1 KUB IVP
Transcript of 1 KUB IVP
Normal KUB-IVPGUT Viewbox
Ma. Mercedes Victoria M. Tanchuling
What is it?
Intravenous Pyelogram• Assessment of the urinary tract through the
injection of a radio-opaque dye, after which a series of films are taken over a span of 15-20 minutes
• Gives excellent anatomical images of the pelvicalyceal systems and an indication of renal function
Indications & Preparation
• Lumbar pain, hypertension, palpable abdominal mass, hematuria (>10 RBC/hpf)
• Prior to IVP, the patient must be:– NPO 8 hours prior to the study– Laxatives for cleansing
• BUN/Crea must be checked to make sure patient can clear the contrast media
• Check for history of asthma and allergies must be verified in order to avoid possible allergic reaction with the contrast media
Types of Contrast
• Ionic – more allergenic– hyperosmolar– cheaper (~P400)
• Non-ionic– hypoallergenic– less osmolar– more expensive (~P1500)
Patient Preparation• Night before the exam:
– Very light supper– At 7PM, let patient take in 4 Dulcolax tablets and 60cc
castor oil.– From 7PM onwards, NPO but patient can still drink 1
glass of water per hour until 12 midnight.– At 5AM, rectal suppository• Patient should empty bladder before the procedure• All films should be taken at deep expiration
Procedure
• Contrast media is injected into the arm intravenously, excreted by the glomerular filtration
• X-ray films are taken at the following intervals:– 3 minutes (supine)– 5 minutes (supine)– 10-15 minutes (prone) COMPRESSION APPLIED– Post-void(upright)
BONES VISCERA COLLECTING SYSTEMBONES VISCERA
•Psoas Line obliterated? Retroperitoneal mass
•Liver
•Spleen
•May show : metscortical thinningdegenerative changes
•Pelvis•Vertebrae
COLLECTING SYSTEMVISCERA
•Bean Shaped, smooth outline
10-15 cm long, 5cm across, 2.5cm thick
T12-L3 Left > Right by 0.5cm Right lower than Left
by 2cm Calyces are cupped,
not splayed
KIDNEYS• Normally hard to see!
•8mm diameter, vertical descent parallel to vertebra
3 areas of narrowing:1. Ureteropelvic junction – most common place
of obstruction
2. Ureterovesical junction3. Bifurcation of the iliac vessels
URETERS•Regular smooth appearance and complete voiding
•Smooth mucosa; ovoid
•Dome is round in males, flat in females (due to uterus)
BLADDER
Inject contrast material
3 minutes
• More or less an opacification of the intrarenal collecting system
kidneys and upper
collecting system
visualized
5 minutes
contrast is seen passing through the calices and pelvis
contrast is seen passing through the calices and
pelvis
5 Minutes
5 Minutes
Pelvis and ureters opacifying
10 Minutes
10 Minutes, oblique view
Ureteral filling
Check for stones!
20 minutes
1.full bladder has very smooth borders2.“dapat bilog na”
full bladder has very smooth borders
Post-void
to check urinary retention
<50 cc
you can still see some degree of
contrast in various areas of the GU system
References
Adam, Dixon. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed.
Brant and Helm. Fundamentals of Diagnostic Radiology. 3rd ed.
Dyer, RB et al. Intravenous Urography: Technique and Interpretation. Journal of Radiographics, Volume 4:21, August 2001.