URINARY TRACT DISORDERSURINARY TRACT DISORDERS Urinary tract Calculi : Urinary tract Calculi :

-Calcified to varying degree-Calcified to varying degree

uniformuniform

laminated laminated

-Radiolucent ( Xanthine and Uric acid)-Radiolucent ( Xanthine and Uric acid)

- all stones are seen on CT and US- all stones are seen on CT and US

Shape : Shape :

small : round or oval small : round or oval

large : Staghorn calculi large : Staghorn calculi

Plain film or US ? Plain film or US ?

Always carefully examine preliminary film Always carefully examine preliminary film of IVU of IVU

Stones overly the bones may be obscuredStones overly the bones may be obscured

Stones by US Stones by US

Appearance ( echogenic + shadow )Appearance ( echogenic + shadow )

Size >5mm Size >5mm

Site Site

calyces , pelvis and ureter or U.Bladdercalyces , pelvis and ureter or U.Bladder

Stones by CT Stones by CT

Native CT exquisitely sensitive Native CT exquisitely sensitive

Sometimes ureteric stone need contrast Sometimes ureteric stone need contrast

Nephroclacinosis Nephroclacinosis

Medullary or cortical Medullary or cortical Focal or diffuse calcification of the renal Focal or diffuse calcification of the renal

paranchyma paranchyma Hypercalcaemia , hypercalciurea : renal Hypercalcaemia , hypercalciurea : renal

tubular acidosis and hyperparathyroidism tubular acidosis and hyperparathyroidism Normal calcium metabolism: Medullar Normal calcium metabolism: Medullar

sponge kidney or widespread papillary sponge kidney or widespread papillary necrosis necrosis

Urinary tract Obstruction Urinary tract Obstruction

Dilatation of PCS and ureter.Dilatation of PCS and ureter.

Degree Degree

Level Level

US in Urinary Tract Obstruction US in Urinary Tract Obstruction Fluid collection in middle of central sinus Fluid collection in middle of central sinus

Should be differentiated from cysts Should be differentiated from cysts

Cortex ?Cortex ?

Ureter ( proximal and distal parts seen)Ureter ( proximal and distal parts seen)

Cause ? Stone, bladder mass, pelvic massCause ? Stone, bladder mass, pelvic mass

IVU in obstruction IVU in obstruction

In some centers remains the primary In some centers remains the primary imaging modality of acute ureteric colic .imaging modality of acute ureteric colic .

Plain film : calculus Plain film : calculus

After 15 min of contrast injection : After 15 min of contrast injection :

if urogram normal it rules out uretric if urogram normal it rules out uretric colic as the cause of the pain colic as the cause of the pain

If obstructed : If obstructed :

dense nephrogram dense nephrogram

delayed filmsdelayed films

obstruction can be intermittent obstruction can be intermittent

CT in urinary tract obstrcution CT in urinary tract obstrcution

- In Acute obstruciton ( CT KUB)In Acute obstruciton ( CT KUB)

- Other DD Other DD

A. Appendicitis A. Appendicitis

tumor tumor

Causes of obstruction Causes of obstruction

May be at any level down to the urethraMay be at any level down to the urethra

Within the lumen Within the lumen In the wall In the wall Outside the wall Outside the wall

Causes within the lumen of the Causes within the lumen of the urinary tracturinary tract

Calculi Calculi

Sloughed papillaSloughed papilla

Blood clot Blood clot

Causes arising in the wall Causes arising in the wall

Transitional cell carcinoma Transitional cell carcinoma

On IVU: On IVU:

in PCS appear as filling defecin PCS appear as filling defec

in ureter ( filling defect or stricture) in ureter ( filling defect or stricture)

On Ct : filling defect on urographic imageOn Ct : filling defect on urographic image

Stricture ( infective, trauma) Stricture ( infective, trauma)

Congenital intrinsic PUJ Congenital intrinsic PUJ obstruciton obstruciton

Peristalsis not transmitted Peristalsis not transmitted Age : usually in children and young adultsAge : usually in children and young adultsDiagnoses ? Dilated pelvis , normal ureterDiagnoses ? Dilated pelvis , normal ureter

Should be differentiated from baggy pelvis Should be differentiated from baggy pelvis

by giving diuretic during IVU by giving diuretic during IVU

Extrinsic causes of obstruction Extrinsic causes of obstruction

Best evaluated by CT : Tumors Best evaluated by CT : Tumors

Retroperitoneal fibrosis; usually at the Retroperitoneal fibrosis; usually at the level of L4/5 level of L4/5

Questions?Questions?