IVU Final Copy
Transcript of 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