Imaging UUT kidneys, ureters and prostate/uterus

Question 1

Indication

Answer 1

• abdo mass
• abnormal renal/urinary profile
• altered urination
• abdo/pelvic trauma

Question 2

Which views are necessary for urogenital tract rads?

Answer 2

• orthogonal

- plus butt shot lateral of caudal abdo/perineal region

Question 3

What are the Roentgen signs of the kidneys?

Answer 3

• 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

Question 4

How do cats kidneys differ to dogs?

Answer 4

• sit more caudally
• more ventrally
• both ~ L2-L5

Question 5

Normal size of the kidneys

Answer 5

- 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)

Question 6

Are ureters normally visable on rads? Where do they go?

Answer 6

• exit middle dorsal aspect of the kidneys
• course caudally
• “shephards crook” before entering trigone of bladder
  > not normallly visable unless cat very fat

Question 7

Roentgen signs of bladder

Answer 7

>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

Question 8

Is the urethra normally seen on rads?

Answer 8

No

- oz penis can be seen (dogs and some male cats)

Question 9

How does the urethra differ in females and males?

Answer 9

> 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

Question 10

What may be seen concurrently with nephromegaly? What may this indicate?

Answer 10

• ventral displacement of intestines

> doesnt differentiate tumour, hydronephrosis etc.

Question 11

What will be seen with nephrolithiasis? What does this tell you?

Answer 11

• altered opacity

> doesnt tell you if inflammation/obstruction present

Question 12

Roentgoen signs of the prostate

Answer 12

> 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

Question 13

What is a sign of malignancy in prostatic disease? Which dogs would you suspect to get this?

Answer 13

• 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

Question 14

Where should you look to find effusions?

Answer 14

Fat Triangle between rectum, rectus abdominis, bladder and prostate
- if you have normal peritoneal detail

Question 15

ROentgen signs of uterus

Answer 15

> Size: Variable
> Shape: Tubular
> Opacity: soft tissue
> Margins: Smooth
> Location: Ventral to colon, dorsal to urinary bladder 
- not visable in every animal

Question 16

What can be differentiated with ultrasoudn of the kidney?

Answer 16

> cortex
> Medulla
- hypoechoic cf. cortex 
> Pelvis 
- obstruction/hydronephritis/on IVFT ^ size
- hyperechoic

Question 17

How is renal size measured on ultrasound?

Answer 17

Dog: Variable
Cat: 3.8-4.4 or 3.66±0.46cm

Question 18

Are the ureters visbale on ultrasound?

Answer 18

• no very difficult/impossible if normal

- urinary jet at ureterovesical junction with doppler exam

Question 19

How should the prostate appear on ultrasound?

Answer 19

• homogeneous echogenicity (more hyperechoic than surrounding tissues)
• centrally urethra seen

Question 20

How shoudl the uterus appear on ultrasound?

Answer 20

• tubular structure (large muscularis layer)
• dorsal to urinary bladder
• echogenic line in the midle: collapsed lumen
  > may be just a stump left

Question 21

What contrast study is used to look at kidneys? WHat else is this referred to as?

Answer 21

• excretory urogram OR intravenous pyelogram

> Iodine based dye excretered into urine (no metabolisation before excretion)

Question 22

Indications for contrast studies

Answer 22

• visualising size/shape/integrity of kidneys and ureters

- qualitative assessment of renal functino (time taken to excrete)

Question 23

What are positive or negative contrast media?

Answer 23

- = BLACK 
\+ = WHITE

Question 24

What are the 2 most common contrast media?

Answer 24

> barium
- do not inject!!! GIT or outside animal only
iodine
- ionic v non-ionic (ionic drags in water, non-ionic safer less side effects)

Question 25

Contraindiactions of contrast studies

Answer 25

• 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

Question 26

Patient preparation before contrast studies

Answer 26

> 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

Question 27

What are the 3 stages of contrast in the kidneys?

Answer 27

• vascular phase (aorta and renal arteries)
• nephrogram (reaches the renal parencyma)
• pyelogram (renal pelvis and ureters -> bladder)
  > excreted within minutes!

Question 28

What can be identified on contrast study of the kidneys?

Answer 28

• parenchyme v pelvis

- should fill homogenously

Question 29

If a mass is found on rads what should be done next?

Answer 29

• ultrasoudn and biopsy