Kub - xray and usg

kidney, urinary bladder, ureters, prostate imaging - xray and usg

1. KUB NASIN USMAN

2. Kidneys Retroperitoneal 10 – 15 cm in length ( xray ); Left > Right 3 and ½ lumbar vertebrae Hilum at L1 vertebral level; Ant to Post: VAP Functional unit : Nephron

3. Relations Posteriorly: Diaphragm, 12 th Rib, Pleura, med – lat : Psoas, QL, TA Superiorly: Adrenals Anteriorly: Right: Liver, Duod 2 nd , Asc colon, SI. Left: Stomach, Pancreas, Spleen, SF, Jejunum

4. Capsules Fibrous capsule: surrounds kidney Renal fascia of Gerota (ant) and Zuckerkandl (post): Fuse Laterally as lateral Conal Fascia

5. Coronal Cross Section

6. Bifid renal pelvis (10%)

7. Development

8. Developmental anomalies Duplication of collecting system – commonest (4%) Persistant fetal lobulation 3. Accessory arteries

9. Drooping lily sign

10. 4 . Horse shoe Kidney

11. 5. Persistent Pelvic Kidney

12. 6. Crossed fused ectopia

13. 7. Pancake kidney

14. 8. Thoracic kidney

15. Blood supply Renal arteries from Aorta at L1/L2 level. Right renal artery > Left; posterior to IVC Left renal vein > Right; anterior to Aorta

16. Large left renal p elvic calculus w ith deviation of left ureter

17. Ultrasound Kidney size smaller than on radiographs – 9-12 cm Visualization: Posterolateral, Lateral or Posterior approach

18. Junctional cortical/ parenchymal defects: triangular echogenic areas In upper pole. Represent normal extensions of renal sinus due to partial fusion of embryonic renunculi . DD: Renal Scar, Angiomyolipoma

19. Hypertrophied Column of Bertin : Partial renal duplication of septal cortex in mid portion of kidney – pseudomass appearance Associated with bifid pelvis

20. Uncomplicated renal cyst well- marginated anechoic lesion with thin walls a few thin septa (5 % of cysts) the back wall should be visible posterior acoustic enhancement - nonspecific a small amount of intracystic hemorrhage /debris may be present, and may require further evaluation

21. Complicated renal cyst ​cystic lesions with thickened or irregular walls or septa are suspicious for renal cell carcinoma and warrant further work up vascularity of the septa on color or spectral Doppler is suspicious for renal cell carcinoma

22. Calculus in lower pole echogenic foci acoustic shadowing twinkle artefact on colour Doppler colour comet-tail artefact

23. Hydronephrosis

24. Chronic kidney disease Grade 1 Grade 2 Grade 3

25. Pyelonephritis particulate matter/debris in the collecting system reduced areas of cortical vascularity by using power Doppler gas bubbles (emphysematous pyelonephritis) abnormal echogenicity of the renal parenchyma 1 focal/segmental hypoechoic regions (in oedema) or hyperechoic regions (in haemorrhage) mass-like change

26. CT KUB Slices T12 to L3 Renal substance: homogenous in unenhanced CT [HU - 30-50] After IV contrast: Arterial corticomedullary : after 25 – 70 sec Venous Nephrographic : 80 – 180 sec (contrast homogenous) Excretory phase: after 180 sec (contrast in collecting system) Arteries in first 25 secs ; Veins after 60 secs

27. Findings identification of calcified renal tract calculi size and position stone composition assessment with dual energy CT assessment of the sequelae of calculi obstruction infection assessment of other causes of flank pain if negative for calculus disease presence of further calculi at risk of obstructing

28. Staghorn calculus with enlarged left kidney

29. Pyelonephritis with subcapsular collection

30. Ureters 25 – 30 cm long; diameter of 3mm Narrower at following sites: Junction of pelvis and ureter Pelvic brim Intravesical ureter

31. Relations: Abdominal ureter Following the course of the ureter from superior to inferior:   posteriorly: psoas muscle;  genitofemoral nerve; common iliac vessels; tips of L2-L5 transverse processes anteriorly Right ureter:  descending  duodenum,   gonadal vessels; right colic vessels;  ileocolic vessels left ureter:  gonadal artery; left colic artery; loops of jejunum; sigmoid mesentery and colon medially right ureter: IVC left ureter: abdominal aorta, inferior mesenteric vein

32. Pelvic ureter posteriorly: sacroiliac joint, internal iliac artery inferiorly male: seminal vesicle female: lateral fornix of the vagina anteriorly male:  ductus deferens female: uterine artery (in the broad ligament) medially female: cervix

33. Development Blind diverticulum from the metanephric duct Developmental anomalies Duplication: commonest significant congenital anomaly of urinary tract. Commoner in females. Weigert -Meyer law : during complete duplication, ureter serving the upper renal moiety drains fewer calyces and is inserted lower into the bladder than that draining the lower moiety – maybe as low as the bladder neck Upper moiety – obstruction Lower moiety – reflux

34. Ectopic ureter

35. Left ureterocele

36. IVU: Prone views aid filling Distension of proximal part by compression band across abdomen Oblique views for UV junction Ultrasound: Prox and distal visible when well distended. CT: Replaced IVU as IOC for ureteric calculi

37. Bladder pyramidal muscular organ when empty It has a triangular shaped base posteriorly The ureters enter the postero - lateral angles and the urethra leaves inferiorly at the narrow neck , which is surrounded by the (involuntary) internal urethral sphincter Extraperitoneal – only superiorly covered The ability of the full bladder to elevate and displace bowel loops is taken advantage of in pelvic ultrasound, where the full bladder provides an acoustic window

38. median ligament is the fibrous remnant of the urachus medial ligaments are the fibrous remnants of the umbilical arteries

39. Relations: male anteriorly: pubic symphysis posteriorly: rectovesical pouch and rectum inferiorly: prostate,  obturator internus muscle,  levator ani muscle superiorly: peritoneum laterally:  ischioanal fossa female   anteriorly: pubic symphysis posteriorly: vesicouterine pouch, uterus, cervix, vagina inferiorly: pelvic fascia, perineal membrane superiorly: uterus, peritoneum laterally:  ischioanal fossa

40. Male

41. MRI female

42. B ladder is relatively fixed inferiorly via condensations of pelvic fascia, which attach it to the back of the pubis, the lateral walls of the pelvis and the rectum continuity with the prostate in male - strong puboprostatic ligaments Bladder rupture - # pelvis - Blunt injury abd

43. Development: Trigone from mesoderm Ventral bladder wall endodermal from urogenital sinus Double bladder

44. Wall thickness 3-5 mm

45. Bladder calculi

46. UB mass

47. Hyperdense lesion in right lateral wall

48. Right VUJ calculus Normal bladder - < 10HU

49. Intraperitoneal bladder rupture with extravasation of contrast

50. Prostate shaped like an upside-down truncated cone and surrounds the base of the bladder and the proximal (prostatic) urethra, extending inferiorly to the urogenital diaphragm and external sphincter. weighs between 20-40 grams with an average size of 3 x 4 x 2 cm 70% glandular tissue and 30% fibromuscular or stromal tissue seminal vesicles are superior and posterior to the prostate gland. Its ejaculatory ducts pierce the posterior surface of the prostate below the bladder

51. 3 zones: Peripheral (70%) Central (25%) Transition (5%)

52. Prostatic calcification in Prostate cancers with bony mets

53. Transabdominal Ultrasound  can assess the volume of the prostate but is not reliable to diagnose carcinoma fill their bladder with at least 60ml of fluid probe is angled approximately 30 degrees caudal using the bladder as a window

54. BPH increase in volume of the prostate with a calculated volume exceeding 30 mL (width x height x length x 0.52) central gland is enlarged, and is hypoechoic or of mixed echogenicity calcification may be seen both within the enlarged gland as well as in the pseudocapsule (representing compressed peripheral zone) PVR

55. BPH CT KUB central zone appears hyperdense between 40-60 HU peripheral zone appears hypodense between 10-25 HU useful staging metastatic spread

56. Prostate CA In advanced disease, CT scan is the test of choice to detect enlarged pelvic and retroperitoneal lymph nodes, hydronephrosis and osteoblastic metastases