What is wrong with this picture?What is wrong with this picture?

Is this an ovary?Is this an ovary?

What is Going on Here?What is Going on Here?

Percutaneous Percutaneous NephrostomyNephrostomy

IndicationsIndications

External drainage of renal collecting ductExternal drainage of renal collecting duct– In cases of obstructionIn cases of obstruction– As a diversion to allow for healing of distal structuresAs a diversion to allow for healing of distal structures– Decompression of renal and perirenal fluid collectionsDecompression of renal and perirenal fluid collections

Tract creation for inserting devices (for Tract creation for inserting devices (for nephrolithotomy, biopsies, stricture nephrolithotomy, biopsies, stricture dilatation, stenting)dilatation, stenting)

Direct infusion of agents for dissolving Direct infusion of agents for dissolving stones and antibacterial, antitumor, or stones and antibacterial, antitumor, or antifungal drugsantifungal drugs

ProcedureProcedure

1) Directly approach desired calix from 1) Directly approach desired calix from the posterior to opacify the collecting the posterior to opacify the collecting system.system.

2) Use the fluoroscopically identified 2) Use the fluoroscopically identified collecting duct system for insertion collecting duct system for insertion of the catheter (this has a lot of mini of the catheter (this has a lot of mini steps). steps).

3) Confirm catheter position by 3) Confirm catheter position by injecting a small amount of contrast.injecting a small amount of contrast.

Tubes (2 types)Tubes (2 types)

Malecot

Pigtail catheter

What it’s supposed to look like What it’s supposed to look like when you’re done.when you’re done.

SourcesSources Kandarpa, K. and Aruny, J.E. Kandarpa, K. and Aruny, J.E. Handbook of Handbook of

Interventional Radiologic Procedures, 3Interventional Radiologic Procedures, 3rdrd Edition.Edition. 2002. 2002.

www.emedicine.comwww.emedicine.com http://www.e-radiography.net/ibase5/Renal

/Renal_hydronephrosis_ct.jpg http://www.e-radiography.net/ibase5/Renal

/Renal_hydronephrosis_ct.jpg http://www.learningradiology.com/caseofw

eek/caseoftheweekpix/cow130.jpg