INTRAVENOUS UROGRAPHY

INTRAVENOUS
UROGRAPHY (IVU)
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai

Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2

DEFINITION
RADIOGRAPHIC STUDY OF THE RENAL PARENCHYMA, PELVIS,
URETERS AND URINARY BLADDER AFTER INTRAVENOUS INJECTION
OF CONTRAST MEDIA
3
Dept of Urology, GRH and KMC, Chennai.

TERMINOLOGY
•Urogram
Visualization of kidney parenchyma,
calyces and pelvis resulting from IV
injection of contrast.
• Pyelogram
Describes retrograde studies visualizing
only the collecting system.
•IVP is misnomer
4

Moses Swick
HISTORY
• Introduction of excretory
urography was done in 1929, by
American urologist Moses Swick.
• He injected an organically-bound
iodide compound—later named
Uroselectan—into a vein, taking
X-rays as the material cleared
the body through the urinary
tract.
5

INDICATIONS
American College of Radiology (ACR) guidelines
• To evaluate the presence or continuing presence of
suspected or known ureteral obstruction.
• To assess the integrity of the urinary tract status
post trauma.
• To assess the urinary tract for suspected congenital
anomalies.
• To assess the urinary tract for lesions that may
explain hematuria or infection
• Investigation of HTN in young adults not controlled
6

Contraindications
Absolute contraindication – Contrast Allergy
Relative contraindications-
• Renal failure (raised serum creatinine level >1.5
mg/dL)
• Hepatorenal syndrome
• Generalized allergic conditions
• Multiple myeloma
• Pregnancy
• Infancy
• Thyrotoxicosis
• Diabetes
7

Advantages
• Clearly outlines of the entire urinary system so can see even
mild hydronephrosis.
• Easier to pick out obstructing stone when there are multiple
pelvic calcifications.
• Can show non-opaque stones as filling defects.
• Demonstrate renal function and allow for verification that the
opposite kidney is functioning normally.
8

Disadvantages
• Need for IV contrast material
• Contrast agent may provoke anaphylactoid reactions,
nephropathy.
• Multiple delayed films (Can take hours as contrast passes quite
slowly into the blocked renal unit and ureter.)
• May not have sufficient opacification to define the anatomy and
point of obstruction.
• Requires a significant amount of radiation exposure and may
not be ideal for young children or pregnant women
9

Anatomy
• The parenchyma of the kidney is
divided into two major
structures: superficial is the renal
cortex and deep is the renal
medulla.
• Grossly, these structures take the
shape of 8 to 18 cone-shaped
renal lobes, each containing renal
cortex surrounding a portion of
medulla called a renal pyramid
(of Malpighi).
• Between the renal pyramids are
projections of cortex called renal
columns (of Bertin).
10

• Nephrons, the urine-producing
functional structures of the
kidney, span the cortex and
medulla.
• The tip, or papilla, of each
pyramid empties urine into a
minor calyx(8-12)
• Minor calyces empty into major
calyces (2-4), and major calyces
empty into the renal pelvis,
which becomes the ureter.
11

Shape & Size
12

Position
• Lumbar fossa
• Left kidney slightly higher than
right
• Upper pole of left kidney – T11-
12
• Upper pole of Right kidney –
T12-L1
• Lower limit – well above iliac
crest at the level of L3 or L3-4 IV
disc
• Medial border – parallel to
psoas margin
13

Renal Axes
• Long axis of the kidney is
parallel to the lateral border of
the psoas muscle and lies on the
quadratus lumborum muscle.
• In addition, the kidneys lie at an
oblique angle, that is the
superior renal pole is more
medial and anterior than the
inferior pole.
• Their transverse axes form an
approximately 45° angle with
the sagittal plane
14

Intravascular Radiological Contrast Media
(IRCM)
▪ Iodine is the main element which imparts Radio opacity
▪ All currently used IRCM are chemical modifications
of a 2,4,6-tri-iodinated benzene ring.
▪ They are classified on the basis of their physical
and chemical characteristics, including their
chemical structure, osmolality, iodine content, and
ionization in solution.
▪ In clinical practice, categorization based on
osmolality is widely used.
15

HIGH
• IONIC
MONOMERS
• Contain sodium
or meglumine
salts
• 2 ORGANIC
SIDECHAINS &
CARBOXYL
GROUP
• 1500-1900
MOSM/KG H2O
• EG:
DIATRIAZOATE –
Urograffin ,
angiograffin, &
Urovision.
• IOTHALAMATE
ISO
OSMOLAR
• NON IONIC
DIMERS
• EG: IOTROL
• IODIXANOL
LOW
• NON IONIC MONOMERS:
• ORGANIC SIDE
CHAIN+HYDROXYL
GROUP
• EG:IOHEXOL IOPAMIDOL
IOVERSOL IOPROMIDE
• AGENTS OF CHOICE
• LOW TOXICITY since do
not dissociate in the
body
• IONIC DIMERS:
• 2 IONIC MONOMERS-
CARBOXYL GROUP
• EG: IOXAGLATE
• ADR:3%
• Expensive than HOCM
16

17

18

Patient Preparation
• Complete urine and blood examination to assess the renal function.
• The patient is given mild laxatives about twelve to twenty four hours prior.
The patient is kept nil by mouth over night
• In active healthy patients, food or liquid restriction or administration of
laxative has little value.
• With modern contrast media overhydration should be avoided but
dehydration is unnecessary.
• Pretesting does not provide reliable information regarding sensitivity to
contrast media and is therefore not performed before the injection
• Take informed consent
19

• Dose of contrast :patient size ,radiologist preference
• 200mg of I per pound body weight: 20-30 g ,50-100ml
• Pediatric – 1ml/kg
• Bolus injection given through IV access
• Rapid : < 60 sec-better nephrogram
• Slow: 2-3 min ,less side effects
• Density of nephrogram = plasma level of contrast
• Drip infusion: 40-45g of I in 250-400 ml of fluid; not practised nowadays
20

• Bolus injection gives immediate peak plasma level followed by rapid
decline due to
• Vascular mixing
• Extravascular diffusion
• Renal excretion
• Diagnostic quality depends on
• Amount of iodine excreted
• Volume of urine formed to distend PCS
21

Technique
• Venous access via the median
antecubital vein is the preferred
injection site because flow is
retarded in the cephalic vein as it
pierces the clavipectoral fascia.
• The gauge of the cannula/needle
should allow the injection to be given
rapidly as bolus to maximize the
density of nephrogram. Usually 18
gauze cannula is used
• Upper arm or shoulder pain may be
due to stasis of contrast in vein which
may be relieved by abduction of the
arm.
22

Scout Film ( plain film of abdomen)
•State of bowel preparation
•Calcified density in the renal tract
•To check exposure factors & positioning
•Skeletal abnomality – spinal deformities in
congenital disorders, skeletal metastases,
metabolic bone changes as in rickets
•Abdominal masses
•Foreign bodies
23

Preliminary Film
➢ Supine, full length AP of
abdomen in inspiration.
➢ The lower border of cassette
is at the level of symphysis
pubis and the x-ray beam is
centred in the midline at the
level of iliac crests.
➢ To demonstrate bowel
preparation, check exposure
factor, and location of
radiopaque stones or any
radiopaque artifacts.
24

Film Sequence
➢1-3 minutes Antero-posterior- film coned to the renal area
➢5 minutes Antero-posterior-film coned to the renal area (to see if excretion
is symmetrical; if poor opacification, further injection of contrast)
➢Apply ureteral compression
➢10 minutes Antero-posterior (5mins after compression; 10mins from
contrast administration – Pyelographic phase)
➢“Flush”, “X” or “Release view”- - full length view at 20 minutes (ureter &
bladder images after release of compression)
➢Upright post void Antero-posterior
25

26

27

28

29

Contraindications to Ureteral Compression
•Evidence of obstruction on the 5-minute
image
•Abdominal aortic aneurysm or other
abdominal mass
•Severe abdominal pain
•Recent abdominal surgery
•Suspected urinary tract trauma
•Presence of a urinary diversion
•Presence of a renal transplant
30

Additional Views & Modifications
• Plain films – Additional oblique views to assist the location of
potentially intra renal opacities
• 5min film – Second injection of contrast to improve opacification of
PCS if inadequate
• 15 mins release film
• When the bladder is poorly filled additional delayed films
• Small suspected calculus in distal ureter confirmed with oblique films
31

• Delayed films – 3, 6, 12, 24 hrs for delayed opacification
• Early nephrogram but collecting system not visualised
• Long standing HUN – Rim sign
• In certain congenital lesions such as nonvisualised upper calyceal system
with ectopic or obstructed ureter
• Unrewarding in total absence of an early nephrogram
• Immediate after micturition film – VU reflux
• Rapid sequence urography
• Renal artery stenosis
• 2, 4, 6 min
• To compare rate of excretion of each kidney
32

• Prone film
• For viewing filling of ureteral areas that are not seen in supine position
• Useful in renal ptosis, lesions on the anterior bladder wall, bladder
herniation
• Erect film
• For demonstrating renal ptosis, bladder hernias, cystocoeles
• Demonstrates layering of calculi in cysts or abscesses
33

• Hypertensive urogram
• Discontinued
• Work up for renal hypertension in pts younger than 50 years
• Findings – small kidney (smaller than the opposite kidney by more than
1.5cm), delayed nephrogram, hyperconcentration in late film
• Hydration urogram / Frusemide IVU
• 20 mg of Frusemide IV after 15 min film
• Suspected PUJO not evident of standard IVU
• Provoke HUN & pain
34

WHATTOLOOKFORINIVU
➢Size, shape, position and axis of kidneys
➢External cortex and inner medulla
➢Calyceal system
➢Renal pelvis and ureteropelvic junction
➢Ureter
➢Uretero-vesical junction
➢Urinary bladder
➢Relation of ureter to spine and psoas muscle
RADIATION DOSE FROM IVU
➢1,465 mR/projection for males
➢1,047 mR for females
35

Phases of Nephrogram
• Spontaneous nephrogram
• Non opacified kidney outlined by retroperitoneal fat visible on plain film
• Vascular nephrogram
• Contrast reaches renal artery in 15 secs (arm to kidney time)
• Coexists with diffusion of contrast
• Lasts for few secs to 1 min
• Total body opacification phase
• Contrast freely filtered by glomeruli
• Due to opacification of pre & retro renal softtissue
• Lasts for 1 min
• Tubular Phase
• Contrast in proximal and distal tubules
• Density fades
• Pyelographic phase
• Contrast in the collecting system
36

Vasular (Angiographic Nephrogram)
• Occurs during passage of contrast material through the cortical
microvasculature.
• Short lasting seen within 30 sec of rapid IV bolus
• Approx. 80% of renal blood flows to the cortex → renal cortex looks
much more radiodense as compared to medulla (CM differentiation)
• If CM differentiation is not seen, the vascular nephrogram is
inadequate & must be interpreted with great caution
• Requires intact vascular system – indicator of disturbance in blood
flow to the kidney
37

Tubular (Urographic Nephrogram)
• Appear after the contrast medium has been concentrated in PCT
• Density is greater approx 1 min of injection of IV bolus at which time peak
plasma level is reached
• Radiodensity of medulla equals to that of cortex → homogenous with no CM
differentiation
• Permits accurate evaluation of fundamentals of renal radiology – size,
position, axis & contour
• Normal tubular nephrogram requires
• Normal blood flow
• Structural & functional integrity of nephrons
• Unobstructed flow of filtrate through the tubules
38

Failure to Visualise Nephrogram
• Insufficient dose of contrast
• Acute or chronic renal failure
• End stage renal disease
• Absent kidney
• Renal artery occlusion / avulsion
39

Abnormal Density Patterns
• Immediate, faint & persistent nephrogram
• Increasingly dense nephrogram
• Immediate, dense & persistent nephrogram
40

Immediate, faint, persistent nephrogram
• Peak density is seen on the first film exposed at the completion of injection
of contrast
• Density is disproportionate with amount of contrast material injected.
Though faint, persists for several hours
• Cause
• Reduction in number of functioning nephrons → immediate faint nephrogram
• Severely impaired glomerular filtration & low plasm clearance rate of contrast →
persistent nephrogram
• Conditions
• Chronic glomerular disease
• Sudden loss of glomerular function – atheroembolic renal disease
41

Increasingly dense nephrogram
• Faint to begin with and
increasingly dense over a period
of hours to days
• Seen in
• Acute extrarenal obstruction
• Diminished perfusion pressure of
kidney – SHT, RAS
• Intratubular obstruction –
calculus, casts, acute papillary
necrosis
• Acute renal vein thrombosis
• Acute glomerular disease
• Acute tubular necrosis
42

Immediate, dense, persistent nephrogram
• As dense as normally expected to be at 1 min
• Level of density persists
• Pathogenesis
• Unimpaired glomerular filtration → immediate dense nephrogram
• Diffusion of filtrate into interstitium due to damaged tubules return of
filtered material to the circulation → persistent nephrogram
• Seen in
• Acute tubular necrosis
• Acute bacterial nephritis
43

44

45

Inhomogenous nephrograms
• Striated nephrogram / Sunburst nephrogram
• Fine linear strands of alternating lucency & density uniformly oriented in
direction similar to that of tubules & collecting ducts
• Seen in – Acute extrarenal obstruction, Acute bacterial nephritis, acute
pyelonephritis, AR-Infantile polycystic kidney disease, Medullary cystic
disease, Medullary sponge kidney
• Patchy nephrogram
• Patchy densities in nephrogram
• Seen in – Polyartertitis nodosa, scleroderma, Necrotising angitis
• Cortical rim nephrogram
• Only thin rim of peripheral cortex is opacified that is perfused by capsular
collateral arteries
• Reliable indicator of underperfusion of kidney
• Seen in – Infarction of kidney, segmental RA occlusion, Renal vein
thrombosis (some cases)
46

SUNBURST NEPHROGRAM
CORTICAL RIM NEPHROGRAM
PATCHY NEPHROGRAM
47

•The size of the kidneys should be assesed during
neprographic phase
•The normal kidney may range from 9 to13 cm in
cephalocaudal length, with the left kidney
inherently larger than the right by 0.5 cm and
the kidneys slightly larger in men than in women
•Significant discrepancies (right kidney 1.5 cm
larger than the left kidney,left kidney 2 cm
larger than the right kidney) require explanation.
48

5 & 10 MINUTE FILM
• At this stage the calyces, renal pelvis and part of the ureters will be
visible.
• Nephrogram will be reduced but both kidneys should have the same
density
49

•In normally functioning kidneys, contrast is first seen in the calyces at 2 mins
following bolus injection.
50

• On the 5-minute image, the nephrogram should be receding as the
collecting system becomes opacified.
• On the 10-minute image, the pyelogram is the dominant urographic
element.
• Alterations in this temporal sequence require explanation.
51

• Visualization of the collecting system and renal pelvis can be
augmented with the use of abdominal compression, Trendelenburg
position, and other gravity maneuvers such
as placing the patient with the side of interest in the ipsilateral
posterior oblique position
• The appearance of the calices and renal pelvis should be examined
closely
52

• Early and mild obstruction is indicated by subtle rounding of the
forniceal margins
• More severe and prolonged obstruction evidenced by progressive
loss of the papillary impression and eventual clubbing of calices.
53

➢Ureters
➢Ureters begin to transport opacified urine about 3 mins post injection
➢Maximum ureteral filling occurs between 5-10 minutes.
54

• At the release of compression, the bolus of contrast material–laden
urine entering the ureters provides optimal visualization throughout
their length
• Persistence of a standing column of contrast material on several images
may indicate obstruction or ureteral ileus (nonobstructive dilatation).
• Medial deviation of the ureter should be considered when the ureter
overlies the ipsilateral lumbar pedicle.
• Lateral deviation should be considered when the ureter lies more than
1.5 cm beyond the tip of the transverseprocess, but comparison with the
position of the contralateral ureter should always be made
55

• An absolute ureteral diameter exceeding 8 mm is considered a
criterion for dilatation.
• Asymmetry of ureteral caliber is a more significant finding.
• Early in its course, high-grade ureteral obstruction may be
associated with only minimal ureteral dilatation.
• More chronic forms of obstruction and other chronic ureteral
conditions are typically associated with greater degrees of ureteral
dilatation
56

Bladder
• By 15–30 minutes after the
injection of contrast material, the
bladder is often sufficiently filled,
and the 15-minute KUB radiograph
may be adequate for evaluation.
• As the bladder distends with
contrast the intraluminal contrast
material should be spheric and
smoothly marginated and the wall
progressively less evident.
• Bladder wall thickening and
irregularity of the luminal contrast
material should be noted
57

• The postvoid image may also be helpful in evaluating patients with
upper urinary tract dilatation.
• Persistence of the dilatation on the postvoid image suggests fixed
obstruction,
• The postvoid image is most helpful in assessing residual volume.
58

Congenital anomalies &
variations

Unilateral Agenesis
60

Renal Ectopia
• Failure of complete ascent of
the kidney to its normal
position
• IVU- abnormally placed kidneys
61

Crossed fused Renal ectopia
• Two complete pelvicalyceal
systems on one side usually
one above the other
• Ureter from the lower renal
pelvis crosses the midline and
enters bladder normally
62

Crossed Fused Ectopic Kidney
63

Horshoe Kidney
• Kidneys placed lower than normal
• Malrotation of pelvis
• Lower pole calyces of both sides
deviated towards midline
• Ureters have characteristic vaselike
curve
• Pelvicalyectasis
• Renal calculi
• Intravenous urogram (IVU) shows
an altered renal axis with medially
directed lower renal poles, which
suggests horseshoe kidney. Also
note the dilated collecting system
of the left kidney, resulting from a
uretero pelvic junction obstruction;
this is a frequently associated
finding
64

Horshoe Kidney
65

• Minor form – bifid renal
pelvis
• Ureteral duplication
• Incomplete – ureters fuse in
their course
• Complete – 2 ureters open
seperately in bladder, lower
moiety inserted
orthoptically & upper
moiety ectopically
• “Drooping lily” sign-
obstructed upper moiety
ureter, in a completely
duplicated system, may
produce downward and
lateral displacement of the
functional lower moiety
collecting system,
DUPLEX COLLECTING SYSTEM
66

DROPPING LILY SIGN
67

URETEROCOELE
Contrast filled structure with a thin
smooth radiolucent wall surrounded by
contrast containing urine in the
bladder- “Cobra’s head” appearance.
68

Retrocaval Ureter
• The ureter may have a sickle, S
or reverse J appearance before
crossing behind and medial to
the IVC.
• The ureter descends medial to
right lumbar pedicle.
• Proximal ureter is dilated.
69

Congenital Hydronephrosis
• Due to functional obstruction at the pelvi-ureteral junction
• Aetiology- cong. Bands, adhesions, neuro muscular inco-
ordination, abberent vessels
• Advanced cases - large soft tissue mass replacing the renal
parenchyma; No opacification of collecting system
• Lesser degrees of obstruction
• Thin rim of renal substance outlining kidney.
• Later films – crescent shaped opacities produced by dilated
stretched tubules surrounding the enlarged non opacified
calyx
• Delayed films – slow filling of calyces & renal pelvis
• Mildest form- minimal deviation from the normal appearance
70

Grading of Hydronephrosis
• Grade 1 (mild)
• dilatation of the renal pelvis without dilatation of the calyces (can also occur
in the extrarenal pelvis)
• no parenchymal atrophy
• Grade 2 (mild)
• dilatation of the renal pelvis (mild) and calyces (pelvicalyceal pattern is
retained)
• no parenchymal atrophy
• Grade 3 (moderate)
• moderate dilatation of the renal pelvis and calyces
• blunting of fornices and flattening of papillae
• mild cortical thinning may be seen
• Grade 4 (severe)
• gross dilatation of the renal pelvis and calyces, which appear ballooned
• loss of borders between the renal pelvis and calyces
• renal atrophy seen as cortical thinning
71

72

Grade 3
73

PUJO
• The balloon on a string
sign This sign refers to the
appearance of a high and
somewhat eccentric exit
point of the ureter from a
dilated renal pelvis and is a
typical finding of
ureteropelvic junction
obstruction
74

Polycystic kidney
• Autosomal dominant
➢Plain films- cyst calcification
➢IVU- enlarged kidneys with
compression and displacement
of calyces by intrarenal cyst
• Autosomal recessive
• B/L symmetrical enlargement
of kidneys
• Streaky nephrogram
• Calyces maybe distorted
75

Polycystic Kidney
• B/l enlarged kidneys
• Asymmetric (left> right)
• Multiple parenchymal defects
“Swiss cheese” nephrogram
76

Polycystic Kidney
77

Malrotated Kidneys
78

Persistence of Fetal Lobulations
79

Dromedary hump
• Prominent cortical hump in the interpolar region of the left kidney.
• On a compression image obtained in a later phase of the sequence,
the hump is subtended by a normal collecting system.
• Normal variants of the renal contour, caused by the splenic impression
onto the superolateral left kidney.
• Dromedary humps are important because they may mimic a renal
mass, and as such is considered a renal pseudotumour.
80

Atrophic Small Smooth Kidney
• Chronic glomerulonephritis
• Arteriosclerosis
• Papillary necrosis
• Embolic disease
• Hypotension
• Alport syndrome
• Nephrosclerosis
• Amyloidosis (late)
81

Papillary Necrosis
82

Papillary Necrosis
Central Excavation with “Ball on Tee”
apperance
83

Papillary Necrosis
• Excavation extending from the
caliceal fornices
• “LOBSTER CLAW” deformity
84

Renal masses
•Small lesions → Localised bulge with increased thickness
of the renal substance; Deforms or displaces or distends a
calyx
• Medium sized lesions → Localized or generalized
enlargement of the kidneys; Displacement or distortion of
renal pelvis, ureter or adjacent structures
• Very large lesions → Non functioning kidneys; Calycine
spreading; Visceral displacement
85

Renal Mass
• Loss of renal contour
• Displacement and splaying of calyces
86

Features of Malignant Masses
• Pathognomonic – Invasion of
collecting system producing
amputation of calyx or
intraluminal filling defect.
• Suggestive
• Vascular mass
• Calcification
• Tumor shell – wall is thick &
irregular
• Absent mobility with respiration
& change in position
87

URETER
88

89

90

Transitional Cell Carcinoma
• Multiple filling defects in Left
renal pelvis and ureter
• “Goblet” appearance below the
filling defect – typically seen in
lesions that grow slowly into the
lumen of the ureter
91

• Ureteral filling defects may be
single or multiple and can
usually be attributed to luminal,
mural, or extrinsic causes.
• Urographic image shows
multiple filling defects in the left
renal pelvis and ureter.
• Multifocal transitional cell
carcinoma was confirmed in this
case.
92

93

Bladder Pathologies
• Overlapping intestines
• Intravesical gas
• Intravesical solid/fb
• Calculi
• Clots
• Diverticulum
• Intramural lesions
• Extrinsic compression
• Prostate enlargement
• Vaginal mass (“female prostate
defect”)
94

Clot within Bladder
95

96

97

Bladder transitional cell carcinoma
.
• Bladder image shows a filling
defect with a papillary
configuration along the right
bladder wall
• Note the irregular distribution of
contrast material associated
with the filling defect (“stipple
sign”)
98

99

100

Hemorrhagic Cystitis
Bladder shows contrast material with a
lobulated and irregular contour within the
lumen of the bladder 101

GU TB - plain KUB
• Disparity in renal size on plain films may indicate early increase in
size of the affected kidney due to caseous lesions or a shrunken
fibrotic kidney of autonephrectomy.
• Calcifications are seen in 30% to 50%
• A characteristic diffuse, uniform,extensive parenchymal, putty-like
calcification, forming a lobar cast of the kidney is seen with
autonephrectomy
• Calculi may also be seen in the collecting system or ureter
secondary to stricture formation.
• Ureteral calcifications are rare and are characteristically
intraluminal as opposed to the mural calcifications of
schistosomiasis
102

• . Bladder wall calcifications seen in late cases of bladder contraction.
• Calcifications of the prostate and seminal vesicles are seen in 10% of
cases .
• Plain film findings suggestive of tuberculosis may be seen in
surrounding tissues such as erosions of the vertebral bodies or
calcifications in a cold abscess of the psoas muscle.
103

104

• Extensive calcification which
was non-functional
• “Putty Kidney”
• Consistent with
autonephrectomy
105

GU TB - IVU
• The most common findings being hydrocalycosis,hydronephrosis, or
hydroureter due to stricture formation .
• Early signs include the moth-eaten appearance of calyceal erosion
and papillary irregularity- best seen on early excretory films.
106

107

• Cavitary lesions communicating with the collecting system are
characteristic of TB.
• These lesions eventually enlarge as parenchymal destruction
ensues.
• Fibrotic distortion of the collecting system and ureter is also seen.
• Calyceal obliteration and amputation, hydrocalycosis, segmental or
total hydronephrosis, and a shriveled reduced capacity renal pelvis
may all be signs of renal tuberculosis
108

109

110

GUTB – Ureter & Bladder
• Scarring and angulation of the ureteropelvic junction (UPJ) may also
occur, the so-called “Kerr’s kink” .
• Tuberculosis of the ureter is commonly seen as a rigid, straightened
“pipe-stem”
• Ureter also beaded, corkscrew appearance due to multiple strictures
• Ureterovesical junction obstruction is caused by tuberculous cystitis
or strictures of the distal third of the ureter.
• The cystogram films may show a small contracted bladder due to
excessive fibrosis
111

Kerr’s Kink
• Scarring & angulation of
ureteropelvic junction
• Hiked up pelvis
112

113

114

115

116

117

INTRAVENOUS UROGRAPHY

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INTRAVENOUS UROGRAPHY