Podcast
Questions and Answers
What does the drooping lily sign indicate in renal imaging?
What does the drooping lily sign indicate in renal imaging?
Which condition is most commonly associated with ureteral duplication?
Which condition is most commonly associated with ureteral duplication?
What characteristic feature is associated with a ureterocele in imaging?
What characteristic feature is associated with a ureterocele in imaging?
What anatomical anomaly is indicated by a duplex kidney with an ectopic ureter insertion?
What anatomical anomaly is indicated by a duplex kidney with an ectopic ureter insertion?
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Which feature is most characteristic of a right renal duplex system with hydronephrosis?
Which feature is most characteristic of a right renal duplex system with hydronephrosis?
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What does a persistent nephrogram typically indicate in a patient?
What does a persistent nephrogram typically indicate in a patient?
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Which of the following describes the typical presentation of radiolucent renal stones in imaging?
Which of the following describes the typical presentation of radiolucent renal stones in imaging?
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In which demographic is a ureterocele most commonly found?
In which demographic is a ureterocele most commonly found?
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What is the normal serum creatinine range for men?
What is the normal serum creatinine range for men?
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Which of the following is a contraindication for intravenous urography?
Which of the following is a contraindication for intravenous urography?
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What diagnostic value does intravenous urography provide?
What diagnostic value does intravenous urography provide?
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In which condition would you expect to find a dorsal displacement of the ureter?
In which condition would you expect to find a dorsal displacement of the ureter?
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What is an essential requirement before performing intravenous urography?
What is an essential requirement before performing intravenous urography?
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What condition is characterized by the absence of a kidney?
What condition is characterized by the absence of a kidney?
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Which imaging finding is typical for a horseshoe kidney?
Which imaging finding is typical for a horseshoe kidney?
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Which of the following describes bilateral malrotated kidneys?
Which of the following describes bilateral malrotated kidneys?
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Study Notes
Intravenous Urography (IVU)
- IVU is a diagnostic imaging procedure
- Normal serum creatinine levels range from 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women
- IVU requirements include fasting for 4-6 hours, adequate hydration, bowel preparation, and renal function tests beforehand
- IVU uses non-ionic contrast media
Diagnostic Value of IVU
- IVU shows renal function
- Detects urinary tract obstructions
- Identifies renal and bladder masses
- Evaluates congenital anomalies
Contraindications for IVU
- Renal impairment
- Hypersensitivity to contrast media
IVP Series
- IVP series involve X-ray images taken at different time intervals (e.g., 10 minutes, 20 minutes, 30 minutes)
IVU Post-Procedure
- Requirements include compression film, full bladder and post-micturition
Congenital Renal Lesions
- Absent kidney
- Hypoplastic kidney
- Malrotated kidney
- Duplex kidney and ureter
- Ectopic kidney
- Horseshoe kidney
- PUJ obstruction
- Uretrocele
- Calyceal diverticulum
Renal Agenesis
- Solitary, hypertrophied left kidney
- Normal course of the left ureter
- No right kidney identified
Hypo Plastic Kidney
- Small kidney size
- Hypo plastic kidney
- Post-obstructive atrophy
- Chronic pyelonephritic kidney
Malrotation
- Abnormalities in renal position due to incomplete rotation
- Renal pelvis facing anteriorly
- Asymmetrically arranged calyces
- Oblique views for evaluation
Bilateral Malrotated Kidneys
- Bilateral malposition of the kidneys
Ectopic Pelvic Kidney
- Left kidney located in the pelvic cavity
- Near the sigmoid colon
- Contact with the upper border of the bladder
- No observed dilation
- Short left ureter
- Normal right kidney and collecting system
Crossed Ectopic Kidney
- "Left" kidney located below the right kidney
Horseshoe Kidney
- Axial and coronal CT images show the connection of both renal moieties across the midline
- Enhancing renal tissue connects both renal moieties
Horseshoe Kidney, IVP
- Characteristic appearance of a horseshoe kidney on IVP
- Abnormal renal axis
- Incomplete rotation of the renal pelvis
- High ureteric attachment
Bifid Renal Pelvis
- Incidental bifid left renal pelvis
- Patient with hematuria
- No filling defect or other cause of hematuria identified
Duplex Kidney and Ureter
- Single right ureter
- Incomplete left ureteral duplication
- Two left ureters extending to the sacrum
- Left ureters fused together
Complete Double System
- Complete ureteral duplication on the right
- Upper moiety ureter empties below and medial to the lower moiety ureter
- Duplex collecting system on the left
Drooping Lily Sign
- Inferolateral displacement of the opacified lower pole moiety
- Obstructed, un-opacified upper pole moiety
- Duplicated collecting system
Intravenous Pyelogram (IVP) Findings
- Right renal duplex system with normal lower moiety
- Hydronephrotic upper moiety with delayed excretion
- Hydroureteronephrosis of upper moiety
- Distal obstructing uretrocele
- Duplex right kidney
- Ectopic insertion of the ureter draining the upper moiety at the prostatic urethra
- Dilated and tortuous right ureter
- Thinning-out of the upper moiety renal parenchyma
Ureterocele
- Cystic dilatation of the terminal ureter
- More common in women
- 10% are bilateral
- Associated with ureteral duplication in up to 80% of cases
- Childhood-associated hydro ureter and hydronephrosis
- Adult-associated absence of ureter dilatation
Ureterocele Findings (IVP)
- Well-defined intravesical filling defect centered on the left vesicoureteric junction
- Mild proximal ureteric dilatation
- Ureterocele fills with contrast in delayed films
Radiolucent Renal Stone
- Well-defined filling defect in the left renal pelvis
- Lower pole calyces representing radiolucent stones
- Normal right collecting system
Radiopaque Urinary Bladder Stones
- Urinary bladder stones are usually large
- Radiopaque due to urine stasis
Persistent Nephrogram
- Nephrogram persistent on the left side due to ureteric calculus
- Renal parenchyma on the left is still opacified
- Contrast medium already excreted on the right side
Ureteric Stone Proximal to Stricture
- Left lower ureteric calculus on plain film
- Moderately dilated ureter
- Calculus seen to move up and down
- Abrupt narrowing of the left ureter
- Dilatation of the proximal part
Stone Masked by Contrast
- Large bilateral renal stones seen in plain film
- Stones completely masked by excreted contrast material
- Normal ureters and urinary bladder
Stone, Reflux, Stricture
- Findings related to stones, reflux, and ureter strictures, possibly seen on imaging
IVP Right Sided Dilated Ureter and Pelvicalyceal System
- Moderately dilated ureter and pelvicalyceal system on the right, shown on IVP
- Radiopaque stone found in the terminal course of the ureter
- Normal left collecting system and ureter
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Description
This quiz covers the essentials of Intravenous Urography (IVU), including its diagnostic uses, requirements, contraindications, and post-procedure considerations. It also discusses the significance of IVU in evaluating renal function and detecting urinary tract obstructions.
