intra venous urography by dr sahar zubair
TRANSCRIPT
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INTRA-VENOUS UROGRAPHY
Prepared by Dr Sahar Javed
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Normal IVU
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Congenital lesions and variants
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Renal agenesis• Failure of ureteric bud to reach the
metanephros • Ipsilateral ureter and hemitrigone also fails to
develop
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Renal agenesis (left sided)
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Renal agenesis(right sided)
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Renal ectopia•Failure of complete ascent of kidney from pelvis to the lumbar region •Kidney comes to lie anywhere from pelvis upwards •Over ascent is rare •Pelvic kidney •Pancake kidney•Intra-thoracic kidney
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Pelvic kidney• Often small with increased risk of trauma ,
vesico-ureteric reflux and calculus formation(due to stasis).
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Right sided pelvic kidney
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Left sided pelvic kidney
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Pancake kidney• When both kidneys remain in the pelvis ,they
may fuse together producing the small pancake kidney
• Very frequently associated with other congenital anomalies
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Pancake kidney
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Intra-thoracic kidney• Over ascent is almost always limited by the
diaphragm but there may be some superior herniation through a localized eventeration and very rarely a true thoracic kidney
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Intra-thoracic kidney
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HORSE SHOE KIDNEY• A midline connection ( isthmus) b/w the lower
poles • Associated malrotation and accessory renal
arteries• Increased incidence of renal calculi and injury
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Horse shoe kidney
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Horse shoe kidney
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Crossed fused ectopia• A horse shoe kidney that has slipped
superolaterally so that both kidneys come to lie on one side
• The ureter draining the upper moiety inserts orthotopically on the ipsilateral side of the bladder
• The lower moiety ureter also inserts orthotopically but into the contralateral side of the bladder
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Crossed fused ectopia
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Crossed fused ectopia
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Crossed fused ectopia
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Crossed fused renal ectopia
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Duplication abnormalities(duplex kidneys)
• Characterized by two (on rare occasions more than two ,up to 6 having been reported ) ureters and renal pelves.
• Duplication may be complete or incomplete
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Duplex collecting system
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Duplex collecting system(complete)
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Duplex collecting system (incomplete)
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Ureteral triplication with contralateral duplication and
ureterocoele
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Ureterocoele• Submucosal dilatations of intramural distal
ureter• They often project into the bladder lumen
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Ureterocoele
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Polycystic kidneys
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Polycystic kidneys
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Medullary sponge kidney• Ectasia (fusiform or cystic) of the collecting
ducts within the renal pyramids.• Seen in 1 in 200 IVUs• Generally bilateral but may be unilateral or
segmental affecting as little as a single papilla• Usually a benign incidental finding but there is
a weak association with some tumors (Wilm`s and pheochromocytoma)
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Medullary sponge kidney
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Calyceal diverticulum• Common variant (1 in 250 IVUs)• An intra-parenchymal cavity lined with
transitional epithelium• Do not receive drainage from nephrons and
therefore opacify during IVU after the rest of the calyces
• Diverticula are usually a few millimeters in diameter & communicate with minor calyx
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Calyceal diverticulum
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Retrocaval ureter• Right ureter occasionally takes an aberrant
course, running sharply medially posterior to IVC and then dropping inferiorly towards the pelvis along a course medial to the pedicles
• Rarely associated with hydronephrosis
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Retrocaval ureter
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Primary megaureter• Due to congenitally abnormal musculature of
the distal ureter leading to focal failure of peristalsis
• Ureter above the abnormal segment becomes dilated sometimes massively
• In severe cases dilatation involves the entire ureter and renal pelvis
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Primary mega ureter
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Prune-belly syndrome
• Following bladder outflow obstruction in utero due to urethral valves with development of hydro ureters and hydronephrosis
• Obstruction is overcome but obstructive phase produces defective development of anterior abdominal wall and ureteric musculature with subsequent poor peristalsis and persistent non obstructive dilatation of collecting systems
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Prune belly syndrome
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Inflammatory diseases
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Acute pyelonephritis• IVU may be normal• Kidney may be smoothly enlarged and calyces
compressed by the adjacent swollen parenchyma
• Kidney may show reduction in perfusion and function and a striated nephrogram
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Acute pyelonephritis
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Renal abscess(IVU usually shows a non specific mass)
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Renal TB
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Renal hydatid
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Malignant masses
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Renal cell carcinoma
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Transitional cell carcinoma
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TCC
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TCC
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TCC
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Wilm`s tumor
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Calculi
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Renal calculi
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Stag-horn calculus
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calculi
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Ureteric calculus
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Ureteric calculus
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Ureteric calculus
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Vesical calculi
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Vesical calculi
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Renal trauma
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Vesical diverticulum
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Vesical diverticulum
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Vesical diverticula