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IVU FINDINGS.pptx

  1. 1. IVU FINDINGS IN COMMON CASES DR. SABHILASH SUGATHAN
  2. 2. REDUCED RENAL SIZE • Chronic Renal disease (end stage) • Chronic Pyelonephritis • Glomerular Nephrits • Nephrosclerosis
  3. 3. • lymphoma • Acute pyelonephritis • Acute tubular / cortical necrosis • Polycystic disease ENLARGEMENT OF THE KIDNEYS
  4. 4. CONGENITAL ANOMALIES
  5. 5. UNILATERAL AGENESIS
  6. 6. HORSE SHOE KIDNEY—FLOWER VASE SIGN
  7. 7. DUPLEX KIDNEY • Two PCS • Single or double ureter • Lower pole system dominant
  8. 8. Normal kidney has 10 to 14 minor calyces POLYCALYCOSIS MEGACALYCOSIS Nonobstructive dilatation of renal calyces without enlargement of pelvis .
  9. 9. CONGENITAL PUJ OBSTRUCTION • Functional abnormality at the PUJ • Failure of initiation of peristalsis
  10. 10. The hump is subtended by a normal collecting system element, indicating that it represents normal functioning tissue. DROMEDARY HUMP
  11. 11. indentation at the junction of middle and lower aspects of the kidney (sulcus interpartialis inferior) NORMAL INDENTATION. Indentations in the renal contour reflect persistent fetal renal anatomy.
  12. 12. PROLONGED NEPHROGRAM (PERSISTS) • Obstruction Intra or Extra Renal • Acute Pyelonephritis • Renal Vein Thrombosis • Acute medullary necrosis • Acute tubular necrosis • Multiple Myeloma • Shock DELAYED NEPHROGRAM (DOESN’T APPEAR IMMEDIATELY) • Hypotension • Renal ischemia
  13. 13. Increasingly dense nephrogram Distal ureteric calculus 10 min 4 hrs
  14. 14. Immediate dense persistent nephrogram Acute tubular necrosis 10 min 12 hrs
  15. 15. PAN Small vessel occlusion and multiple areas of parenchymal infarction with islands of preserved perfusion. PATCHY NEPHROGRAM
  16. 16. A small right kidney with delayed concentration of contrast in collecting system RENAL ARTERY STENOSIS. 3 mts 15 mts
  17. 17. OBSTRUCTION Obstructive Uropathy Rt Kidney
  18. 18. STAG HORN CALCULI
  19. 19. • Dilatation of left renal pelvis & calyces • Above obstructing calculi
  20. 20. Pyeloureteric junction obstruction Dilatation of right renal pelvis & calyces.
  21. 21. • Extravasation of contrast from the left kidney • Secondary to high grade obstruction
  22. 22. OBSTRUCTION High grade obstruction of the proximal ureter with dense nephrogram left kidney
  23. 23. • Stab wound right ureter with extravasation of contrast
  24. 24. CYSTIC DISEASE Adult polycystic kidney disease: -Enlargement of the kidney -Distortion of the pelvicalyceal system. (by multiple cysts of varying sizes, which may calcify) -‘Swiss cheese’ nephrogram may be seen. -Uretric calculi in 20% of cases. Simple cysts: -May not be visualized in IVU. . -Peripheral cysts- bulge in the renal outline. -USG is the simplest method.
  25. 25. In a young patient with asymmetric findings –Multiple Cysts Polycystic kidney disease. ENLARGED KIDNEYS
  26. 26. POLYCYSTIC KIDNEY DISEASE: SPIDER LEG • The calyces have a classical stretched appearance due to the presence of multiple cysts(due to compression of calyces by cysts)
  27. 27. Simple cyst. Cortical “beaking” at the margins of unenhanced
  28. 28. Calcifications clustered in medullary portion of kidney Cavities seen within renal papilla calcifications appear within them. MEDULLARY SPONGE KIDNEY. Medullary sponge kidney represents a developmental defect affecting the formation of collecting tubules and results in cystic dilatation of medullary and papillary portions of collecting ducts
  29. 29. The intravenous pyelogram shows ectatic distal collecting ducts containing the microcalcifications, forming the bouquet of flowers appearance. Also dilated contrast-filled tubules within the renal medulla which is known as the paintbrush appearance.
  30. 30. PYELONEPHRITIS Renal outline should be closely paralleled by a line connecting the papillary tips . Deviations from this pattern require explanation. Pyelonephritis. (indentation in the parenchyma)
  31. 31. CHRONIC PYELONEPHRITIS • Small and scarred kidneys, • Unilateral or bilateral, • Always asymmetric. • Cortical loss with distorted and clubbed calyces, • Commonly affects the upper and lower poles, with disruption of the normal inter papillary line.
  32. 32. With dilated collecting system. CHRONIC ATROPHIC PYELONEPHRITIS
  33. 33. RENAL TUBERCULOSIS • a)IVU may be normal initially • b)Calcification (33%) • -Small punctuate areas to complete replacement of the kidney. • -Ureter, bladder, prostate, vas deferens and • seminal vesicle may calcify. • c)Caseation and abscess formation • -The renal outline may be deformed. • d)Cavitation and stricture formation • e)Fibrosis and atrophy
  34. 34. Intravenous urogram shows calyceal amputation involving superior pole (MOTH EATEN RENAL TUBERCULOSIS Calyceal dilatation in lower pole and loss of parenchyma. Calcifications in paraspinal lymph
  35. 35. TUBERCULOSIS. Irregularity of calices in left lower pole phantom calices
  36. 36. PAPILLARY NECROSIS: Central excavation with ball-on-tee appearance lobster claw appearance , signet ring appearance , and sloughed papilla with clubbed calix Different patterns of excavation
  37. 37. Contrast fills central excavations in papilla of interpolar region, giving ball-on-tee appearance Ball-on-tee PAPILLARY NECROSIS.
  38. 38. LOBSTER CLAWS WITH LOBSTER
  39. 39. SIGNET RING
  40. 40. Clustered calcifications in the upper pole of right kidney. A large cavity in communication with, the upper most calix. CALICEAL DIVERTICULUM
  41. 41. DROOPING LILY Opacified lower pole moiety of a duplicated system , nonfunctional upper pole moiety Adrenal Mass
  42. 42. TUMOURS Plain • -Soft tissue mass • -Curvilinear or amorphous calcification Contrast • -Distorted collecting system • -Irregular filling defect within the collecting system.
  43. 43. A mass in the midportion of left kidney producing parenchymal thickness and distorting collecting system RENAL CELL CARCINOMA.
  44. 44. a large papillary filling defect with irregularity of the renal pelvis and proximal ureteral lumen. TRANSITIONAL CELL CARCINOMA
  45. 45. URETER TRIPLICATE URETER DUPLEX URETER
  46. 46. PRIMARY MEGAURETER • Diameter of 7mm or >
  47. 47. Circumcaval ureter ECTOPIC URETER
  48. 48. “cobra head” configuration of an ureterocele in bladder URETERAL OBSTRUCTION secondary to ureterocele.
  49. 49. Dilated right renal pelvis and ureter. Scoliosis of spine and compression of the urinary bladder PSOAS ABSCESS
  50. 50. RETROPERITONEAL FIBROSIS Medial Deviation of Ureters by Fibrosis
  51. 51. A filling defect due to transitional cell carcinoma, with dilatation of the ureter below GOBLET SIGN.
  52. 52. Multiple filling defects in renal pelvis and ureter TCC
  53. 53. BLADDER DUPLICATION BLADDER AGENESIS OF BLADDER
  54. 54. BLADDER DIVERTICULUM
  55. 55. Thickness of the bladder wall CYSTITIS
  56. 56. THIMBLE BLADDER Small urinary bladder schistosomiasis.
  57. 57. • Benign Prostatic Hyperplasia • White – Bladder • Dark –Benign enlargement of prostate pushing down inferior bladder
  58. 58. “female prostate” defect associated with an anterior vaginal wall mass. VAGINAL MASS.
  59. 59. PEAR-SHAPED BLADDER Extraperitoneal bladder rupture with urinary extravasation and pelvic hematoma Pelvic Lipomatosis
  60. 60. BLADDER NEOPLASM
  61. 61. • Round shadow on right side of bladder later shown to be a bladder cancer.
  62. 62. • Nodular squamous cell cancer of bladder • Dilated left ureter probably due to obstruction by tumor • Nonvisualization of right ureter due to complete obstruction.
  63. 63. THANK YOU

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