IMAGING FOR UNDERGRADUATE MEDICAL STUDENT

1. IMAGING
Dr Bashir BnYunus
SURGERY RESIDENT

2. CXR

8. ABDOMINAL X RAY

13. INTRAVENOUS UROGRAM(IVU)
Indications
• To see the anatomy and physiology of urinary system
• Trauma
• Calculi- renal, ureteric, bladder
• Congenital anomalies- ectopic kidney, horseshoe kidney, renal agenesis
• Infective pathology
• Renal tumour
• Unknown Haematuria
• Renal hypertension
• Bladder pathology- diverticula, fistula
• Vesico ureteric reflux
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14. Contraindications:
• Hypersensitivity to iodinated CM
• Renal insufficency
• Hepato renal syndrome
• Thyrotoxicosis,
• Pregnancy, (Allow 28 days from childbirth)
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15. Films
• Preliminary film:
 Supine, full length AP of
abdomen in inspiration.
 Position
 To demonstrate bowel
preparation, check exposure
factor, and location of
radiopaque stones or any
radiopaque artifacts.
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16. Films
• 0 MIN :
 AP of the renal areas.
 After injection of
contrast
 Aims to show the
nephrogram
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17. • 5-min film: excretion phase
 AP of renal areas.
 To determine if excretion is symmetrical
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18. • 15 min film:
 Supine full length AP
 There is usually adequate
distension of the pelvicalyceal
systems with opaque urine by
this time.
 Outlines the ureters
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19. • Release film (full bladder) : coned view of bladder area
• Taken to show the bladder. If this film is satisfactory, the pt is
asked to empty the bladder.
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20. • After micturition film:
• Main aim of films is to
 Assess bladder emptying
 To demonstrate return of dilated upper
tracts with relief of bladder pressure.
 Aid diagnosis of VJ calculi
 Dx of bladder tumors
 Demonstrate urethral diverticulum.
 Residual vol of urine.
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21. IVU

23. RUG

24. • INDICATIONS
 Urethral stricture.
 Urethral tear.
 Congenital abnormalities.
 Periurethral / prostatic abscess.
 Fistula / false passages.
• CONTRAST MEDIUM
 Urograffin 60%.
 Pre warming the contrast helps to
prevent external urethral sphincter spasms
• EQUIPMENT
 Tilting radiography table.
 Fluroscopy / spot film device.
 Foley catheter no 8 / knutsson`s clamp.
• PREPARATION
 Patient micturates prior to the procedure

25. • TECHNIQUE
 Preliminary film – coned supine PA view of bladder base and urethra.
 In supine position penile clamp is applied or tip of the catheter is inserted so that the
balloon lies on the fossa navicularis
 Balloon is inflated with 1 – 2 ml of water.
 Contrast medium is injected under fluoroscopic control.
• FILMING
 30* left anterior oblique.
 Supine PA.
 30* right anterior oblique.
• COMPLICATIONS
 Contrast reaction ( due to absorption through bladder mucosa )
 UTI
 Urethral trauma.
 Intravasation of contrast – due to use of excessive pressure in stricture.

31. MCUG
 CHILDREN
• Voiding difficulties.
• Vesico ureteric reflux.
• Posterior urethral valve.
• Baseline study prior to urinary tract surgery.
ADULTS
• Functional disorders of bladder & urethra.
• Suspected vesicovaginal / vesicocolic fistula.
• Suspected bladder / urethral trauma.
• Urethral diverticula

33. • COMPICATIONS
 Contrast reaction.
 Contrast induced cystitis.
 UTI.
 Catheter trauma.
 Bladder perforation – overfilling.
 Retention of a foley catheter.
 Catheterisation of vagina / ectopic ureter.
• CONTRAINDICATIONS
 Acute UTI.
• AFTERCARE
 Warned – of rare dysuria , retention.
 Reflux - Antibiotcs.

34. Posterior urethral valves
 Congenital thick folds of mucous membrane located in the posterior urethra
(prostatic + membranous) distal to the verumontanum.
 Most common cause of severe obstructive uropathy in children.
 Almost exclusively in males.
 Now rare for them to present with severe UTI and septicaemia -diagnosis is
generally made in early infancy and antenatal period.

35. Types
Type I:
 Most common.
 Two folds extend anteroinferiorly from caudal aspect of verumontanum often
fusing anteriorly at a lower level.
Type II:
 No longer considered a valve.
 Hypertrophic band of muscle running from ureteric orifice to verumontanum along
postero lateral urethral wall.
Type III:
 Circular diaphragm with a central or eccentric narrow aperture in membranous
urethra.

36. Fusiform dilatation & elongation of
proximal posterior urethra
persisting throught voiding
Transverse/curvilinear filling defect in
posterior urethra
MCU – Lateral view.

37. Grading of VUR
• Grade 1 : reflux limited to ureter
• Grade 2 : reflux into renal pelvis
• Grade 3 : mild dilatation of ureter
and pelvicalyceal system.
• Grade 4 : tortuous ureter with
moderate dilatation, blunting of
fornicies but preserved papillary
impressions.
• Grade 5 : tortuous ureter with
severe dilatation of ureter and
pelvicalyceal system, loss of
fornicies and papillary impressions

39. Barium swallow
Mass in mid oesophagus-
shouldering and irregular shadow
D/D-carcinoma; mass out
oesophagus e.g.mediastinal mass
Confirmation-oesophagoscopy
and biopsy and rule out bronchus
invasion

40. RAT TAIL APPEARANCE
Hugely dilated oesophagus with
narrow lower end rat tail appearance)
D/D-Achalasia cardia, carcinoma lower
end oesophagus , stricture
Confirmation-oesophagoscopy and
manometry
Biopsy and follow up

41. Barium meal
Hugely dilated oesophagus with
narrow lower end rat tail appearance)
D/D-Achalasia cardia, carcinoma lower
end oesophagus , stricture
Confirmation-oesophagoscopy and
manometry
Biopsy and follow up

42. CT SCAN

47. QUESTIONS