PowerPoint Presentation Tract Imaging.pdf · Ureter opacification 2. pyleogram phase +/- compression band occlusion Bladder filling 3. clearance phase compression applied: ... LK

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Dr. Russell Tucker, DACVR

Brief Review with tips &Case Based Illustrations

K9 Kidneys:

Rt @ T13-L1

Lt @ L2-L4

Kidney location

& visualization

K9 Kidneys:

Rt @ T13-L1

Lt @ L2-L4

Size = 2.5 - 3.0 x L2 Size = 2.4 - 3.0 x L2

L2

Kidney visualization

Kidney visualization

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Superimposed -

but not in contactRt & Lt kidneys superimposed

IV iodinated contrast (15min)

880mg I/kg

(400mg I/lb)

give as bolus

Opacification of kidneys,ureters & urinary bladder

+flank band compression

Ectopic ureter

w/ air in bladder to help

visualize the entrance

7 year old M/C miniature schnauzer

Previous history of urinary blockage

a) Bladder stonesb) Kidney stonesc) Urethral stonesd) All of above

7 year old M/C miniature schnauzer

Previous history of urinary blockage

a) Bladder stonesb) Kidney stonesc) Urethral stonesd) All of above

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7 year old M/C miniature schnauzer

Previous history of urinary blockage

Renal Calculi

Urethral Calculi~ pull legs forward* evaluate entire urinary system

8 year old FS mix

Recurrent UTI’s

feces over both kidneys…

8 year old FS mix K9

Recurrent UTI’sEnema to clean out colon 8 year old FS mix K9

Recurrent UTI’s Barium painted on nipple

positive contrast

negative contrast

double contrast

5 - 10 cc/kg (cats ½ volume)

2 - 5 cc/lb

Palpate while distending bladder!

Bone/water Liver/water Fat/water Air/air

Bone/fat Liver/fat Fat/fat Water/water

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center squares identical, but look different gray shades

in the different surrounding backgrounds

Horizontal beam

Fluoroscopy exam: ruptured bladder

Deflated bladder on US

Requires positive contrast to visualize

Retrograde urethrography

Normograde urethrography

Dose dependent on sizeHelpful to have bladder distended

1. Uniform kidney

opacification

2. Diverticula & renal

pelvis excretion

3. Proximal ureters

peristalsis of ureters

Normal “nephrogram”

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2

3

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Uniform enhancement

1. nephrogram phase

~ symmetric kidneys

Ureter opacification

2. pyleogram phase

+/- compression band occlusion

Bladder filling

3. clearance phase

compression applied:

- left & right ureters

0 - 10 min

10 - 20 min

30 - 45 min

Early phase Collection phase

Ureter entering trigone

Clean out colon before IVP performed! LR

Severe hydronephrosis & hydroureter

LRSevere hydronephrosis & hydroureter!

Transverse at bladder

Dorsal reconstruction

Sagittal reconstruction

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2 year old M/C miniature poodle

Dribbling urine for 1 year, especially when sleeping or relaxed

Legs forward

Dribbling urine for 1 year, especially when sleeping or relaxed

2 year old M/C miniature poodle

left right

L KidR Kid

Nuclear ScintigraphyTc-99m attached to agent filtered by kidneys

Dynamic acquisition (0- 3mins)create composite image:

Dark = TC-99m accumulation

Rt kidney >>> Lt kidney

Dorsal view

2 year old M/C miniature poodle

Dribbling urine for 1 year, especially when sleeping or relaxed

RK

LK

Bladder

CT 3-D volume recon

2 year old M/C miniature poodle

Dribbling urine for 1 year, especially when sleeping or relaxed

Misshapen left kidney-hydronephrosis

2 year old M/C miniature poodle

Dribbling urine for 1 year, especially when sleeping or relaxed

Left hydroureter

Misshapen left kidney-hydronephrosis

2 year old M/C miniature poodle

Dribbling urine for 1 year, especially when sleeping or relaxed

Left hydroureter

Left ectopic ureter

Misshapen left kidney-hydronephrosis

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10 year old F/S DSH

Straining to urinate

10 year old F/S DSH

Straining to urinate

Enlarged right kidney

10 year old F/S DSH

Straining to urinate

Enlarged right kidney

? Ureter stone obstruction

10 year old F/S DSH

Straining to urinate

Enlarged right kidney

a) Ultrasoundb) Excretory urographyc) Exploratory surgeryd) Renal biopsy or FNA

10 year old F/S DSH

Straining to urinate

Enlarged right kidney

a) Renal ultrasoundb) Excretory urographyc) Exploratory surgeryd) Renal biopsy or FNA

10 year old F/S DSH

Straining to urinateright kidney & ureter

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TCC Urethra

Resource for contrast exams:Handbook of Veterinary ContrastRadiography- by Seth Wallack (2003)

Amazon.com Or 800-533-5111$50 soft cover text

-Indications-Contraindications-Contrast agents & Doses-Exam descriptions-Interpretations