Introduction to KUB system

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Veronica Nichols
7 years ago
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1 Introduction to KUB system

2 Plain film Identify abnormal calcification Renal outlines Psoas shadows Bony structures Intestinal gas

4 Intravenous pyelography (IVP) Intravenous injection of contrast medium Fluid restriction in normal renal function patient to increased urine concentration, dense pyelogram Film timing (5,10, 20 min., full bladder and post voiding )

5 IVP (cont.) Renal shadows position axis size shape Renal pelvisp elvis, minor calyx : cupped Ureters : seen only some part Urinary bladder : smooth outline, empty after voiding

9 Retrograde pyelography (RP) Direct injection of CM into pelvicalyceal system or ureters via the catheter inserted into the bladder Demonstrates pelvicalyceal system and ureters in case of nondemonstrable on IVP study Shows anatomy but not renal function

11 Angiography Demonstrates details of vascular anatomy prior to surgery Assess renal vascular disease eg. renal artery stenosis Aim for endovascular treatment eg. percutaneous balloon angioplasty/ stent and embolization

13 Ultrasound Exclude hydronephrosis esp. in renal failure Diagnosis cyst, abscess or tumour Renal size measurement Retroperitoneal mass Doppler flow study Guided interventioni

14 Ultrasound (cont.) Kidneys Smooth outline Renal parenchyma, central echo complex size 9-12 cm. Normal ureters are not seen Urinary bladder

15 Normal renal ultrasound

16 Computerized tomography (CT) Useful in diagnosis of focal parenchymal problems eg. renal masses, trauma, infarction Retroperitoneal structures eg. tumours, abscess, lymphadenopathy

17 CT (cont.) Noncontrast VS contrast scan Renal cortex, medulla and pelvicaliceal system Ureters lie anterior to psoas muscle Urinary bladder outlined by fat in pelvic cavity

18 Non-contrast scan Post-contrast scan

19 Non-contrast scan Post-contrast scan

20 Other investigations Cystography,, urethrographyu Voiding cystourethrography rography (VCUG) Magnetic resonance imaging (MRI) Perinephric gas insufflation

21 Voiding cystourethrography rography (VCUG) Indications Vesicoureteral reflux Posterior urethral valve

22 Voiding cystourethrography

25 Voiding cystourethrography rography

26 MRI

27 Perinephric gas insufflation

29 Abnormalities 1 Congenital anomalies* 2 Calculi* 3 Infection* 4 Tumours* 5 Cystic disease 6 Vascular 7 Trauma

30 Congenital anomalies number : single, supranumerary kidney size : hypo- and hyperplasia fusion anomalies : horseshoe, pancake cross ectopia with fusion position : thoracic, pelvic kidney duplication : most frequent unilateral eral/bilateral complete/incomplete

37 Urinary calculi Nearly all urinary calculi are calcified Opaque stones : calcium oxalate, carbonate, phosphate Poor density stones : uric acid, xanthine, cystine

38 Urinary calculi (cont.) Plain film necessary before IVP study Ultrasound/IVP stone site of obstruction degree of obstruction renal function (IVP)

39 Urinary calculi (cont.) Differential diagnoses cartilage, bone lymph nodes blood vessels gallstones

43 IVP of urinary tract obstruction dense nephrogram delayed pyelogram clubbing of calyx dilated collecting system until point of obstruction causes : calculi, tumors, infection, retroperitoneal disease, etc.

49 Ultrasound (obstruction) dilated collecting system causes of obstruction

52 Infection Acute pyelonephritis usually due to bacterial infection ascending infection normal, mild caliectasis, incomplete filling or irregularity of calyces US: enlarged kidney, decreased echoes due to cortical edema CT : patchy diminished density, inhomogeneous enhancement

54 Infection (cont.) Chronic pyelonephritis thinning of renal parenchyma cortical scar small sized kidney caliectasis US : small kidney, increased echogenicity

57 Infection (cont.) Renal/perinephric abscess IVP : difficult to detect, local bulging US : thick wall, cystic and solid components CT: enhancing wall

59 Infection (cont.) Tuberculosis blood born spread of M. tuberculosis normal CXR does not exclude the diagnosis IVP : normal in early stage irregularity of a calyx, calcification renal substance is destroyed, loss of parenchymal width stricture of any portions of pelvicalyceal or ureters irregular bladder

64 Tumor Almost all solitary masses in renal parenchyma are malignant tumors Adults : almost malignant tumors are RCC (renal cell carcinoma) Children : Wilm s tumors

65 Renal mass IVP bulging of renal outline displacement of major and minor calices increase in renal size

66 Renal mass Ultrasound solid VS cystic simple cyst : clear fluid, no internal echo, acoustic enhancement

70 Renal mass CT scan simple cyst : spherical mass, imperceptible wall, homogeneous density similar to water RCC : spherical or lobulated, frequently have poorly defined margin, density close to renal parenchyma

73 Urothelial tumor Transitional cell CA grows within the collecting system lobulated/ frond-like filling defects may present as multiple sites may cause obstruction

77 Differential diagnoses Filling defect in collecting system clot cancer calculus fungal ball polyp air bubble

78 Wilm s tumor Most common malignant abdominal neoplasm in children 1-8 yr. Peak age yr. IVP: distorted calices US: echogenic mass CT: large intrarenal tumor, distorted calices, may invade IVC/Rt. atrium

80 Neuroblastoma Most common solid abdominal mass in infancy, originate from neural crest 25% during 1st year, 50%< 2 years IVP: displacement of collecting system, drooping lilly sign US: hypo/hyperechoic hyperechoic mass CT: extrarenal mass, strippled calcification, encasement of IVC

82 Wilm s tumor VS. Neuroblastoma Wilm s childhood calc % 15% distortion of collecting system metastasis to lung VMA and cathecholamine -ve Neuroblastoma may be congenital calc. >50% displacement of collecting system metastasis to brain, bone VMA and cathecholamine +ve

83 Autosomal Dominant Polycystic Kidney Disease (ADPKD) Adult polycystic kidney disease Bilateral enlarged kidneys with multiple cysts IVP : elongated and distorted pelvicalyceal system Ass. with cysts in liver, pancreas, cerebral aneurysm

87 Obstetric and Gynecologic Radiology Plain film Hysterosalpingography Ultrasound Pelvic arteriography or venography

88 Calcified fibroid myoma

90 Hysterosalpingography Sterility problem Investigation of uterine bleeding Visualization of sinus tract communicating with female genital tract Congenital anomalies of uterus : hypoplasia, septate, unicornuate, arcuate, bicornuate, didelphys

93 Ultrasound uterus, cervix, adnexa IUD gestational age fetal viability, development fetal anomalies amniotic fluid placenta

95 Uterine myomas

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis