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radiology.Urinary tract lecture 2.(dr.nasr)

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  • 1. URINARY TRACT DISORDERS
    • Urinary tract Calculi :
    • -Calcified to varying degree
    • uniform
    • laminated
    • -Radiolucent ( Xanthine and Uric acid)
    • - all stones are seen on CT and US
  • 2.  
  • 3.
    • Shape :
    • small : round or oval
    • large : Staghorn calculi
  • 4.
    • Plain film or US ?
    • Always carefully examine preliminary film of IVU
    • Stones overly the bones may be obscured
  • 5. Stones by US
    • Appearance ( echogenic + shadow )
    • Size >5mm
    • Site
    • calyces , pelvis and ureter or U.Bladder
  • 6. Stones by CT
    • Native CT exquisitely sensitive
    • Sometimes ureteric stone need contrast
  • 7. Nephroclacinosis
    • Medullary or cortical
    • Focal or diffuse calcification of the renal paranchyma
    • Hypercalcaemia , hypercalciurea : renal tubular acidosis and hyperparathyroidism
    • Normal calcium metabolism: Medullar sponge kidney or widespread papillary necrosis
  • 8.  
  • 9. Urinary tract Obstruction
    • Dilatation of PCS and ureter.
    • Degree
    • Level
  • 10. US in Urinary Tract Obstruction
    • Fluid collection in middle of central sinus
    • Should be differentiated from cysts
    • Cortex ?
    • Ureter ( proximal and distal parts seen)
    • Cause ? Stone, bladder mass, pelvic mass
  • 11.  
  • 12.  
  • 13. IVU in obstruction
    • In some centers remains the primary imaging modality of acute ureteric colic .
    • Plain film : calculus
    • After 15 min of contrast injection :
    • if urogram normal it rules out uretric colic as the cause of the pain
  • 14.
    • If obstructed :
    • dense nephrogram
    • delayed films
    • obstruction can be intermittent
  • 15. CT in urinary tract obstrcution
    • In Acute obstruciton ( CT KUB)
    • Other DD
    • A. Appendicitis
    • tumor
  • 16. Causes of obstruction
    • May be at any level down to the urethra
    • Within the lumen
    • In the wall
    • Outside the wall
  • 17. Causes within the lumen of the urinary tract
    • Calculi
    • Sloughed papilla
    • Blood clot
  • 18. Causes arising in the wall
    • Transitional cell carcinoma
    • On IVU:
    • in PCS appear as filling defec
    • in ureter ( filling defect or stricture)
    • On Ct : filling defect on urographic image
    • Stricture ( infective, trauma)
  • 19. Congenital intrinsic PUJ obstruciton
    • Peristalsis not transmitted
    • Age : usually in children and young adults
    • Diagnoses ? Dilated pelvis , normal ureter
    • Should be differentiated from baggy pelvis
    • by giving diuretic during IVU
  • 20.  
  • 21. Extrinsic causes of obstruction
    • Best evaluated by CT : Tumors
    • Retroperitoneal fibrosis; usually at the level of L4/5
  • 22.  
  • 23.  
  • 24. Questions?

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