Structure and function of urinary system.
Timed series of radiographic
images of urinary system after
administration of IV contrast.
Suspected urinary tract pathology.
Repeated infections -focus, damage
Investigation of hypertension not
controlled by medication in young
General contra indications to contrast
Raised urea creat. urography unlikely to
Basic psychological preparation with
reassurance & explanation of technique
Bladder emptied immediately before exam.
Hx of Previous I.V.U.
Previous experience of iodinated
Abdominal surgery, Allergies, drugs Hx.
Ionic or HOCM eg urograffin used.
Iodine is main element which imparts
300mg I/kg body wt. 15-25 gm of iodine
given. 20ml of 76% urograffin
Greatest single predictor of contrast
reaction is previous reaction to contrast
MILD & TRANSIENT – NO Rx REQUIRED:
-nausea,vomiting,sensation of heat, tingling,
metallic taste,pain in arm,deire to urinate.
ANTI-HISTAMINE & STEROID Rx:
-Skin rashes;urticaria ,diffuse erythema.
ADRENALINE,AMINOPHYLLINE or SALBUTAMOL,O2
& STEROIDS Rx:
-Broncho spasm and layryngeal edema particularly
due to meglumine.
Administration of contrast
Aim to produce better PC distension
C/I: Recent abd surgery.
Large abd mass.
If 5min film shows adequate
End of Injection, A.P. of the renal areas to show the nephrogram, i.e. the
renal parenchyma opacified by the contrast medium in the renal tubules.
Value of fluoroscopy. Fluoroscopic spot images demonstrate the entire
luminal surface of the ureters.
On a radiograph obtained during bladder filling, the contrast material is
smoothly defined and the bladder wall has become less evident. A normal
uterine impression on the superior margin is noted
Post Micturition film to demonstrate the bladder emptying success, and the
return of the previously distended lower ends of ureters to normal.
Area: supra-renal - below symphysis.
Assessment of Bones, stones, masses &
Oblique view helpful when pt symptomatic
but no cause seen on KUB.
Urethral calculus in pt with hx of severe right flank pain.Collimated Radiograph shows
calcification centered behind symphysis . CT helped confirm presence of urethral
calculus.This case shows importance of full coverage of anatomic structures at KUB.
(a) Collimated preliminary radiograph of the pelvis shows no obvious stones
Rt post oblique radiograph of pelvis shows 6mm ureteral calculus now projected onto
iliac bone.urogram (not shown)helped confirm rt ureteral obstruction 2ndry to the
stone. This case shows how a calculus can be obscured by the complex sacral anatomy.
The plain KUB
AP radiograph of pelvis shows parasymphyseal bone fragment along left
pubis ,mild p. symphysis diastasis, &transverse fracture of rt transverse
process .irregularity of rt SI joint space, suggestive of fracture.
with chills and
pus cells and
mal gas in the
aged 45yr with
showing air with
in the bladder
KIDNEYS: visualised if peri-renal fat.
GUT GASES: may over lap.
Change in shape & location
displaced by compression.
CALCIFICATION OVER RENAL AREA:
-True lat/ips-ilateral post oblique views.
-Displacement with ins/exp/upright films.
-Calcified Costal Cartilage, supra-RG.
-Calcification in tail of pancreas, GB,
liver, Splenic artery.
-Phleboliths, chip fracture of TP.
On a scout image
a calculus fills nearly
the entirety of a
bifid right renal
giving it a branched
antlers of a stag.
Plain radiograph of
calcification in the
left kidney, which
(the putty kidney),
URETERS: not visualized.
-Intra-Luminal: ureteral stones.
GAS SHADOWS: conform to shape of ureter.
-phleboliths, calcification in arteries.
U.BLADDER & URETHRA:
- not visualised.
- visualised if calculi or foreign body.
Contrast in glomeruli & tubules.(1-3min)
SPONTANEOUS: Non-opacified, outlined by
RP fat on plain film.
VASCULAR: Opacification of intra-renal
TOTAL BODY: “ of pre and retro renal soft
tissue + vascular nephrogram
INTRA-TUBULAR:” of intra-renal tubules.
Size - Normal range-height of three vertebra.
Enlarged kidneys suggest
-acute pyelo or glomerulonephritis
Small kidneys imply chronic disease.
Shape –Cysts & tumors may cause distortion.
Orientation - disorientation may be
-intrinsic, e.g. horseshoe kidney, or
-extrinsic, i.e. pressure effect of other organs
image of a
size is normal.
On a 10-minute
image, no pyelogram
is evident. The
persistent, and the
kidneys are smaller.
With this imaging
the patient should be
immediately for the
to the procedure or
as a reaction to
asymmetry of the
opacity, with less
opacity in the right
kidney than in the
at 80 minutes
in acute high-
at the right
Enlarged kidneys in a
young patient with
findings of autosomal
kidneys, the left
more so than the
right. Note the
shows a small
filling of the
with the left
renal size. Note
tion of contrast
material in the
Opacification of pelvicalceal system &bladder
Filling defects include:
stone,tcc,blood clots,papillary necrosis
with sloughing of infarcted papilla.
Strictures due to :
-Post inflammation,previous stone impaction
-Post infection,TB, Shistosomiasis
absence of the
colon into the
Common findings in bladder:
-Filling defects , tumors
-Trabeculated , thick walled bladder.
different patterns of excavation that can be seen with papillary necrosis:
normal (A), central excavation with ball-on-tee appearance (B), forniceal
excavation (C), lobster claw appearance (D), signet ring appearance (E), and
sloughed papilla with clubbed calix (F).
necrosis. On an
(arrows) in the
papilla of the
in the upper and
lower poles as
image from excretory