel injury (renal A. or V. injury).
4. PUJ injury .

20. Chronic Renal failure 1-reduction in the size of the kid.
The role of imaging is to confirm or exclude UT
obstruction as a cause of renal failure .
US is often the first investigation .
US findings :
1-reduction in the size of the kid.
2-reduction in the cortical thickness
3-increase in the cortical echogenicity
4-loss of C-M differentiation.

21. Could be single or multiple
Urinary Bladder US is the simplest imaging modality to assess UB Normal UB should be echofree & uniform wall thickness.
Most UB calculi are radiolucent , radiopaque stones are large & laminated
Could be single or multiple
UB Calculi

23. UB TUMOR Commonest site of neoplasm in UT , mostly transitional
call carcinoma ( squamous cell carcinoma is less
common type ) , usually it’s multifocal, may obstruct the
ureters , calcification may be present
Findings in US :
1.Solid mass lesion project into the lumen.
2.localized UB wall thickness.
3.US can not accurately assess extra luminal extension
Findings of IVU : 1.to assess the obstructive effect detect other lesion in UT.

25. BLADDR DIVERTICULUM Either its due to chronic UB outflow obstruction
or its congenital .
It predispose to infection ,obstruction & even tumor
Usually it demonstrated in the post voiding film in
IVU study or in micturating cystography

28. Bladder outlet obstruction
Causes : 1.prostatic enlargement :which is the commonest cause of bladder outflow obstruction in elderly men , either due BPH or carcinoma.

30. 2 .posterior urethral valve

31. 3.urethral stricture

32. Radiological findings of bladder outflow obstruction :
A- increase trabeculation and thickness of bladder wall ,often with diverticula formation .
B- dilatation of collecting system
C-residual urine .

33. UB TRAUMA :
Cystography (introduction of contrast media directly into UB )
is the best way to show the site of rupture .
intraperitoneal rupture
Extraperitoneal rupture
Blunt trauma or invasive procedure
Pelvic fracture
Causes 1
Dome of the UB
UB base
Location 2
Contrast around bowel loops in peritoneum
Contrast in perivesical space (lateral to UB)
Imaging findings 3

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