Intravenous Urography Overview

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Questions and Answers

What does the drooping lily sign indicate in renal imaging?

  • Delayed excretion in the upper moiety.
  • Hydronephrosis of the lower moiety.
  • Inferolateral displacement of the lower pole moiety (correct)
  • Complete ureteral duplication

Which condition is most commonly associated with ureteral duplication?

  • Ureterocele (correct)
  • Persistent nephrogram
  • Renal cyst
  • Renal stone

What characteristic feature is associated with a ureterocele in imaging?

  • Sign of the cobra head (correct)
  • Hydronephrosis without other findings
  • Normal ureteral appearance
  • Intra parietal dilatation without filling defects

What anatomical anomaly is indicated by a duplex kidney with an ectopic ureter insertion?

<p>Hydronephrosis and back pressure changes (B)</p> Signup and view all the answers

Which feature is most characteristic of a right renal duplex system with hydronephrosis?

<p>Distal obstructing uretrocele (C)</p> Signup and view all the answers

What does a persistent nephrogram typically indicate in a patient?

<p>Ureteric calculus obstruction (D)</p> Signup and view all the answers

Which of the following describes the typical presentation of radiolucent renal stones in imaging?

<p>Well-defined filling defect in the renal pelvis (D)</p> Signup and view all the answers

In which demographic is a ureterocele most commonly found?

<p>Women, with 10% being bilateral (D)</p> Signup and view all the answers

What is the normal serum creatinine range for men?

<p>0.7 to 1.3 mg/dl (B)</p> Signup and view all the answers

Which of the following is a contraindication for intravenous urography?

<p>Renal impairment (C)</p> Signup and view all the answers

What diagnostic value does intravenous urography provide?

<p>Show congenital anomalies (C)</p> Signup and view all the answers

In which condition would you expect to find a dorsal displacement of the ureter?

<p>Malrotation of the left kidney (C)</p> Signup and view all the answers

What is an essential requirement before performing intravenous urography?

<p>Renal function tests beforehand (C)</p> Signup and view all the answers

What condition is characterized by the absence of a kidney?

<p>Renal agenesis (B)</p> Signup and view all the answers

Which imaging finding is typical for a horseshoe kidney?

<p>Fusion of the renal tissue across the midline (B)</p> Signup and view all the answers

Which of the following describes bilateral malrotated kidneys?

<p>Each kidney showing an anteriorly facing renal pelvis (A)</p> Signup and view all the answers

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Flashcards

Duplex Kidney

Two ureters draining a single kidney, with the upper ureter often draining into a lower location (e.g., bladder, urethra).

Cobra Head Sign

An X-ray finding seen in ureterocele, showing a radiolucent halo around the ureterocele.

Ureterocele

A cyst-like outpouching of the distal ureter, often found near the bladder.

Complete Double System

A condition where one kidney has two collecting systems, each with its own ureter.

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Drooping Lilly Sign

A specific sign observed in a duplex collecting system, where the lower pole of the kidney is displaced downwards by an obstructed upper pole.

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Ectopic Ureter

A condition where one of the ureters from a duplex kidney inserts abnormally, often leading to urinary tract infections.

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Persistent Nephrogram

A persistent contrast enhancement on an X-ray indicating a blockage within the ureter.

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Radiolucent Renal Stone

A condition where a kidney stone is not visible on X-ray because it's composed of less dense materials.

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Intravenous Urography (IVU)

A diagnostic imaging test that uses contrast dye injected into a vein to visualize the kidneys, ureters, and bladder. It helps identify abnormalities in the urinary tract, such as kidney stones or infections.

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IVU Requirements

This test requires patients to be fasting for 4 to 6 hours and have adequate bowel preparation. Renal function tests are crucial prior to the IVU to ensure patient safety.

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IVU Contraindications: Renal Impairment and Contrast Allergy

These are the contraindications for IVU, meaning it is not recommended for patients with these conditions. It is important to carefully consider each patient's medical history and underlying conditions before performing IVU.

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IVP Series

A series of X-ray images taken at specific intervals after the contrast dye injection during an IVU. It provides a dynamic view of the urinary system.

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IVU Compression Film

A type of IVU where a compression film is taken after the contrast dye has been injected. It is used to assess the condition of the urinary tract, especially in cases of suspected obstruction or reflux.

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Malrotation of Kidneys

This is a common abnormality where one or both kidneys do not fully rotate during fetal development. It can lead to various complications like urinary tract infections.

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Renal Agenesis

An uncommon condition where one kidney is missing completely. It can cause problems with kidney function and urinary tract infections.

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Hypo Plastic Kidney

A condition where a kidney is smaller than normal. This can occur due to various causes, including genetic factors, pre-natal damage, or chronic infections.

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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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