IVU Presentation PDF

# IVU ## By: Dr. Mahmoud Bakheet ## Intravenous Urography ### Normal serum creatinine * 0.7 to 1.3 mg/dl for men * 0.6 to 1.1 mg/dl for women ### Omnipaque ### Requirements * Fasting 4-6 hours, good hydration is essential * Adequate bowel preparation * Renal function tests beforehand * Non-io...

# IVU ## By: Dr. Mahmoud Bakheet ## Intravenous Urography ### Normal serum creatinine * 0.7 to 1.3 mg/dl for men * 0.6 to 1.1 mg/dl for women ### Omnipaque ### Requirements * Fasting 4-6 hours, good hydration is essential * Adequate bowel preparation * Renal function tests beforehand * Non-ionic contrast media are used ### Diagnostic Value * Show the renal function * UT obstruction * Renal and bladder masses * Congenital anomalies ### Contraindication * Renal impairment * Hypersensitivity to contrast media ### IVP series * PUT * 10 minutes * 20 minutes ### IVU * Compression film * Full bladder * Post micturition ### Congenital Lesions * Absent kidney * Hypo plastic kidney * Malrotated kidney * Duplex kidney and ureter * Ectopic kidney * Horseshoe kidney * PUJ obstruction * Uretrocele * Calyceal diverticulum **Malrotation of the left kidney:** Note the lateral displacement of the ureter and the elongation of the pelvis ### Renal Agenesis Intravenous pyelogram. Note the solitary, hypertrophied left kidney and the normal course of the left ureter. No right kidney was identified by isotope or ultrasound scans ### Hypo Plastic Kidney #### Small kidney * Hypo plastic kidney * Post obstructive atrophy * Chronic pyelonephritic kidney ### Malrotation * Abnormalities of the renal position due to incomplete rotation * The renal pelvis is facing anteriorly * Asymmetrically arranged calyces * Oblique views may be useful for evaluation ### Bilateral Malrotated Kidneys ### Ectopic Pelvic Kidney Left kidney in the pelvic cavity, located near the sigmoid colon, in contact with the upper border of the bladder; no dilatation was observed, with short left ureter. Right kidney and collecting system of normal location and anatomy ### Crossed Ectopic Kidney Intravenous urography demonstrating crossed renal ectopy. The "left" kidney is located below the right kidney. ### Horseshoe Kidney Axial and coronal reformatted CT images showing a horseshoe kidney with enhancing renal tissue connecting both renal moieties across the midline. ### Horseshoe Kidney, IVP Intravenous urography shows characteristic appearance of horseshoe kidney with an abnormal renal axis, incomplete rotation of the renal pelvis and high ureteric attachment.. ### Bifid Renal Pelvis Incidental bifid left renal pelvis in a patient presenting with hematuria. No filling defect or other cause of hematuria identified. ### Duplex Kidney and Ureter This intravenous urogram shows a single right ureter but an incomplete left ureteral duplication, with the two left ureters extending down to the sacrum, where they are fused. ### Complete Double System Excretory urography in a woman shows complete ureteral duplication on the right. The upper moiety ureter empties below and medial to the ureter of the lower moiety. Note the duplex collecting system on the left. ### Drooping Lilly Sign The drooping lily sign refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed, un opacified upper pole moiety in duplicated collecting system. ### Right Renal Duplex System Intravenous pyelogram showing right renal duplex system with normal lower moiety and hydronephrotic upper moiety with delayed excretion and hydroureteronephrosis of upper moiety as well as distal obstructing uretrocele ### Duplex Kidney with Ectopic Ureter #### Recurrent urinary tract infection. Right loin pain. Duplex right kidney. The ureter draining the upper moiety having an ectopic insertion at the prostatic urethra with marked back pressure changes in the form of dilated and tortuous right ureter with thinning-out of the upper moiety renal parenchyma ### Ureterocele * Cystic dilatation of the terminal ureter * It is more common in women, 10% are bilateral * Association with ureteral duplication in up to 80% of cases * In childhood it can lead to hydro ureter and hydronephrosis * In adult it may be present without dilatation of the ureter ### Uretrocele * It can produce a bladder filling defect caused by intra parietal dilatation. * Characteristically in IVU shows the "sign of the cobra head" with a radiolucent halo ### Ureterocele Intravenous pyelogram shows a well-defined intra vesical filling defect centered on the left vesicoureteric junction [cobra head sign] with mild proximal ureteric dilatation indicates a ureterocele The ureterocele appears as a filling defect in early film, in the delayed film the ureterocele fills with contrast ### Radiolucent Renal Stone Intravenous pyelogram shows a well-defined filling defect in the left renal pelvis as well as the lower pole calyces representing radiolucent stones. Normal right collecting system ### Radio-opaque UB stones Urinary bladder stones are usually large and radiopaque due to urine stasis ### Persistent Nephrogram Persistent nephrogram on the left side due a ureteric calculus. The renal parenchyma on the left is still opacified by contrast medium, whereas it has already been excre ted on the right side. ### Ureteric Stone Proximal to a Stricture IVP shows a left lower ureteric calculus on plain film The contrast study shows a moderately dilated ureter and the calculus is seen to move up and down. The left ureter has an abrupt narrowing with dilatation of the proximal part. ### Stone Masked by Contrast Large bilateral renal stones seen in plain film The stones are completely masked by the excreted contrast material. Normal ureters and urinary bladder ### Reflux * Stone * Reflux * Stricture ### Right Sided Moderately Dilated Ureter IVP shows right sided moderately dilated ureter and pelvicalyceal system, the early film showed a radiopaque stone at the terminal course of the ureter. Normal left collecting system and ureter ## Thank you