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

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

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

    • 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
    •  
      • Shape :
      • small : round or oval
      • large : Staghorn calculi
      • Plain film or US ?
      • Always carefully examine preliminary film of IVU
      • Stones overly the bones may be obscured
    • Stones by US
      • Appearance ( echogenic + shadow )
      • Size >5mm
      • Site
      • calyces , pelvis and ureter or U.Bladder
    • Stones by CT
      • Native CT exquisitely sensitive
      • Sometimes ureteric stone need contrast
    • 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
    •  
    • Urinary tract Obstruction
      • Dilatation of PCS and ureter.
      • Degree
      • Level
    • 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
    •  
    •  
    • 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
      • If obstructed :
      • dense nephrogram
      • delayed films
      • obstruction can be intermittent
    • CT in urinary tract obstrcution
      • In Acute obstruciton ( CT KUB)
      • Other DD
      • A. Appendicitis
      • tumor
    • Causes of obstruction
      • May be at any level down to the urethra
      • Within the lumen
      • In the wall
      • Outside the wall
    • Causes within the lumen of the urinary tract
      • Calculi
      • Sloughed papilla
      • Blood clot
    • 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)
    • 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
    •  
    • Extrinsic causes of obstruction
      • Best evaluated by CT : Tumors
      • Retroperitoneal fibrosis; usually at the level of L4/5
    •  
    •  
    • Questions?