IVU Final Copy

8/6/2019 IVU Final Copy

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INTRAVENOUS

UROGRAM I.V.U


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Radiographic examination of urinary tract

including renal parenchyma, calyces &pelvis after IV injection of contrast media.

IVP - misnomer


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NORMAL I.V.U


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IND

ICATIONS

IN ADULTS:

Screening of urinary tract haematuria/pyuria

Diseases of renal collecting system & pelvis

Differentiation of function of both kidneys

Abnormalities of ureter

Obstructive uropathy (gold std)


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TB of urinary tract

Calculi

Potential renal donors Prior to endo-urological procedures & surgery of

urinary tract

Suspected renal injury


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IN CHILDREN

VATER anomalies

Malformation of urinary tract

Girls with constant/intermittent dampness

s/o ectopically inserted ureter (mandatory)

Anorectal anomalies


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CONTRAINDICATIONS(relative)

Iodine sensitivity

Pregnancy

H/O AnaphylaxisRISK FACTORS

Cardiac failure

Dehydration

Diabetes with azotemia Previous allergic reaction

H/O Phaeochromocytoma


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CONTRAST MEDIA

In adults

Non ionic media

Iohexol Omnipaque300 mg I/ml 40-80ml

Ionic media

300 to 600 mg iodine

equivalent/kg bw. Max of40 mg of iodine

In children

240 mg I/ml 300mg I/ml

7 kg: 3ml/kg 2ml/kg

Meglumine iothalamate or

diatrizoateDose : 1-2 ml/kg bw


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MODE OF ADMINISTRAION

I.V bolus inj within 30-

60 secs

Density ofnephrogram directly

proportional to

plasma conc of

contrast


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PREPARATION

FOR ADULTS

Past history

Fasting for 4 hrs Do not dehydrate the pt

Bowel preparation

FOR CHILDREN

NPO for 3-4 hrs Do not dehydrate

Colon should be empty


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PROCEDURE

Pt in supine position withpelvis at the cathode side ofthe tube

Support placed under ptsknees to reduce lordoticcurvature of LS spine

Scout film is taken

Contrast injected IV intoprominent vein in the arm.Testinj of 1 ml given & pt observed

for reactions Contrast injected rapidly within

30-60 secs


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CORTICAL NEPHROGRAM : within 20 secs of inj.Renalparenchyma opacified by contrast.

cortical phase vascular filling

tubular phase contrast within lumen of renal tubulesPYELOGRAM: (contrast in calyces) 2 mins after inj

If a kidney fails to excrete detectable amount of contrast intocollecting system termed Non-visualising kidney.


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FILMING TECHNIQUE: low KV(65-75) high mA(600-1000)& short exposure to get optimum image contrast

STD FILMS TAKEN

Plain X-ray KUB/Scout film- 14 * 17 1 min film 10 * 12

5 min film 10 * 12

10 min film 15 * 12

15 min film -15 * 12

35 min film -14 * 17

Post void film 10 * 8


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1 min film shows nephrogram.

5 min film shows nephrogram,renal pelvis, upper part of ureter

Compression band : produces better pelvicalyceal distension.

Contraindicated inrenal trauma

large abdominal mass

abd. Aneurysm

after abdominal surgery

if 5 min film shows dilated calyces obstruction exists

If compression is applied, film is taken 5 mins after compression todemonstrate distended calyceal system & prox ureters.


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15 min film :better visualisation of ureter in prone position / modified trendelenberg

position 35 min film : complete overview of urinary

tract kidney, ureter, bladder.

Post void film:assess residual urine,bladder mucosal lesions, diverticula,

bladder tumor, outlet obstruction, VUR.


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Mast Gagan 7 yrs


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MrD

harnappa, 31 yrs


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SPECIAL FILMS IN I.V.U

OBLIQUE VIEW :

project ureter away from spine & separateradio opaque shadows mimicking calculi.

Visualisation of posterolateral aspects ofbladder

Differentiation of extrinsic or intrinsic renal,ureteral or bladder masses & doubtful urethral

masses.


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ERECT FILM

Provoke emptying of urinary tract

Demonstrate layering of calculi in cysts &

abscesses

Detect urinary tract gas not seen in other

films

Demonstration of renal ptosis,bladder

hernia, cystocele & obstruction in ureter


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PRONE FILM

View ureteral areas not seen in supine films

Demonstration of renal ptosis & bladder hernia.

DELAYED FILMS

Cases of obstruction where early nephrogram is seenbut collecting system is not seen

Long standing hydronephrosis renal parenchyma isseen but collecting system is not visualised until manyhrs later.

Congenital lesions : non-visualised upper calycealsystem with ectopic or obstructed ureter.


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MODIFICATIONS OF UROGRAM

1. Diuretic Urogram

2. Hypertensive Urogram

3. Tailored Urogam

4. Drip Infusion Urography

5. Limited Urography

6. Emergency Urography

7. High Dose Urography


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COMPLI

CATIONS

DUE TO CONTRAST

Minor reactions ( 5%) nausea, vomiting, mild

rash, headache, mild dyspnoea Intermediate reactions (1%) extensive

urticaria,facial edema, bronchospasm,laryngealedema, hypotension

Severe reaction (0.05%) circulatory collapse,pul edema, severe angina, MI,convulsions ,coma, cardiac/respiratory arrest


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DUE TO TECHNIQUE

Upper arm or shoulder pain.

Extravasation of contrast into injection site.AFTER CARE

Watch for late contrast reactions.

Prevention of dehydration.

In high risk patients, RFT should be done towatch for deterioration.


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THANK YOU

IVU Final Copy

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