This document discusses radiology of the urinary tract system and disorders. It describes how different imaging modalities like CT, ultrasound, and IVU can be used to identify urinary tract calculi, nephrocalcinosis, and obstruction at different levels of the urinary tract. Causes of obstruction include calculi, tumors, strictures, congenital issues, and extrinsic compression that are best evaluated using CT, ultrasound, or IVU depending on the level and nature of obstruction.

1. RADIOLOGY IN URINARYRADIOLOGY IN URINARY
TRACT SYSTEMTRACT SYSTEM

2. URINARY TRACT DISORDERSURINARY TRACT DISORDERS
Urinary tract Calculi :Urinary tract Calculi :
-Calcified to varying degree-Calcified to varying degree
uniformuniform
laminatedlaminated
-Radiolucent ( Xanthine and Uric acid)-Radiolucent ( Xanthine and Uric acid)
- all stones are seen on CT and US- all stones are seen on CT and US

4.  Shape :Shape :
small : round or ovalsmall : round or oval
large : Staghorn calculilarge : Staghorn calculi

5.  Plain film or US ?Plain film or US ?
 Always carefully examine preliminary filmAlways carefully examine preliminary film
of IVUof IVU
 Stones overly the bones may be obscuredStones overly the bones may be obscured

6. Stones by USStones by US
 Appearance ( echogenic + shadow )Appearance ( echogenic + shadow )
 Size >5mmSize >5mm
 SiteSite
calyces , pelvis and ureter or U.Bladdercalyces , pelvis and ureter or U.Bladder

7. Stones by CTStones by CT
 Native CT exquisitely sensitiveNative CT exquisitely sensitive
 Sometimes ureteric stone need contrastSometimes ureteric stone need contrast

8. NephroclacinosisNephroclacinosis
 Medullary or corticalMedullary or cortical
 Focal or diffuse calcification of the renalFocal or diffuse calcification of the renal
paranchymaparanchyma
 Hypercalcaemia , hypercalciurea : renalHypercalcaemia , hypercalciurea : renal
tubular acidosis and hyperparathyroidismtubular acidosis and hyperparathyroidism
 Normal calcium metabolism: MedullarNormal calcium metabolism: Medullar
sponge kidney or widespread papillarysponge kidney or widespread papillary
necrosisnecrosis

10. Urinary tract ObstructionUrinary tract Obstruction
 Dilatation of PCS and ureter.Dilatation of PCS and ureter.
 DegreeDegree
 LevelLevel

11. US in Urinary Tract ObstructionUS in Urinary Tract Obstruction
 Fluid collection in middle of central sinusFluid collection in middle of central sinus
 Should be differentiated from cystsShould be differentiated from cysts
 Cortex ?Cortex ?
 Ureter ( proximal and distal parts seen)Ureter ( proximal and distal parts seen)
 Cause ? Stone, bladder mass, pelvicCause ? Stone, bladder mass, pelvic

14. IVU in obstructionIVU in obstruction
 In some centers remains the primaryIn some centers remains the primary
imaging modality of acute ureteric colic .imaging modality of acute ureteric colic .
 Plain film : calculusPlain film : calculus
 After 15 min of contrast injection :After 15 min of contrast injection :
if urogram normal it rules out uretricif urogram normal it rules out uretric
colic as the cause of the paincolic as the cause of the pain

15.  If obstructed :If obstructed :
dense nephrogramdense nephrogram
delayed filmsdelayed films
 obstruction can be intermittentobstruction can be intermittent

16. CT in urinary tract obstrcutionCT in urinary tract obstrcution
- In Acute obstruciton ( CT KUB)In Acute obstruciton ( CT KUB)
- Other DDOther DD
A. AppendicitisA. Appendicitis
tumortumor

17. Causes of obstructionCauses of obstruction
 May be at any level down to the urethraMay be at any level down to the urethra
 Within the lumenWithin the lumen
 In the wallIn the wall
 Outside the wallOutside the wall

18. Causes within the lumen of theCauses within the lumen of the
urinary tracturinary tract
 CalculiCalculi
 Sloughed papillaSloughed papilla
 Blood clotBlood clot

19. Causes arising in the wallCauses arising in the wall
 Transitional cell carcinomaTransitional cell carcinoma
On IVU:On IVU:
in PCS appear as filling defecin PCS appear as filling defec
in ureter ( filling defect or stricture)in ureter ( filling defect or stricture)
On Ct : filling defect on urographicOn Ct : filling defect on urographic
imageimage
 Stricture ( infective, trauma)Stricture ( infective, trauma)

20. Congenital intrinsic PUJCongenital intrinsic PUJ
obstrucitonobstruciton
 Peristalsis not transmittedPeristalsis not transmitted
 Age : usually in children and young adultsAge : usually in children and young adults
 Diagnoses ? Dilated pelvis , normal ureterDiagnoses ? Dilated pelvis , normal ureter
 Should be differentiated from baggy pelvisShould be differentiated from baggy pelvis
by giving diuretic during IVUby giving diuretic during IVU

22. Extrinsic causes of obstructionExtrinsic causes of obstruction
 Best evaluated by CT : TumorsBest evaluated by CT : Tumors
 Retroperitoneal fibrosis; usually at theRetroperitoneal fibrosis; usually at the
level of L4/5level of L4/5

25. Thank you………Thank you………