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

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

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

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