Overview Urogenital Imaging Anatomy Pathology PDF

Urogenital Imaging: Renal Anatomy Imaging Evaluation Congenital Abnormalities Loizos Siakallis Consultant Radiologist ANATOMY Urinary System Kidney Ureter Bladder Urethra Anatomy Anatomy IMAGING MODALITIES Plain abdominal x ray Kidneys ureter bladder x Ray (KUB) Intravenous pyelogram (IVP) Retrograd...

Urogenital Imaging: Renal Anatomy Imaging Evaluation Congenital Abnormalities Loizos Siakallis Consultant Radiologist ANATOMY Urinary System Kidney Ureter Bladder Urethra Anatomy Anatomy IMAGING MODALITIES Plain abdominal x ray Kidneys ureter bladder x Ray (KUB) Intravenous pyelogram (IVP) Retrograde uretrography/cystography/urethrocystography Voiding Cystourethrography Ultrasonography CT Scan CT Urogram (Urography) MRI Nuclear Imaging ABDOMINAL X-RAY PLAIN (Routine) ABDOMINAL X-RAY Low sensitivity/ specificity Good quality films will show the kidney outlines Enlargement (mass/hydronephrosis) can be recognized Calcification Opaque calculi in the kidney, ureter or bladder Nephrocalcinosis : calcification in the renal parenchyma. Routine abdominal x-Rays have limited value in detecting urogenital abnormalities. Ultrasound Normal Anatomy Smooth external contour (May be lobular in cases of persistent lobar lobulation) Echogenicity of the cortex: Equal or less than liver, less than spleen. Collecting system should NOT be visualised. Case A: Small kidney (8 cm longitundinal diameter). – Chronic kidney disease (Cr: 4 mg/dl) B: Normal size / hyperechoic kidney : 32 yo man with uncontrolled hypertension (Cr: 3.3 mg/dl) CT phases of contrast enhancement Unenhanced Nephrogenic (90-100 sec) Corticomedullary (35-40 sec) Excretory (3-15 min) CT phases of contrast enhancement Normal urinary bladder CT Normal urinary bladder on Non Contrast and excretory Phase CT. Thin uniform wall. No intraluminal filling defects. CT urography Coronal Axial Maximum intensity projection (MIP) reconstruction. CT urography has largely replaced traditional intravenous urogram (aka IV pyelogram). Illustrates the collecting systems, ureters and bladder with intravenous contrast in a single acquisition. CT urography ? Coronal CTU and Coronal Maximum Intensity Projection. CT urography Combination of multiplanar reconstructions allows characterisation. Obstructing transitional cell carcinoma of the ureter. Congenital abnormalities of kidneys Related to: Number Position Form Renal Agenesis (“related to number”) Elongated (“lying down”) adrenal sign of agenesis of left kidney vs nephrectomy. Renal Agenesis (related to number) Renal agenesis (absent kidney, absent ipsilateral renal artery). Unilateral : increased incidence of extra renal abnormalities (e.g meningomyelocele, vsd,intestinal tract strictures, imperforate anus) Compensatory hypertrophy of the contralateral kidney Bilateral renal agenesis: (Potter syndrome -Fatal in first few days of life due to pulmonary hypoplasia secondary to the associated oligohydramnios) Case ? IV pyelogram (urogram) Ectopic Kidney (cross fused renal ectopia) Arrested cephalic migration of one or both kidneys during normal embryological development,. => Ectopic location (pelvic, thoracic, cross fused renal ectopia). Ectopic Kidney (cross fused renal ectopia) Consequence of abnormal renal ascent in embryogenesis with the fusion of the kidneys within the pelvis. Increased risk of injury. Horseshoe Kidney (related to form) The most common type of renal fusion anomaly. Fusion of right and left kidneys at lower poles in 90% Bilateral malrotation Associated with other anomalies in 50% e.g. Turners syndrome, ureteral duplication. Susceptibility to trauma, risk factor for development of renal calculi and transitional cell carcinoma of the renal pelvis. Duplication of collecting system The most common congenital anomaly of the urinary tract. Incomplete (A) (Ureters join and enter bladder through a single ureteral orifice) Complete (B) duplication of collecting system. Separate ureters. Complete duplication associated with reflux (lower pole ureter) and ureterocele - obstruction – megaureter (upper pole ureter) Duplication of collecting system Ureterocele – Megaureter related to duplicated collecting system. Combra sign Thank you