imaging the urogenital system tony pease, dvm, ms assistant professor of radiology north carolina...
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Imaging the Urogenital System
Tony Pease, DVM, MSAssistant Professor of RadiologyNorth Carolina State University
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Reading
• Thrall
Chapters 42-46
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Prostate Gland
• Not visible radiographically in normal dogs– Enlarges with age, especially if intact
• Causes for enlargement– Cysts
– Infection
– BPH
– Cancer
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MILD PROSTATOMEGALY
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TRIANGULAR REGION OF FAT AIDS IN MAKING THE DIAGNOSIS
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SOMETIMES SEE THE PROSTATE GLAND IN THE
PELVIC CANAL ON THE VD
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Radiographic evidence of mineralization
• Cancer
• Chronic prostatitis
• In castrated male– Cancer until proven otherwise
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Mineralized prostate tumor with metastasis to medial iliac LN
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11mm 17 x 20 mm
26 x 32 mm
Normal – CastratedEnlarged - Castrated
Tumor
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Two circular soft tissue opacities in the caudal abdomen
Paraprostatic cyst
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Kidneys
• Retroperitoneal Organs– Right kidney cranial to the left
– Left kidney more variable in location.
• Size on VD
Dog: 2.5 – 3.5 x length of L2
Cat: 2.4 – 3.0 x length of L2
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Kidneys
• Cranial pole of the right kidney– Difficult to see
– Silhouettes with caudate lobe of liver
• With lack of fat– Difficult to see either kidney
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Normal dog
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Normal dog
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Normal Cat
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Normal Cat
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Mass Effect - Kidney
• Kidney masses – Ventral displacement of intestine
– Especially colon
• A normal size kidney – Still can have disease
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Right kidney Left kidney
Left kidney
Right kidneyRight kidney
•Lymphoma•FIP•Hydronephrosis
Bilateral renal enlargement
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Small Kidneys + MineralizationLine is 2.4x L2
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Small Kidneys + MineralizationLine is 2.4x L2
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Excretory Urography
• Improves morphologic assessment
• Poor test of function
• Iodinated water-soluble contrast medium– Blood flow
– Glomerular filtration
– Tubular reabsorption of water
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GlomerulusAfferent arteriole
I II
I
I
I
I
I
II
I
I
II
IIIII
I
IIIII
I
III
I
I
Tubule
II
II
H20
H20
II
III
II
IIII
Iodine concentration increases in tubule as H2O is resorbed
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Excretory Urogram
• Contrast medium– Ionic water soluble – Non-ionic if patient is compromised
• Contraindications– Azotemia + dehydration– Pheochromocytoma– Multiple myeloma– Prior allergic reactions to C.M.
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Excretory Urogram
Standard Protocol• Survey radiographs • Inject contrast medium rapidly
– 400mg Iodine per pound– Approximately 1 ml per pound– Usually do not exceed 50 ml
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Projections
• Immediate VD radiograph – Vascular phase
• Lateral and VD radiographs at 5 minutes– Nephrogram and pyelogram phases
• Lat and VD radiographs at 20 and 40 min.
– Urogram phase
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T=0 T=5 T=20
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Loss of serosal detail.
Bladder rupture
Left ureter rupture
Dilated left renal pelvis & proximal ureter
Urinary tract rupture
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Pyelonephritis• Blunt diverticulae• Dilated pelvis
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Misshapen & Pyelonephritis Hydronephrosis
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Ultrasound of hydronephrosis
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Vaginography
Gartner’s duct
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Technique
• General anesthesia
• Foley catheter placed inside labia
• Labia clamped to seal outlet
• Contrast medium infused
• Resistance will often be encountered
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Normal Retrograde Vaginogram
Vestibule
Vagina
Urethra
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Ectopic Ureters
Ectopic ureters
Urethra
Vestibule
Vagina
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Urinary Bladder
• Easier to evaluate with ultrasound
• Very few radiographic urinary tract studies are performed
• If suspect bladder problem–Carefully consider relative merits
• Radiography versus ultrasonography
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• To identify significant bladder problems in survey radiographs is unusual– Stones
– Gas in wall; rare
Urinary Bladder
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Urethral Calculi
“BUTT SHOT” useful to assess
entire urethra
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Emphysematous cystitis
• Diabetes (glucosuria) with secondary bacterial infection
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Urinary Bladder• Contrast Examinations
– Positive contrast cystogram• Put contrast medium in bladder
– Negative contrast cystogram• Rarely used
• Don’t use room air; use CO2
– Double contrast cystogram• Useful for mucosa assessment
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Cystography
Double Contrast Cystogram
Positive Contrast Cystogram
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Urinary bladder masses
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Urinary Bladder – Contrast
• Double Contrast Cystogram necessary to evaluate bladder mucosa.
• Assess:– Serosal margin– Mucosal margin– Bladder wall thickness– Luminal filling defects
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Ultrasound is better
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Positive contrast cystography
• Looking for rupture
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Air Embolism• More common in cats• Especially those with hematuria
Air around bladder neckAir in C.V.C.
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Air Embolism
Air in R.V.
Air in P.A.
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What to do!
• Put animal in left lateral recumbency
• Elevate the tail– This makes the right ventricle the
highest point
– Traps air before getting to lungs
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What not to do!
• Scream
• Panic
• Cry
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Conclusion
• Normal radiograph of kidney– Not necessarily a normal kidney
• Contrast studies– Negative contrast cystogram– Positive contrast cystogram– Double contrast cystogram– Excretory urogram
• Ultrasound is slowly replacing these