Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Blok 17
Keluhan dan penyakit berkaitan dengan
sistem uropoetik
Semester V
Mashuri, dr.,Sp.Rad.,M.Kes
Position of kidneys:
R: L1-L3
L: T12-L3
Long axis of the kidneys is directed downward and outward, parallel to the
lateral border of the psoas muscles
Ureter
Urinary Bladder
Urethra
Plain Photo Abdomen (KUB)
or BNO
• Indication:
– Renal opaque calculi,
– Preparation for IVU
– Check placement of
catheters/stents/drains/foreign bodies
• Contraindication: none
• Technique: supine position
Plain photo abdomen
• KUB
• All exposures at end
of expiration for any
urinary system study
• The Last 2 Ribs
• All Lumber And Sacral
Vertebrae
• Psoas Muscles
• Symphysis Pubis
Plain X-ray film
• Renal shadow
• Gastrointestinal tract shadow
• Calcification or radiopaque shadow
• Psoas shadow
• Bone
IVU (dulu IVP)
1. Suspected congenital anomaly
2. Renal Tumor
3. Renal colic
4. Persistent urinary tract infection
5. Renal Trauma
Indications
Preparation
Male Female
Cystourethrography
Micturating cystourethrogram(MCU)/
Voiding Cystourethrogram (VCUG)
Functional and anatomic evaluation of bladder
Indication:
1. To detect vesicoureteric reflux who have recurrent
infection
2. Bladder rupture
3. Demonstrate posterior urethral valve
4. Ureterocele,
5. Dysfunctional voiding
6. Urethral strictures
7. Bladder/urethral diverticula
Micturating cystourethrogram(MCU)/
Voiding Cystourethrogram (VCUG)
• Scout
• Pediatric: 5 or 8 F feeding tube, fill bladder with contrast
(age +2 x 30). Mainly for peadiatric patient
• Adult: standard catheter
• Filling the bladder with contrast introduced via urethral
catheter
• Film during filling- bladder pathology, early reflux
• Films during void- reflux, urethral abnormality
• Oblique- evaluate grade 1 reflux, males
• Post-void film
MCU
• A voiding
cystourethrogram (VCUG)
of a patient with grade III
vesicoureteral reflux
(VUR). Note that the
contrast flows up the
ureter and into the renal
pelvis. The calyces are
sharp
• This is an example of
grade V
vesicoureteral reflux
(VUR). Note the
dilated renal pelvis
and calyces. The
ureter also is dilated
and tortuous.
• This is bilateral
vesicoureteral reflux
(VUR)
Ultrasound
Indication Technique
1. Renal mass A 3.5 transducer is
2. Haematuria generally used to
3. Flank pain scan the adult kidney
4. Blood urea elevation Liver and spleen act as
acoustic window for
5. Poor non functioning evaluation R and L
kidney on IVU kidneys respectively
6. Biopsy / Patient position:
interventional Supine, decubitus or
guidance prone
Ultrasound of Right Kidney
Ultrasound of Kidneys
NORMAL STUDY
DILATED RENAL
PELVIS
• The parenchyma is
relatively normal in
thickness.
• The dilation of the
collecting system
extends from the
renal pelvis to the
calyces.
Computed tomography
• Giving predominantly
anatomical
information
• Used when US
finding is inconclusive
• Staging of tumor
• Renal trauma
• Renal artery stenosis
• Calculi / obstructive
uropathy
Emphysematous pyelonephritis.
Cystic renal cell carcinoma.
RCC with inferior vena cava
invasion
MRI
• Anatomical information
• When US or CT is inconclusive
• MRA: for renal artery stenosis
• Multiplanar imaging – sag, coronal and
axial
• Time consuming / expensive
Large right renal cell carcinoma with renal vein
and inferior vena cava invasion.
• T2-weighted axial
MRI
• Dynamic gadolinium-enhanced magnetic
resonance angiogram (MRA) shows normal
renal arteries.
Renal Angiography
Nuclear Scintigraphy
• Physiologic and anatomic info
• Renograph:
– Non-imaging (Ulin Hospital)
– With imaging (Gamma camera)
• Radioisotop+Radiofarmaka
– TC-99 m (t ½= 6 hrs)
– MAG3- cleared by tubular secretion, no glomerular
infiltration- evaluate renal function and renal
plasma flow
– DTPA- glomerular filtration- evaluate obstruction
and renal function
– DMSA- cleared by filtration and secretion- renal
cortical image
Urogenital Disease
• Developmental variations disorders
• Collecting system (Obstruction, stone,
hydronephrosis)
• Acute and chronic inflammation
• Circulation disorders (renovascular
hypertension, function failure)
• (Diseases of the parenchyma)
• Trauma
• Space occupying lesions/SOL (cystic, solid)
Normal variations and
congenital disorders
• Fusion abnormalitiy
– Horseshoe kodney
• Extrarenal pyelon
• Congenital malposition (ectopic kidney)
• Agenesis, hypoplasia
Obstruction, stone,
hydronephrosis
• Acute:
– Enlarged kidney
– Slow perfusion and excretion
– Moderate dilatation of the pyelum, stone, other
causes
• Chronic:
– Dilated collecting system
– Thin parenchyma
– Pure excretion
– Stone
• Autoimmun: large/small kidney
• Acute pyelonephritis (acute focal
bacterial nephritis, etc)
• Emphysematous pyelonephritis: large
kidney, hypodensity, decreased contrast
uptake, space occupation, thikening of
the renal fascia, gas in the parenchyma
• Pyonephros : hydronephrosis, thik wall of
the pyelon
• Abscess: APN + abscess cavity
• Segmental, polar, global atrophy
• Infarction (partial, complete): no
enhancement, absence of excretion
• Renal vein thrombosis: large kidney,
slow perfusion, venous filling defect,
perirenal collaterals, no excretion
• Renal artery stenosis, renovascular
hypertension aneurysma
• Kidney failure: parenchyma
destruction, calcification, pure
excretion (contrast material?!?)
Trauma
• Blount or penetrating injuries, contusion
• Haematoma (subcapsular/perirenal)
• Urinoma
• Parenchyma laceration
• Artery/vein injury
• Ureter ruptur
SOL
• Cystic
– Simple (soliter/multiple)
– Herediter (polikistik disease)
– Atypical (closed calyx, diverticula, cystic
tumour, abscess, cystic nephroma)
• Solid
– Beigne (AML, adenoma)
– Malignant
• Primary (RCC, TCC, Wilms Tumor)
• Secondary (HL, NHL, Metastasis)
Case 1. Horseshoe kidney
• Axis and position
alteration in
horseshoe kidney.
Case 2. filling defect in IVU
Common causes
1. Calculi
2. Cyst
3. Tumours
4. Blood clot
Case 3. focal Bulge
• Renal cyst with
splaying of calyces
Case 4. simple cyst
• Increased parenchymal thickness &
distortion of collecting system - simple
cyst (confirm by us)
Case 6. pcs
duplex
• Excretory urography in a
woman shows complete
ureteral duplication on
the right. The upper
moiety ureter empties
below and medial to the
ureter of the lower
moiety.
• Note the duplex
collecting system on the
left
Case 7. bilateral ureteral
duplication
• Excretory urography
in an adult patient
with bilateral
complete ureteral
duplication.
Case 8. duplex right kidney
• Excretory urography
in a patient with a
duplex right kidney
shows hydronephrosis
of the lower moiety.
Case 9.Calculus
• Bladder base
defect -
prostate
enlargement
THANKS YOU