Intra venous urography By Dr Sahar Zubair
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Transcript of Intra venous urography By Dr Sahar Zubair
INTRA-VENOUS UROGRAPHY
Prepared by Dr Sahar Javed
5
Normal IVU
Congenital lesions and variants
Renal agenesis• Failure of ureteric bud to reach the
metanephros • Ipsilateral ureter and hemitrigone also fails to
develop
Renal agenesis (left sided)
Renal agenesis(right sided)
Renal ectopia•Failure of complete ascent of kidney from pelvis to the lumbar region •Kidney comes to lie anywhere from pelvis upwards •Over ascent is rare •Pelvic kidney •Pancake kidney•Intra-thoracic kidney
Pelvic kidney• Often small with increased risk of trauma ,
vesico-ureteric reflux and calculus formation(due to stasis).
Right sided pelvic kidney
Left sided pelvic kidney
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Pancake kidney• When both kidneys remain in the pelvis ,they
may fuse together producing the small pancake kidney
• Very frequently associated with other congenital anomalies
Pancake kidney
Intra-thoracic kidney• Over ascent is almost always limited by the
diaphragm but there may be some superior herniation through a localized eventeration and very rarely a true thoracic kidney
Intra-thoracic kidney
HORSE SHOE KIDNEY• A midline connection ( isthmus) b/w the lower
poles • Associated malrotation and accessory renal
arteries• Increased incidence of renal calculi and injury
Horse shoe kidney
Horse shoe kidney
Crossed fused ectopia• A horse shoe kidney that has slipped
superolaterally so that both kidneys come to lie on one side
• The ureter draining the upper moiety inserts orthotopically on the ipsilateral side of the bladder
• The lower moiety ureter also inserts orthotopically but into the contralateral side of the bladder
Crossed fused ectopia
Crossed fused ectopia
Crossed fused ectopia
Crossed fused renal ectopia
Duplication abnormalities(duplex kidneys)
• Characterized by two (on rare occasions more than two ,up to 6 having been reported ) ureters and renal pelves.
• Duplication may be complete or incomplete
Duplex collecting system
Duplex collecting system(complete)
Duplex collecting system (incomplete)
Ureteral triplication with contralateral duplication and
ureterocoele
Ureterocoele• Submucosal dilatations of intramural distal
ureter• They often project into the bladder lumen
Ureterocoele
Polycystic kidneys
Polycystic kidneys
Medullary sponge kidney• Ectasia (fusiform or cystic) of the collecting
ducts within the renal pyramids.• Seen in 1 in 200 IVUs• Generally bilateral but may be unilateral or
segmental affecting as little as a single papilla• Usually a benign incidental finding but there is
a weak association with some tumors (Wilm`s and pheochromocytoma)
Medullary sponge kidney
Calyceal diverticulum• Common variant (1 in 250 IVUs)• An intra-parenchymal cavity lined with
transitional epithelium• Do not receive drainage from nephrons and
therefore opacify during IVU after the rest of the calyces
• Diverticula are usually a few millimeters in diameter & communicate with minor calyx
Calyceal diverticulum
Retrocaval ureter• Right ureter occasionally takes an aberrant
course, running sharply medially posterior to IVC and then dropping inferiorly towards the pelvis along a course medial to the pedicles
• Rarely associated with hydronephrosis
Retrocaval ureter
Primary megaureter• Due to congenitally abnormal musculature of
the distal ureter leading to focal failure of peristalsis
• Ureter above the abnormal segment becomes dilated sometimes massively
• In severe cases dilatation involves the entire ureter and renal pelvis
Primary mega ureter
Prune-belly syndrome
• Following bladder outflow obstruction in utero due to urethral valves with development of hydro ureters and hydronephrosis
• Obstruction is overcome but obstructive phase produces defective development of anterior abdominal wall and ureteric musculature with subsequent poor peristalsis and persistent non obstructive dilatation of collecting systems
Prune belly syndrome
Inflammatory diseases
Acute pyelonephritis• IVU may be normal• Kidney may be smoothly enlarged and calyces
compressed by the adjacent swollen parenchyma
• Kidney may show reduction in perfusion and function and a striated nephrogram
Acute pyelonephritis
Renal abscess(IVU usually shows a non specific mass)
Renal TB
Renal hydatid
Malignant masses
Renal cell carcinoma
Transitional cell carcinoma
TCC
TCC
TCC
Wilm`s tumor
Calculi
Renal calculi
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Stag-horn calculus
calculi
Ureteric calculus
Ureteric calculus
Ureteric calculus
Vesical calculi
Vesical calculi
Renal trauma
Vesical diverticulum
Vesical diverticulum
Vesical diverticula