1. What is wrong with this picture?

2. Is this an ovary?

3. What is Going on Here?

4. Percutaneous Nephrostomy

5. Indications  External drainage of renal collecting duct –In cases of obstruction –As a diversion to allow for healing of distal structures –Decompression of renal and perirenal fluid collections  Tract creation for inserting devices (for nephrolithotomy, biopsies, stricture dilatation, stenting)  Direct infusion of agents for dissolving stones and antibacterial, antitumor, or antifungal drugs

6. Procedure 1) Directly approach desired calix from the posterior to opacify the collecting system. 2) Use the fluoroscopically identified collecting duct system for insertion of the catheter (this has a lot of mini steps). 3) Confirm catheter position by injecting a small amount of contrast.

7. Tubes (2 types) Malecot Pigtail catheter

8. What it’s supposed to look like when you’re done.

9. Sources  Kandarpa, K. and Aruny, J.E. Handbook of Interventional Radiologic Procedures, 3 rd Edition. 2002.  www.emedicine.com www.emedicine.com   http://www.e- radiography.net/ibase5/Renal/Renal_hydr onephrosis_ct.jpg http://www.e- radiography.net/ibase5/Renal/Renal_hydr onephrosis_ct.jpg   http://www.e- radiography.net/ibase5/Renal/Renal_hydr onephrosis_ct.jpg http://www.e- radiography.net/ibase5/Renal/Renal_hydr onephrosis_ct.jpg   http://www.learningradiology.com/caseof week/caseoftheweekpix/cow130.jpg http://www.learningradiology.com/caseof week/caseoftheweekpix/cow130.jpg