Imaging UUT kidneys, ureters and prostate/uterus Flashcards
Indication
- abdo mass
- abnormal renal/urinary profile
- altered urination
- abdo/pelvic trauma
Which views are necessary for urogenital tract rads?
- orthogonal
- plus butt shot lateral of caudal abdo/perineal region
What are the Roentgen signs of the kidneys?
- Position: Retroperitoneal space (R cranial: renal fossa of liver T13-L2, L caudal: L1-L4)
- Shape: Bean shaped
- Margins: Smooth
- Opacity: Soft tissue
- Number: 2
How do cats kidneys differ to dogs?
- sit more caudally
- more ventrally
- both ~ L2-L5
Normal size of the kidneys
- measure on VD view > dog - 2.5-3.5 x L2 > cat - 1.9-2.6 x L2 (Intact male: 2.1-3.2 x L2)
Are ureters normally visable on rads? Where do they go?
- exit middle dorsal aspect of the kidneys
- course caudally
- “shephards crook” before entering trigone of bladder
> not normallly visable unless cat very fat
Roentgen signs of bladder
>Size: variable >Shape: Pear shaped >Opacity: soft tissue (needs to be full to be more visable) >Margins: Smooth >Location: Caudoventral abdo - Ventral to colon, uterus/stump - Cranial to prostate - Normally cranially to pubis
Is the urethra normally seen on rads?
No
- oz penis can be seen (dogs and some male cats)
How does the urethra differ in females and males?
> dogs - females straight out through pelvis - males courses back round the very caudal end of the body and down to os penis and out > cats - both only course straight out the back
What may be seen concurrently with nephromegaly? What may this indicate?
- ventral displacement of intestines
> doesnt differentiate tumour, hydronephrosis etc.
What will be seen with nephrolithiasis? What does this tell you?
- altered opacity
> doesnt tell you if inflammation/obstruction present
Roentgoen signs of the prostate
> Size: Shape: oval - round
Opacity: soft tissue (cats not visable, dogs can see well)
Margins: smooth
Location: surrounding prostatic urethra
- caudal to bladder
- ventral to colon (will always push up)
- dorsal to pubis
- pelvis inlet
What is a sign of malignancy in prostatic disease? Which dogs would you suspect to get this?
- mineralisation in the prostate
- NEUTERED dogs (esp those neutrered at an early age)
> entire dogs get benign hyperplasia/prostatitis which may also mineralise but be more worried in neutered dogs
Where should you look to find effusions?
Fat Triangle between rectum, rectus abdominis, bladder and prostate
- if you have normal peritoneal detail
ROentgen signs of uterus
> Size: Variable > Shape: Tubular > Opacity: soft tissue > Margins: Smooth > Location: Ventral to colon, dorsal to urinary bladder - not visable in every animal
What can be differentiated with ultrasoudn of the kidney?
> cortex > Medulla - hypoechoic cf. cortex > Pelvis - obstruction/hydronephritis/on IVFT ^ size - hyperechoic
How is renal size measured on ultrasound?
Dog: Variable
Cat: 3.8-4.4 or 3.66±0.46cm
Are the ureters visbale on ultrasound?
- no very difficult/impossible if normal
- urinary jet at ureterovesical junction with doppler exam
How should the prostate appear on ultrasound?
- homogeneous echogenicity (more hyperechoic than surrounding tissues)
- centrally urethra seen
How shoudl the uterus appear on ultrasound?
- tubular structure (large muscularis layer)
- dorsal to urinary bladder
- echogenic line in the midle: collapsed lumen
> may be just a stump left
What contrast study is used to look at kidneys? WHat else is this referred to as?
- excretory urogram OR intravenous pyelogram
> Iodine based dye excretered into urine (no metabolisation before excretion)
Indications for contrast studies
- visualising size/shape/integrity of kidneys and ureters
- qualitative assessment of renal functino (time taken to excrete)
What are positive or negative contrast media?
- = BLACK \+ = WHITE
What are the 2 most common contrast media?
> barium
- do not inject!!! GIT or outside animal only
iodine
- ionic v non-ionic (ionic drags in water, non-ionic safer less side effects)
Contraindiactions of contrast studies
- dehydration (if stay in contact with nephron for long time can cause damage)
- hypersensitivity to iodine (Very severe)
- heart fialure (give fluids to flush through, may overload to heart failure)
- azotaemia NOT contraindications if adequate hydration provided
Patient preparation before contrast studies
> survey rads - empty colon with enema > GA or heavy sedation > +- pneumocystogram > Iodine based contrast medium 800mg/kg iV bolus > Rads at time intervals - VD @ 0, 2, 5, 10, 15) - lateral @ 5, 10, 15 - consider oblique views
What are the 3 stages of contrast in the kidneys?
- vascular phase (aorta and renal arteries)
- nephrogram (reaches the renal parencyma)
- pyelogram (renal pelvis and ureters -> bladder)
> excreted within minutes!
What can be identified on contrast study of the kidneys?
- parenchyme v pelvis
- should fill homogenously
If a mass is found on rads what should be done next?
- ultrasoudn and biopsy
