Diagnostic Imaging of the Lower Urinary Tract: Urinary Bladder and Urethra

Question 1

contrast studies - different types

Answer 1

Retrograde (vagino-) urethrography
Positive contrast cystography
Double contrast cystography
Negative contrast cystography - Pneumocystogram

Question 2

pneumocystogram - method

Answer 2

Foley catheter inserted retrograde into the urinary bladder
4-11ml/kg gas - Co2, Nitrous oxide
Views obtained - Lateral (left + right) + VD

Question 3

pneumocystogram - which diagnoses can be made using this

Answer 3

Underdistension/Overdistension
bladder location
suspected bladder rupture - +ve contrast

Question 4

+ve contrast cystogram - contrast medium

Answer 4

4-11ml/kg water soluble iodine based
Undiluted contrast if suspected ruture
Dilute to 25% concentration with saline for other indications
Prefill catheter with contrast medium

Question 5

+ve contrast cystogram - views taken

Answer 5

Lateral (left and right) and VD views

Question 6

+ve contrast cystogram - which diagnoses can be made using this

Answer 6

suspected rupture

traumatic inguinal hernia

Question 7

Double contrast Cystogram - Procedure

Answer 7

empty bladder
small volume non-diluted iodine based contrast medium
Add gas (Co2, Nitrous oxide) 4-11ml/kg
Reposition patient (‘roll’)

Question 8

Double contrast Cystogram - what you can see

Answer 8

Uroliths
Blood clots
Air bubbles

Question 9

Double contrast Cystogram - urolith appearance

Answer 9

sit in the middle of the fluid - roll to lowest point

Question 10

Double contrast Cystogram - blood clot appearance

Answer 10

along the rim of the contrast puddle

irregular shape

Question 11

Double contrast Cystogram - air bubble appearance

Answer 11

sit around the rim of the puddle

Question 12

+ve contrast retrograde vagino-urethro-cystogram - method

Answer 12

Catheter - Foley for females (balloon tip)
Clamps
10-15ml water soluble contrast medium 5-10ml for cats
Lateral views when injecting the last 2-3ml

Question 13

+ve contrast retrograde vagino-urethro-cystogram - findings

Answer 13

Filling defects Intraluminal, Mural +Extramural lesion
Extravasation of contrast - Rupture, Fistula, Diverticula
Abnormal shape, position or number - Strictures, displacement, duplications

Question 14

=ve contrast Retrograde urethrogram - diagnoses possible

Answer 14

Urethra: air bubbles
Urethral calculi
urethral trauma
urethral neoplasia

Question 15

Bladder neoplasia

Answer 15

Transitional carcinoma most common - Trigonal area
Other neoplasia: LSA, leiomyoma/-sarcoma
Assess medial iliac lymph nodes