aparelho urinário 2006/2007 joão alpendre
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Aparelho urinário 2006/2007 João Alpendre Serviço Universitário de Radiologia do Hospital Pulido Valente. TÉCNICAS RADIOLÓGICAS TOMOGRAFIA COMPUTORIZADA RESSONÂNCIA MAGNÉTICA ECOTOMOGRAFIA RADIOGRAFIA SIMPLES DO ABDÓMEN OUTRAS TÉCNICAS (urografia de eliminação….) ORDEM?. - PowerPoint PPT PresentationTRANSCRIPT
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Aparelho urinário
2006/2007
João Alpendre
Serviço Universitário de Radiologia do Hospital Pulido Valente
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TÉCNICAS RADIOLÓGICAS
TOMOGRAFIA COMPUTORIZADA
RESSONÂNCIA MAGNÉTICA
ECOTOMOGRAFIA
RADIOGRAFIA SIMPLES DO ABDÓMEN
OUTRAS TÉCNICAS (urografia de eliminação….)
ORDEM?
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TOMOGRAFIA COMPUTORIZADA
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Lembrar a anatomia
Linhas de referência
Densidades básicas
Ar
Gordura
Água
Músculo
Cálcio
TOMOGRAFIA COMPUTORIZADA
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Rins
Topografia:
Retroperitoneais
Na metade superior do abdómen
Envoltos pela gordura perirrenal e fascia perirrenal
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Relações com outros órgãos:
Face posterior:
Segmento diafragmático: Diafragma, 2 últimos arcos costais
Segmento lombar: psoas, quadrado lombar, aponevrose do transverso; grande dorsal e massa comum paravertebral
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Face anterior:
RD:
Fígado (fundo saco peritoneal hepato-renal); Ângulo hepático; duodeno
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RE:Baço e cauda do pâncreas, ângulo esplénico, ansas delgado
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Contorno interno:
Hilo: pedículo vascular (vasos, nervos, bacinete, uretero)
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POLOS
Glândulas Supra-renaisAdjacentes ao polo superior de cada rim
rodeadas pela gordura peri-renal
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Orientação:
Oblíquos para baixo, fora e diante, empurrados pelo psoas que aumenta o seu diâmetro inferiormente.
O psoas condiciona também a rotação de 30º ao longo do eixo crânio-caudal
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Morfologia:
Forma de feijão. Grande eixo crânio-caudal
Duas faces convexas, anterior e posterior
Dois contornos, externo(convexo) e interno (côncavo),cujo centro é o hilo do órgão
Dois pólos, superior e inferior
10-12 cm diâmetro bipolar
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EstruturaCápsulaParênquima renal:
CortexMedula
Seio renal
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UROGRAFIA DE ELIMINAÇÃO
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ÁRVORE EXCRETORA
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Vasos
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TOMOGRAFIA COMPUTORIZADA
Vantagens
• Resolução espacial
• Resolução de contraste
Desvantagens• Função• Histologia• Radiação, contraste• Não é em tempo real• Bexiga
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TOMOGRAFIA COMPUTORIZADA
Indicações
• Caracterização de massas renais
• Estadiamento de massas renais
• Litíase do aparelho urinário
• Traumatismos
• Patologia vascular (estenose artéria renal, trombose venosa)
• Intervenção
Contra-indicações
• Contraste
• Radiação
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Lembrar a anatomia
Nível do corte
Plano anatómico
Sinais nas diferentes ponderações
Ar, cálcio (sempre hiposinal)
Água (hipo sinal T1, hipersinal T2)
Gordura (forma grosseira hiper sinal, à excepção na saturação)
Músculo (isosinal)
RESSONÂNCIA MAGNÉTICA
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T1
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T1 com supressão gordura
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T2
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T1 com gadolínio e saturação de gordura, fase nefrográfica cortico-medular
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T1 com gadolínio e saturação de gordura, fase nefrográfica
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RESSONÂNCIA MAGNÉTICA
Vantagens
•Sem radiação ionizante
•Não usar contraste iodado
•Maior resolução tecidular
Desvantagens
•Campo magnético
•Dispendiosa/menos acessível/demorada/”hábito”
•Litíase
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RESSONÂNCIA MAGNÉTICA
Indicações:
•Habitualmente utilizada em doentes com contra-indicações à utilização de contraste iodado
•Estudo pélvico
Contra-indicações:
•Pace-maker…
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Cortes sagitais e axiais
Parênquima (cortical e medular)
Seio renal
Ecogenicidades
Anecogénico (urina); hipoecogénico; isoecogénico (parênquima); hiperecogénico (seio renal)
ECOTOMOGRAFIA
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ECOTOMOGRAFIA
Vantagens:
•Acessibilidade
•Portátil
•Caracterização sólido/líquido
•Tempo real
•Sem contraste ev
•Sem radiação
•Bexiga
Desvantagens
•Dependente do examinado (janela, colaboração)
•Dependente do operador
•Reprodutibilidade
•Função
•Uretero
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ECOTOMOGRAFIA
Indicações
•Dimensões, topografia
•Dilatação da árvore excretora
•Caracterização sólido/líquido
•Estudo pélvico
•Intervenção
Contra-indicações
•Não tem
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RADIOGRAFIA SIMPLES DO ABDÓMEN
Na metade superior do abdómen
Envoltos pela gordura perirrenal
Permitindo a sua visualização no RX
Polo superior do RE-espaço intervertebral D11-D12 (expiração e decúbito dorsal)
Polo inferior do RD-contorno superior de L3
RE 1cm acima do RD (fígado)
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RADIOGRAFIA SIMPLES DO ABDÓMEN
LIMITAÇÕES ÓBVIAS
INDICAÇÃO:1 LITÍASE
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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LESÕES RENAIS OCUPANDO ESPAÇO
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CÓLICA RENAL DIREITA
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CÓLICA RENAL DIREITA
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CÓLICA RENAL DIREITA
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HOMEM IDOSO, INTERNADO POR IRA
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HOMEM IDOSO, INTERNADO POR IRA
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Doente com hematúria total
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OBSTRUCAO CRÓNICA
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TRAUMA
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DOENTE COM HIPERTENSÃO ARTERIAL CONTROLADA COM 4 ANTI-HIPERTENSIVOS
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LESÕES VASCULARES
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DOENTE COM AUMENTO DA UREIA E CREATININA
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Doente com febre, vómitos, dor lombar
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Doente diabético, com febre, disúria
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GENITAL FEMININO
Ecografia: SuprapúbicaEndocavitária
RM
TC- Não
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APARELHO GENITAL MASCULINO
Próstata e vesículas seminais
Ecografia
Suprapúbica
Endocavitária
RM
TC- não
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