University of Baghdad

College of Medicine
2022-2023
7/2/2024

Title: Uro Radiology Practical Session 1

Grade: fourth grade

Module: Systemic module
Practical Session 1
Gross Anatomy cross sectional
Anatomy of kidney
 Normal renal Ultrasound

kidneys
• Size (9-12 cm), there may be a
difference between the two
kidneys of < 1.5 cm.
• Smooth outlines
• Renal capsule appear
echogenic
 Normal renal Ultrasound

kidneys
• Central echogenic area (PCS, blood vessels &
surrounding fat) : renal sinus echo

• The cortical echoes are less than that of liver &

spleen

• Pyramids appear as triangular structures of low

echo texture
Normal renal Ultrasound
Normal renal Ultrasound
Intra-venous Pyelography (IVP) or intravenous
Urography (IVU)

Indications:
1. When detailed demonstration of PC system & ureters is required.
2. Suspected ureteric colic.
3. Investigation of renal calculi.
4. check for function of kidneys
5. check for anatomical variants or congenital anomalies (e.g. horse-shoe kidney)
and check the course of the ureters
6. Investigation of hematuria
Contra-indications of IVU :

1. Contrast allergy
2. Raised serum creatinine.
3. Pregnancy.
4. Thyrotoxicosis
5. Hematological syndrome
 Procedure
Plain film (KUB) : full length -Kidney, ureter, bladder (KUB)- to assess radiopaque
shadows overlying the renal, ureteric or vesical regions ,and to assess bone & soft tissue
abnormalities

After Injection of iodinated contrast media (water-soluble contrast; non-ionic

contrast is preferred)
• 1 min (nephrogram)
• 1-5min film (pyelogram) of both kidneys
• 10-15 min (images of the upper collecting system and ureters ) (performed with
compression)
• 20-30 min UB (Cystogram phase)
• Post-voiding film.
Normal KUB Normal plain abdomen
Post-contrast film series
 What to see in IVP

• Renal size
• Renal outline
• Renal position.
• Calyces and renal pelvis
• Ureters
• UB
What to see in IVP

The renal size

➢ adult's kidney measures 9-12 cm

➢ A difference of 1.5 cm is acceptable

between the two sides

➢ A kidney with bifid collecting system is

usually 1-2 cm larger than normal
What to see in IVP

The renal position

• Rt. K.is lower than the Lt.K.

LT
• The renal axis is parallel to the psoas
muscle (abnormal axis in mal-rotation or RT
displacement of the kidney )

• Abnormal position (ectopic, displaced by

mass, transplanted K.)
 What to see in IVP

The renal outlines

• Renal parenchymal width should be symmetrical
& uniform
• renal cortex measurement (1.5- 2 cm ) except at
the poles
• Minor indentation as in Persistence of fetal
lobulation
What to see in IVP

The renal outlines

An important normal variant causing a
bulge of the outline is the socalled ‘splenic
hump’ (Dromedary) hump”
What to see in IVP

The calices
1.Normal calices are cup shape, evenly distributed & fairly symmetrical.
2. Dilated calyx is clubbed in shape

Causes of dilatation
a. obstruction
b. papillary destruction (e.g.: TB, papillary necrosis)

The renal pelvis: Should be funnel shaped

Normal VS dilated calyces in IVP

Cupped Clubbed
 What to see in IVP

The ureters

1.Only portion of the ureter is seen due to peristalsis

2. Diameter =<7 mm
3. Course: along the transverse processes of the
lumbar vertebrae.
4. Dilatation of the renal pelvis & ureter can occur in
obstruction, congenital variant, and VU reflux.
5. Look for filling defects (tumors, stones, blood clot).
 What to see in IVP

The UB

• Smooth outlines
• May show indentation on the superior aspect from the
uterus or sigmoid colon
 Voiding cystourethrography

The bladder is filled with contrast through a catheter

& films are taken during voiding to identify vesicoureteric reflux or urethral valves.
CT Urohgraphy (native and dynamic IV contrast)

Native CT…For evaluation of any renal First phase :Cortico-medullary phase: After 35-40 seconds:
stones or abnormal calcification. The only parts of the renal tract which have enhanced are
the renal arteries and the cortex.
Useful for evaluation of the renal arteries (which may be
reformatted as CT angiogram) and for evaluation of highly
vascular renal tumors.
CT Urohgraphy (native and dynamic IV contrast)

Native CT…For evaluation of any renal First phase :Cortico-medullary phase: After 35-40 seconds:
stones or abnormal calcification. The only parts of the renal tract which have enhanced are
the renal arteries and the cortex.
Useful for evaluation of the renal arteries (which may be
reformatted as CT angiogram) and for evaluation of highly
vascular renal tumors.
 CT Scan

Second phase :nephrogram phase 3rd phase : pyelogram phase (showing excretion of
Contrast enhanced CT scan through the contrast into the collecting system). This is
kidneys taken 90-100 seconds following approximately 10-15 minutes following contrast
contrast administration and would show administration and would show urothelial lesions
renal lesions well. well, such as transitional cell carcinoma, stones,
blood clots.
CT urography (delayed phase)

Delayed Cystogram phase

Nephrocalcinosis
Calculi

Imaging Features: Radiopaque calculus

in KUP
Calculi

Imaging Features: Radiopaque calculus

in KUP
Calculi in KUB

Staghorn stone
Calculi in KUB

Staghorn stone
 Findings of urinary obstruction in IVU
1.Delayed and persistent, dense nephrogram (caused by concentrated non
excreted contrast) due to acute ureteral obstruction

2. Column of opacified urine extends in ureter from renal pelvis to lodged

calculus (diminished or absent peristalsis).

3. Ureter distal to calculus is narrowed (edema, inflammation); may create false

impression of stricture.

4. Ureter proximal to calculus is minimally dilated and straightened

 Findings of urinary obstruction in IVU
1.Delayed and persistent, dense nephrogram (caused by concentrated non
excreted contrast) due to acute ureteral obstruction

2. Column of opacified urine extends in ureter from renal pelvis to lodged

calculus (diminished or absent peristalsis).

3. Ureter distal to calculus is narrowed (edema, inflammation); may create false

impression of stricture.

4. Ureter proximal to calculus is minimally dilated and straightened

Findings of urinary obstruction in IVU

RT LT

Delayed persistent nephrogram

Left Renal stone Left upper ureteric stone
Stone detected by ultrasound

Normal kidney
Right renal Stone detected by CT scan
Urinary Obstruction

The principal feature is dilatation of PC system & ureters.

The primary imaging techniques used are US & IVU, CT can be used

causes are:
1.Stones
2. Tumors (TCC of renal pelvis, ureter, bladder )
3. Blood clot, sloughed papilla (rare)
4. Strictures, surgical ligation of the ureter
5. Congenital: PUJ obstruction, posterior urethral valve
6. Enlarged prostate
7. Compression from adjacent retroperitoneal structures or masses
(aberrant vessel , retroperitoneal LAP, retroperitoneal fibrosis )
Hydronephrosis and proximal hydroureter due to ureteric stone

ureteric
stone
Left sided hydronephrosis with normal ureter
 CT scan in urinary obstruction
• identify very small stones regardless of their consistency (in contrast to IVP).

• stone situated in the mid (better than ultrasound) or distal ureter.

• show & stage ureteric tumors or an external tumors causing compression that
are usually missed in IVP
CT scan in urinary obstruction
Bilateral ureteric stones
CT scan in urinary obstruction

Right ureteric tumor –TCC

CT scan in urinary obstruction 7/2/2024

Right ureteric tumor –TCC