Course title: Radiographic Pathology RAD 312 Course instructor: Dr. Baha Eldeen
Urinary system
Complications of bladder diverticula:
1. Stone formation 2. Inflammation 3. Malignant growths
Differential diagnosis "D.D" for pelvic kidney:
1. Fallen kidney → seen in I.V.U with long ureter. It could be either:
a) Ptosed kidney (fixed with changing patient's position (whether in I.V.U &
U.S) b) Floating "mobile" kidney (change location with changing patient's position
(in I.V.U or U.S) in which it goes down when patient stand & goes up when lie down
2. Pelvic ectopic → seen in I.V.U with short ureter since kidneys initially (in fetus) formed in pelvis then it goes up but when it fails then it becomes pelvic ectopic
3. Transplanted kidney
Some examples of abnormal refluxes:
1. Vesicoureteric reflux: backward movement of urine from UB to ureters.
2. gastroesophageal reflux (heart burn): backward movement of food from stomach to esophagus
► It could be seen & evaluated when patient apply straining (to increase intra- abdominal pressure) during micturation in ascending cystography so if lower part of ureters filled with contrast, it indicates a 1st degree of reflux but if ureters &
pyelocalycealsystem filled & dilated without straining, it indicates a last degree (advanced) reflux. Also we use straining {with trendelenburg position (from supine) in Ba meal after giving Ba & water} to detect gastroesophageal reflux
Types of congenital hernia: {diagnosed by CXR & Ba meal (upper GI contrast study}
A common symptom for it is recurrent chest infection.
1. Morgagni's hernia: A rare congenital diaphragmatic hernia (CDH)result from an abnormal anteromedial-retrosternal opening in the diaphragm
2. Bochdalek's hernia : a rare congenital diaphragmatic hernia result from abnormal posterolateral opening in diaphragm
The appearance of renal calyces of kidney at different grades of hydronephrosis in I.V.U:
Normal 1st grade 2nd grade 3rd grade (cupped) (clubbed) (ballooned) (crescents)
Contraindication to I.V.U:
1. Massive hydronephrosis 2. Nonfunctioning kidney So alternative ways of imaging urinary tract are:
1. Retrograde pyelography {through bladder}
2. Nephrostography "antegrade pyelography" (using percutaneous nephrostomy tube)
Advantages of percutaneous nephrostomy tube:
Provides access to the collecting system for a variety of diagnostic and therapeutic procedures like:
1) Relief of obstruction (preserve renal function, treatment of infection, relieve pain) 2) Diagnostic study (antegrade pyelography, biopsy)
3) Removal of solid material (stone, foreign body) & fluids.
4) Access for ureteral intervention (stricture dilation, stenting) & for nephroscopy
Reasons of doing prone in I.V.U or nephrostography: to pour contrast in renal pelvis & ureter.
Written by:
Lamis Jada'a
Fornix invendibulum