Genito-urinary Tract Radiology

Department of Radiology

FEU-NRMF Medical Center

Kidneys

• BEAN SHAPED ORGANS FOR EXCRETION

• ANATOMY

1. Location – upper lumbar

and thoracic

spines

- descends by 2-3 cm

in upright films

- right kidney is lower

– than the left

• - axis is parallel to the

• lateral border of the

• psoas muscle

DORSAL VIEW

KIDNEYS AND THE GUT

Kidneys

• General Rule:

Adults 3.7 + 0.37 x ht. of

L2 vertebra

Filipino – RK =11.8 + 0.8

- LK = 12.3 + 0.7cm

Children (1-14 y/o) equal to

length of 1st four lumbar

vertebra and disc

spaces

MRI- CORONAL SLICES

NORMAL PLANE OF THE KIDNEYS

ANATOMY OF THE CALYCES AND RENAL PELVIS IN IVP

ANATOMY OF THE CALYCES AND RENAL PELVIS IN IVP

NORMAL AXIAL CT SLICES

NORMAL RENAL ARTERIES IN CT ANGIOGRAM

Ureter

• URETER

Three points of narrowing:

• 1. uretero-pelvic junction

• 2. uretero-vesical junction

3. bifurcation of iliac

vessels

Urinary Bladder

• - projects above the

symphysis pubis

approximately 5-10mm

METHODS OF EXAMINATION

1. Plain film2. Excretory urography (IVP)3. Retrograde urography4. Renal angiography5. Translumbar aortography6. Renal Venography7. Nephrotomography8. Percutaneous antegrade pyelography9. Voiding cystography or cystourethrogram10.Cystography11.Extraperitoneal pneumography12.Ultrasound13.CT scan

METHODS OF EXAMINATION

1. KUB - evaluation of

renal size, shape,

and position

- includes the kidneys,

ureters and bladder

- evaluation of presence of calcifications

- shows adequacy of preparation

KUB SCOUT OR PLAIN FILM

METHODS OF EXAMINATION

• Retrograde Pyelography

- radiographs taken after instillation of contrast media via catheter

– - confirms findings suspected to IVP

– - done if excretory urogram

– is unsatisfactory

Advantages

• 1. direct visualization of calyces under controlled pressure

Disadvantages

• 1. ascending infection

• 2. perforation with hemorrhage

• 3. post manipulative stricture or fibrosis

VOIDING CYSTOGRAM, WITH MILD REFLUX

METHODS OF EXAMINATION

EXCRETOY UROGRAPHY

or Intravenous Pyelography (I.V.P.)

• Advantages of I.V.P.

-test of renal function

-less complication of ascending

infection

Contraindications:

1. hypersensitivity to contrast media

2. presence of combined hepatic and renal disease

3. oliguria

4. serum creatinine

of >7 mg/100 ml

multiple myeloma

>RENAL PAPILLA ARE CUP-SHAPED

>NO ABNORMAL FILLING DEFECTS

>PELVOCALYSES ARE NOT DILATED

>URETERS ARE 3-5 MM IN DIAMETER

> BLADDER IS LOCATE ABOVE THE PELVIC BRIM, MODERATELY DILATED WITH NO FILLING DEFECTS

NORMAL PYELOGRAM

METHODS OF EXAMINATION

• Ultrasound

• - detects abnormality of

the kidneys and urinary

bladder

• - delineation of solid from

cystic masses

detection of lithiasis and

hydronephrosis

NORMAL SONOGRAM OF THE LEFT KIDNEY

LEFT

KIDNEY

SPLEEN

NORMAL SONOGRAM ANATOMY OF THE RIGHT KIDNEY

LIVER

RIGHT

KIDNEY

NORMAL SONOGRAM ANATOMY OF THE RIGHT KIDNEY

LIVER

RIGHT

KIDNEY

NORMAL SONOGRAM, RIGHT KIDNEY, TRANSVERSE PLANE

NORMAL SONOGRAM OF THE URINARY BLADDER

Anomalies of the Kidney

I. Number

• A. Renal Agenesis

- rare anomaly

- larger in patients

with agenesis than

those due to

secondary

compensatory

hyperplasia

• B. Supernumerary kidney

Anomalies of the Kidney• II. Size – more common than anomalies in number

• A. Hypoplasia (infantile)

– - associated with hyperplasia of the other kidney

– - functions normally

- should be differentiated from acquired atrophic

kidney due to vascular or inflammatory disease

• Differences between hypoplasia and atrophy

Hypoplasia Atrophy

• 1. Calyceal system and pelvis small normal

• 2. Relationship of parenchyma

and size of collecting system normal abnormal (dec size)

• 3. Function normal impaired

• B. Hyperplasia

• - associated with agenesis or hypoplasia of the other side

Anomalies of the Kidney

• III. Fusion (Alteration in form)

1. Horseshoe kidney – most common type

- lower pole joined by soft tissue called isthmus

- one or both kidneys are malrotated

1. Crossed Ectopy – with or without fusion

- - lower one is ectopic

- - might be associated with partial obstruction

leading to

infection and calculus formation

2. Caked kidney – fusion of both upper and lower poles

-

Anomalies of the Kidney

• IV. Position

1. Malrotation – almost constantly present in fusion anomalies

2. Crossed ectopy – without fusion

– - ectopic kidney is low in position

3. Superior ectopia or thoracic kidney – usually unilateral

– - associated with herniation at foramen of

– Bochdalek or congenital eventration of

– diaphragm

4. Nephroptosis – abnormal downward displacement of the kidney

more than the width of a lumbar vertebrae

- frequent in the right and females

PELVIC KIDNEYS

CROSSED ECTOPIA, LEFT KIDNEY

HORSESHOE KIDNEYS

ANOMALIES OF THE RENAL PELVIS AND URETER

a. Bifid pelvis – division of upper and lower pole calyces

b. Complete duplication of ureter – upper ureter drains the upper

3rd of the kidney and is ventral; enters in a lower and

medial position

– - lower ureter drains the lower 2/3 of the kidney and

– enters the bladder in an upper and lateral position

c. Incomplete duplication of ureter

COMPLETE DUPLICATION OF THE LEFT URETER

COMPLETE DUPLICATION OF THE LEFT URETER

RENAL CALCULI, LEFT KIDNEY

RENAL CALCULI, LEFT KIDNEY

NORMAL PYELOGRAM

>RENAL PAPILLA ARE CUP-SHAPED

>NO ABNORMAL FILLING DEFECTS

>PELVOCALYSES ARE NOT DILATED

>URETERS ARE 3-5 MM IN DIAMETER

> BLADDER IS LOCATE ABOVE THE PELVIC BRIM, MODERATELY DILATED WITH NO FILLING DEFECTS

STAGHORN CALCULI

IRREGULAR CALCIFIC DENSITIES IN THE PARALUMBAR AREAS, HAVING THE CONFIGURATION OF THE CALYCES

OBSTRUCTING PROXIMAL URETEROLITHIASIS LEFT WITH HYDRONEPHROSIS

HYDRONEPHROSIS, BILATERAL

HYDRONEPHROSIS, RK

IVP SHOWING HYDRONEPHROSIS, LK

CORRELATED WITH ULTRASOUND

NEPHROLITHIASIS WITH HYDRONEPHROSIS

DILATED CALYCES

ECHOGENIC STONE

POSTERIOR SONIC SHADOWING

PELVOCALIECTASIA

DILATATION OF THE PELVOCALYCES

COMMONLY FROM OBSTRUCTING NEPHRO OR PROXIMAL URETEROLITHIASIS

MAY ALSO BE SEEN IN PREGNANT WOMEN

PROXIMAL URETEROLITHIASIS

PLAIN KUB FILMULTRASOUND

BILATERAL URETEROLITHIASES

CYSTOLITHIASIS

X-RAY- LAMELLATED CALCIFIC DENSITY IN THE PELVIC AREA

ULTRASOUND-MOVABLE ECHOGENIC FOCI IN THE BLADDER

RENAL CALCULI, BOTH KIDNEYS

CYSTIC CHANGES OF THE KIDNEYS, CT SCAN

POLYCYSTIC KIDNEYS DISEASE WITH EXTRARENAL CYSTS

RENAL CYST, LEFT KIDNEY

CYSTIC CHANGES OF THE KIDNEYS, USG

RENAL CELL CA, CT SCAN

RENAL TRAUMA, CT SCAN

URETEROCELE, LEFT, COBRA HEAD SIGN

VOIDING CYSTOGRAM, WITH MILD REFLUX