Pediatrics, Barium and Urological contrast technique Revision cases.pdf

Pediatrics, Barium and Urological contrast technique Revision cases

1. Pediatrics pre-exam
most important
cases

2. ByDr.HazemHamed
M.D.Radiodiagnosis

4. Case 1

5. •Classiclocationofneuroblastoma
metastasisonsuturelines.
•Notethelargesuprarenalabdominal
mass containingcalcification
characteristicofneuroblastoma.

6. Case 2

7. Neuroblastoma
•Aretumorsofneuroblasticorigin.
•Thevastmajorityarisefromtheadrenalglandalthoughthey
mayoccuranywherealongthesympatheticchain.
•OnCT,thetumortypicallyisheterogeneouswithcalcifications
seenin80-90%ofcases.Areasofnecrosisareoflow
attenuation.
•Themassseeninsinuatingitselfbeneaththeaortaandlifting
itoffthevertebralcolumn.
•Ittendstoencasevesselsandmayleadtocompression.
•Adjacentorgansareusuallydisplaced,althoughinmore
aggressivetumorsdirectinvasionofthepsoas
muscleorkidneycanbeseen.

8. Case 3

9. Neuroblastoma

10. Case 4

11. •Wilms tumor, also known
as nephroblastoma, is a
malignantpediatricrenaltumor.
•Wilmstumorsareheterogeneoussoft-
tissuedensitymasseswithinfrequent
areasofcalcification(~15%)andfat-
densityregions.
•Enhancementispatchyandallowsfor
delineationoftherelationshipbetweenthe
massandkidney.
•10-20%ofcaseshavelungmetastasesat
the time of diagnosis

12. Case 5

13. Hepatoblastoma
•Hepatoblastomaisthemostcommonprimarymalignant
livertumorinchildrenunderfouryearsofagewho
usuallypresentwithpainlessabdominalmassandraised
AFP.
CT
•Usuallyseenasawelldefinedheterogeneousmass,
whichisusuallyhypoattenuatingcomparedto
surroundingliver.
•Frequentlythereareareasofnecrosisandhemorrhage.
•Densecalcificationsmaybeseeninapproximately40%
ofcases.
•CTisalsoabletoevaluatethelungsformetastasesand
fornodalenlargement.

14. Case 6

15. Chondrodysplasiapunctata
(CDP)
•Isacollectivenameforaheterogenous
groupofskeletaldysplasias.
•Calcificstipplingofcartilageandperi-
articularsofttissuesisoftenacommon
feature.
•Thehallmarkisepiphysealcalcific
deposits.

16. Case 7

17. Osteogenesis imperfecta
•Severeosteoporosis.
•Deformedandgracilebones.
•Corticalthinning.
•Hyperplasticcallusformationwithmultiple
fracturelinesatdifferentages.
•Radiolucentareaswithscleroticmargins.
•Formationofpseudarthrosisatsitesof
healingfractures.

18. Case 8

19. Radiographic grades of reflux.
(I)Ureteranduppercollectingsystemwithoutdilatation
(II)Mildor(III)moderatedilatationoftheureterandmildor
moderatedilatationoftherenalpelvis,onlyslight
bluntingofthefornices
(IV)Moderatedilatationand/ortortuosityoftheureterwith
moderatedilatationoftherenalpelvisandcalycesand
completeobliterationofthesharpangleofthefornices
butmaintenanceofpapillaryimpressioninthemajorityof
calyces.
(V)Grossdilatationandtortuosityofureters,renalpelvis
andcalyces▶papillaryimpressionsarenotvisiblein
themajorityofcalyces.

20. Case 9

21. Osteopetrosis
Note diffuse low signal in MRI
denoting bone sclerosis

22. Case 10

23. Osteopetrosis and pathologically
fractured C2 spinous process

24. Case 11

25. Active rickets
•Fraying:indistinctmarginsofthe
metaphysis
•Wideningofmetaphysealends
•Cupping:concavityofmetaphysis

26. Types of rickets
•Calcipenic rickets
–Parathyroidhormone:markedlyelevated
–Calcium:lowornormal
–Phosphate:lowornormal
•Phosphopenicrickets
–Parathyroidhormone:normalormodestly
elevated
–Calcium:normal
–Phosphate:low

27. Case 12

28. Lissencephaly
•TypeI(classic)lissencephalycanappearasthe
classichourglassorfigure-8appearanceorwith
afewpoorlyformedgyri(pachygyria)anda
smoothoutersurface.Itisusuallyassociated
withbandheterotopia.
•TypeIIlissencephaly,ontheotherhand,hasa
microlobulatedsurfacereferredtoasa
cobblestonecomplex.Bandheterotopiaisnot
evidentandthecortexisthinnerthanintypeI.

29. Case 13

30. Polymicrogyria
•Extensivebilateralcerebralhemisphere
polymicrogyria.
•Virtuallynonormalcortexisseenwithan
overconvolutedgyralpatternanda‘lumpy
bumpy’grey–whitematterinterface.

31. Case 14

32. Sphenoid wing dysplasia
causing asymmetrical orbits
in NF1

33. Case 15

34. Choroid plexus papilloma
•Homogenouslyenhancingcauliflower
lobulatedmasslesioninthetrigoneof
theleftlateralventricle.

35. Case 16

36. Congenital hypertrophic pyloric
stenosis
•Rememberthefirstdigitsofthenumber"pi",
alsorepresentedbytheGreekletter"π":
•π=3.1415
•Pyloricmusclethickness,i.e.diameterofa
singlemuscularwallonatransverseimage>3
mm(mostaccurate)
•Pylorictransversediameter≥14mm
•Length,i.e.longitudinalmeasurement>15mm

37. Case 17

38. Features ofcleidocranial dysostosis
•Largeheadwithfrontalandparietal
bossings.
•Abesentclavicleonbothsides.

39. Thank you

41. Important pre-exam
barium cases

42. Case 1

43. Benign gastric ulcer showing
Hampton line.
•TheHamptonlineisathinmillimetric
radiolucentlineseenattheneckof
agastriculcerinbariumstudies(profile
view),indicatingitsbenignnature.
•Itiscausedbyathinlineofmucosa
overhangingtheulcer'scrater.

44. Case 2

45. Zenker diverticulum
•Zenkerdiverticulum,alsoknownas
apharyngealpouch,isaposterior
outpouchingofthehypopharynx,just
proximaltotheupperesophageal
sphincterthroughaweaknessinthe
musclelayercalledtheKillian
dehiscence.

46. Case 3

47. •Contrastenemawillshowa
microcoloninvolvingtheentirelarge
bowelandmayshowimpacted
meconiumpelletsfillingdefects,
particularlyintherightcolonorinthe
distalileum+secondarymicrocolon

48. Case 4

49. Lead pipe sign in ulcerative
colitis
Imagingfindings:
•Doublecontrastbariumenemademonstratesa
featurelessdescendingandsigmoidcolon(yellow
arrows).
•Thesecolonshowlackingnormalhaustralmarking
andnarrowed.
•Therearenofocalstenosesormasses.
•Noevidenceoffistulaformation.
•Theascendingandtransversecolonappearnormal
withpreservednormalhaustralfolds.
•Theterminalileumisdistendedandnormalin
appearance.

50. Case 5

51. Benign gastric ulcer
A.Supinedouble-contrastviewshows
abnormalfoldsintheantrumwithouta
definiteulcer.
B.Pronecompressionviewshowsfillingof
ananteriorwallulcer(arrow).
Notehowfoldsradiatetotheedgeofthe
ulcer crater.

53. Case 6

54. Gastric carcinoma
•Polypoidmassshowninthelower
bodyofthestomachwithlarge
irregularfillingdefect.

55. Case 7

56. •Carcinoidtumordesmoplastic
reactioncausingdistortionofthe
smallbowelandkinksinthecourse
ofthesmallbowel.

57. Case 8

58. •Aberrantrightsubclavianartery
withsmoothlinearoblique
indentationonesophagealwall.

59. Case 9

60. Caustic esophageal stricture
•Theesophagusisopacifiedwiththecontrast
showinglongsegmentirregularstricture
involvingthedistalpartoftheesophaguswith
proximalesophagealdilatation.
•Normalpassageofcontrastthroughthe
pylorusintotheduodenumisnoted.
•Theduodenumandpartsofthejejunum
alongwithduodenojejunaljunctionisnoted
ontherightsideconsistentwiththeincidental
findingofintestinalmalrotation.

61. Case 10

62. Congenital hypertrophic pyloric
stenosis
Onuppergastrointestinalfluoroscopy:
•Delayedgastricemptying.
•Elongatedpyloruswithanarrowlumen(string
sign).
•Thepylorusindentsthecontrast-filledantrum
(shouldersign)orbaseoftheduodenalbulb
(mushroomsign).
•Theentrancetothepylorusmaybebeak-
shaped(beaksign).

63. Case 11

64. Paraesophageal hernia
•Occurswhenthefundusherniates
throughthehiatusaboveanormally
positionedGEJ.
•UGIseriesina72-year-oldmanwitha
paraesophagealhernia(arrow).The
GEjunctionliesbelowthediaphragm.

65. Case 12

66. Small bowel GIST
•Onupperabdominalstudies,fillingdefect
projectingfromthewallofthesmallbowel
isseen.
•Thetumormarginsaresmoothandmay
formrightorobtuseangleswiththe
adjacentmucosaduetoitsintramural
origin.

67. Case 13

68. Small bowel lymphoma
•Smallbowellymphomaisoneofthemost
common smallbowelmalignancies,
accountingfor~25%ofallprimarysmall
bowelmalignancies,and~40%ofall
primarygastrointestinallymphomas.

69. Case 14

70. •UGI seriesshows a
radiolucenthalo(largearrow)
duetoaCarmanmeniscus
signthatsurroundsacentral
malignantulcercrater(small
arrow).

71. Case 15

72. •Gastricdiverticulaareacquiredandare
usuallysmall,projectingoutwardfromthe
greatercurvature,givingacollar-button
appearance;theyaresometimesmistaken
forabenigngastriculcer.
•Theymaybeassociatedwithprevious
gastriculcerdiseasebutgenerallyhave
noneoftheotherfeaturesthatareusually
associatedwithulcerdisease,including
collarsandfoldthickening.

73. Case 16

74. •Frostberginverted3signisa
radiologicalsignseenonabarium
examinationwherethereiseffacement
anddistortionofthemucosalpatternon
themedialwallofthesecondpartofthe
duodenumduetofocalmassandlocal
edema.
•Itismostcommonly associated
withcarcinomaoftheheadofthe
pancreasbutcanalsobeseen
induodenalcarcinomaandpancreatitis.

75. Case 17

76. Pyloric carcinoma
•Elongatedstretchedpyloriccanalwith
mucosalirregularities.

77. Case 18

78. Crohn’s disease
•Thegastrointestinalstringsign(alsoknown
asthestringsignofKantor)referstothe
string-likeappearanceofacontrast-filledbowel
loopcausedbyitsseverenarrowing.
•Originallyusedtodescribethereversible
narrowingcausedbyspasmsinCrohndisease.
•Itisnowusedforanyseverenarrowingofthe
bowellumen,includingthatseeninhypertrophic
pyloric stenosis, gastrointestinal
tuberculosis,carcinoidtumorandcoloncancer.

79. Case 19

80. Acute erosive gastritis
•Therearenumerouserosionsinthe
stomach(arrows).
•Eacherosionconsistsofasmallcentral
collectionofbariumsurroundedbya
translucentring(asmall‘target’lesion).

81. Case 20

82. •UGIseriesandcoronalCTwithan
organoaxialvolvulus.
•Thegreatercurvature(largearrow)is
superior(cephalad)andthelesser
curvatureinferior(smallarrow).
•TheGEjunctionisindicatedbythe
arrowhead.

84. Case 21

85. •UGIswallowmesenteroaxial
volvulus.
•TheGEjunctionisinferior
(largearrow)andthepylorus,
superior(smallarrow).

86. Case 22

87. •Cricopharyngealbarreferstothe
radiographicappearance of a
prominent cricopharyngeus
musclecontouronbariumswallow.
•Presentinupto20%ofbariumstudies.
•Mostlyasymptomaticandfoundasan
incidentalfindingonbariumswallow.
•Onbariumswallowlateralprojection.
•Smoothposteriorindentationofthe
esophagusatthelevelofC5-C6.

88. Case 23

89. Crohn’s disease
•Pseudodiverticulaformation:dueto
contractionatthesiteofulcerwith
ballooningoftheopposite(usually
antimesenteric)side.
•Widelyseparatedloopsofboweldueto
fibrofattyproliferation.
•Stringsign:tubularnarrowingdueto
spasmorstricturedependingonthe
chronicity.

90. Case 24

91. Crohn’s disease
•Antralerosionsandataperedstricture
involvingthefirstpartoftheduodenum.
•Thesecondpartoftheduodenumis
dilatedasaresultofafurtherstrictureof
thethirdpart.
•Strictureatdistalileum.

92. Case 25

93. •UGIserieswiththickenedantral
foldsandapunctatecollectionof
bariumatthecenter(arrow)due
toanantralulcer.

94. Case 26

95. •UGIwithalargegreatercurvature
malignantulcer(largearrow)witha
surroundingirregularmargin(small
arrows) due to infiltrated
adenocarcinoma.
•Axial contrast-enhanced CT
demonstratingamalignantgastric
ulcer(smallarrow)whichprojectsinto
thegastriclumensurroundedbythe
malignantmass(largearrow)i.e.
ulceratingmass.

96. Case 27

97. •Shortapplecorestricture
in small bowel
adenocarcinoma.

98. Case 28

99. Benign ulcer with hampton line
•TheHamptonlineisathinmillimetric
radiolucentlineseenattheneckofa
gastriculcerinbariumstudies(profile
view)indicatingitsbenignnature.
•Itiscausedbyathinlineofmucosa
overhangingtheulcer'scrater.

100. Case 29

101. Leiomyoma of the oesophagus
•Twoviewsshowingfeaturestypicalof
anintramuralorextrinsiclesion.
•Thereisabroad-basedfillingdefect
bulgingintoandwideningthelumen
oftheoesophagus.

102. Case 30

103. Scleroderma
•Dilatedesophaguswithapersistent
air-fluidlevelindicatingdelayed
emptying.Thereisstrictureofthe
distalesophagus.
•Softtissuecalcificationandacro-
osteolysisinkeeping with
scleroderma.

104. Case 31

105. •GIserieswithmultiple
gastricmucosallesions
(arrows)duetohyperplastic
polyps.

106. Case 32

107. Oesophageal carcinoma
•UprightfrontalandLPOimagesof
barium swallowdemonstrating
irregularpolyploidalfillingdefect
(arrow)inmidesophaguscausing
expansionofesophageallumen

108. Case 33

109. Familial polyposis
•Doublecontrastbariumenemaview
ofthedescendingcoloninFAPwith
multiplesmallpolypsabout5mmin
size,creatingringshadowmenisci
aroundtheirbasesorasafilling
defectinthebariumpool(arrow).

110. Case 34

111. Meckel diverticulum
•Truediverticulum(i.e.alllayersofthe
gastrointestinaltractarepresentinitswall)
andarisesfromtheantimesentericborder
ofthesmallintestine.
•Itcanbeaslongas5cmwithdiameters
upto2cm.
•Most(75%)Meckeldiverticulaarefound
within60cm(range40-100cm)ofthe
ileocecalvalve.

112. Case 35

113. •Felineesophagusreferstothetransient
transversebandsseeninthemidandlower
esophagusonadouble-contrastbarium
swallow.
•Thefoldsare1-2mmthickandrunhorizontally
aroundtheentirecircumferenceofthe
esophageallumen.Thefindingsaretransient,
seenfollowingrefluxandnotduringswallowing.
•Alwaysassociatedwithactivegastro-
esophagealreflux

114. Case 36

115. •Fluoroscopicevaluationwith
bariumdemonstrateslongitudinal
andcurvilinearluminalfilling
defects,representingesophageal
varices.

116. Case 37

117. •Doublecontrastbariumenemashows
apolypoidcoloniccarcinomawith
anirregularin-drawnbase/filling
defect.

118. Case 38

119. •UGIdemonstratingasmooth,rounded
submucosalmass(arrow)thatprovedto
beabenignGIST.
•AxialandcoronalCTshowsasmooth
intraluminalsubmucosalfillingdefectat
thegastricfundus(arrows)duetoaGIST.

120. Case 39

121. •Duringabariummeal,thestomachcannot
beadequatelydistendedduetothe
increasedrigidityofthewallwithonlya
narrowlumenidentified.
•Thenormalmucosalfoldpatternisabsent,
eitherdistorted,thickened,ornodular

122. Linitis plastica
Plastica:
•P pancreatitis
•L lymphoma
•A amyloidiosis
•S sarcoidiosis
•T T.B
•I inflammation
•Cacarcinoma

123. Case 40

124. Ulcerative colitis with toxic
megacolon
•Evenplainxraycandiagnose
ulcerativecolitisandoneofits
complicationswhichistoxic
megacolon(ifcolondiameter
morethan6cm).

125. Case 41

126. •AZenkerdiverticulumisapulsion-
pseudodiverticulumandresultsfrom
herniationofmucosaandsubmucosa
throughtheKilliantriangle(orKillian
dehiscence).

127. Case 42

128. SMA syndrome
•Abdominalradiographafterone-hour
demonstratepersistentcontrast
poolingintheproximalduodenum
withanabruptcut-offatitsthirdpart
(arrows)coincidingwiththesuperior
mesentericarteryimpression.

129. Case 43

130. Gastric bezoar
•GIseriesshowsafixedfillingdefectinthe
stomachwithaswirledpatternofgasand
solidmaterialfoundtorepresenta
trichobezoar.

131. Case 44

132. Large sigmoid giant diverticulum
•Giantcolonicdiverticulum(GCD),definedas
adiverticulumlargerthan4cm.
•Thedefinitivetreatmentforagiantdiverticulum
issurgery.
Complications
•Common
–Perforation
–Abscess formation

133. Case 45

134. •UGIswallowshowsasmall
midesophagealtractiondiverticulum
(largearrow)frompriortuberculous
mediastinaladenopathy.
•Thereisalsoatracheoesophageal
fistula(smallarrow).

135. Case 46

136. Colonic carcinoma apple
core

137. Case 47

138. Imperforate anus
Invertogram
•Acoin/metalpieceisplacedoverthe
expectedanusandthebabyisturned
upsidedown(foraminimum3minutes).
•Thedistanceofthegasbubbleinthe
rectumfromthemetalpieceisnoted:
•>2cmdenoteshightype
•<2cmdenoteslowtype

139. Case 48

140. Pseudomembraneous colitis
•Earlyinthedisease:Boweldilatation,
muralthickeningandthumbprinting(dueto
thickeningofthehaustralfolds)areseen.
•Later:inuntreatedorfulminantcases,
appearanceswillbethoseoftoxic
megacolon,withsubsequentperforation
andfreeintraperitonealgas.
•Theroleofbariumenemahassignificantly
reducedduetoriskofperforation.

141. Case 49

142. Ascaris worm

143. Case 50

144. Oesophgeal perforation with
gastrographin leakage

145. Case 51

146. Trachea-esophageal fistula
•Congenital.
•Acquired.
Malignancy-related causes: common
•Malignancy
–Intheelderly,theyaremostfrequentlyseenwithan
intrathoracicmalignancy,mostcommonlyof
theesophagus
•Radiotherapy
Non-malignancyrelatedcauses:infrequent
•Trauma
•Chronicinflammationtuberculosis
•

147. Case 52

148. •MCUG:Contrastopacified
fistulouscommunicationbetween
theposteriorurethraandthe
rectumgivingarectourethral
fistula.
•MostlyinNewborn with
imperforateanussearchingfor
otheranomalies

149. Case 53

150. Diffuse esophageal spasm
•Corkscrewesophagusor"rosary
beadesophagus"wherenormal
peristalsisisinterruptedbymany
tertiary(non-propulsive)contractions
occurringinthedistalesophagus.

151. Case 54

152. Cobble stone appearance in
ulcerative colitis
•Cobblestoning(havingacobblestone
appearance)canoccurinanumberof
holloworganswithmucosa,most
commonlythebowel,inthesettingof
Crohnandulcerativecolitisdiseases.
•Longitudinaland circumferential
fissuresandulcersseparateislandsof
mucosagivingitanappearanceof
cobblestones.

153. Case 55

154. •Bariumswallowmayreveal
longitudinalesophagealluminal
fillingdefectsrepresenting
esophagealvarices.

155. Case 56

156. Achalasia with bird peak sign
•Thebird'sbeaksignoftheesophagusisusedtorefer
tothetaperingoftheinferioresophagusinachalasia
•Primaryachalasiaismostfrequentlyseeninmiddleand
lateadulthood(age30to70years)withnogender
predilection.
•Pseudoachalasia (secondaryachalasia)isan
achalasia-patterndilatationoftheesophagusduetothe
narrowingofthedistalesophagusfromcausesotherthan
primarydenervation.Oneofthemostcommoncausesis
malignancy(oftensubmucosalgastriccancer)with
extensionintheloweresophagus.

157. •Ausefuldiscriminatorinbariumswallow,
particularlyincasessecondarytounderlying
neoplasmismoremarkedmucosalirregularityof
malignantlesionsinpseudoachalasia
•CTisusuallytheimagingmodalityofchoicefor
equivocalcasesbecauseitmoreclearlydepicts
amalignantlesion,aswellaspotentiallymph
nodeinvolvement,localinvasionormetastatic
spread.

158. Case 57

159. Organo-axial gastric volvulus

160. Case 58

161. Traction diverticula secondary
to T.B
•Middleesophagealdiverticula
•Tractiondiverticula:are(truediverticula)
whichoccursecondarytoscarring,fibrosis
andinflammatoryprocesses(tuberculous
adenitis)inthemediastinumpullingonthe
esophagealwall.

162. Case 59

163. •Epiphrenic diverticulaare pulsion
diverticula(occurssecondarytoincreased
intraluminalpressure)ofthedistalesophagus
arisingjustabovetheloweresophagealsphincter,
morefrequentlyontherightposterolateralwall.
They are associated with:
•Achalasia
•Hiatus hernia
•Osophagealstricture

164. Case 60

165. Intestinal malrotation with
midgut volvulus
•Thisimagedemonstratesadilatedstomachand
duodenumwithabeaklikeappearanceofthe
duodenum.
•Thisisduetoafocaltwistingoftheintestinedueto
congenitalmalrotationofthebowelaswellaslaxityof
themesentericattachment.
•Theentiretyofthevisualizedsmallbowelistotheright
ofthespine,whichisanabnormalposition.
•Thedreadedcomplicationofmalrotationisvolvulus.
Thesepatientsneedemergentsurgeryastwistingofthe
bowelcanobstructthevenousoutflowandarterialinflow
totheintestineleadingtobowelischemia.

166. Thank you

167. Contrast urology cases

168. Case 1

169. Horse shoe kidneys

170. Case 2

171. Crossed fused ectopic
left kidney

172. Case 3

173. Ectopic pelvic left
kidney

174. Case 4

175. Bilateral dupplex
kidney and ureters

176. Case 5

177. Pancake kidney
•Theupperandlowerpolesofthekidneys
arefusedhencegivingitanappearanceof
pancakeandusuallygiverisetotwo
separateureterswhichenterthebladderin
anormalrelationship.

178. Case 6

179. Pelvi-ureteric junction
obstruction

180. Case 7

181. Hydronephrosis
secondary to ureteric
stone

182. Case 8

183. Transitional cell
carcinoma renal pelvis

184. Case 9

185. Circumcaval ureter
•Circumcaval ureter,alsoknown
asretrocavalureter,isatermusedto
describeanabnormalcourseofaureterthat
encirclestheinferiorvenacava.

186. Case 10

187. Ureteritis cystica
•Ureteritiscysticaisabenignconditionof
theuretersrepresentingmultiplesmallsubmucosal
cysts.
•Ureteritiscysticaresultsfromchronicurinarytract
irritationduetostonesand/orinfection.
•Theappearanceisthatofmultiplesmall2-5mm
smooth-walledroundedlucentfillingdefectsprojecting
intothelumen.
•Theyaremostcommonintheproximalureter,butcan
beseenanywherealongtheurinarytract:bladder
(cystitiscystica)orrenalpelvis(pyelitiscystica).The
conditionoccursbilaterallyinupto50%ofcases.

188. Case 11

189. Urinary bladder
dupplication

190. Case 12

191. Urinary bladder
diverticulum

192. Case 13

193. Bilateral ureterocele
•Ureterocelesrepresentabnormalcongenitaldilatationofthedistal-
mostportionoftheureter.Thedilatedportionoftheuretermayherniate
intothebladdersecondarytotheabnormalstructureofvesicoureteric
junction(VUJ)
IVP
•Fillingdefectinthebladder(cobraheadsign)whichmaybe
distended,collapsedoreveneverted.
•Radiolucenthaloeffect
Types:
•Intravesical:occuratthenormalvesicouretericjunctionposition
•Extravesical:occurectopicallylowandmedial,nearbladder
neck/urethra

194. Case 14

195. Uterus indentation

196. Case 15

197. Colo-vesical fistula

198. Case 16

199. Vesico-vaginal fistula
•Vesicovaginalfistulasareabnormalfistulous
connectionsbetweentheurinarybladderandvagina,
resultinginaninvoluntarydischargeofurinethrough
thevagina.
Thereareanumberofcausesincluding:
•Prolongedobstructedlabor
•Surgery,e.g.hysterectomy
•Pelvic malignancy (e.g. bladder
carcinoma,endometrialcarcinoma)
•Radiotherapy

200. Case 17

201. Urinary bladder
carcinoma

202. Case 18

203. Benign prostatic
hyperplasia

204. Case 19

205. Adult polycystic kidney disease
"Spiderlegpyelogram"isalso
describedsincestretchedoutand
attenuatedpelvicalycealsystemisseen
asaresultofmasseffectcausedby
renalcysts.

206. Case 20

207. Medullary sponge kidney
•Ectaticdistalcollectingductsandalso
dilatedcontrastfilledintrapapillary
tubuleswithintherenalmedullaare
seenonintravenouspyelogram.

208. Case 21

209. Bilateral grade V vesico-
ureteric reflux

210. Case 22

211. Posterior urethral stricture
•Urethral stricturesare relatively common and typically
occur either in the setting of trauma or infection.
Commoncausesofurethralstricturesinclude:
•Infection
–gonococcalurethritis(morecommon)
•Inflammatory
•Trauma
–straddleinjury(mostcommon)
–pelvicfractures
•iatrogenic
–instrumentation

212. Case 23

213. Urethral diverticulum
containing stone

214. Case 24

215. •Micturatingcystourethrogramrevealsmarked
dilatationoftheprostaticportionoftheurethra
consistentwithposteriorurethralvalves.
•Posteriorurethralvalves(PUVs)arethemost
common congenitalobstructivelesionof
theurethraandacommoncauseofobstructive
uropathyininfancy.

216. Case 25

217. Transitional cell
carcinoma ureter

218. Case 26

219. Transitional cell
carcinoma upper calyx

220. Case 27

221. Patent urachus
Apatenturachusisdemonstratedby:
•Retrogradeinjectionofcontrastmaterial
intotheorificeofthechannelatthe
umbilicalend
•Reflux up the urachus
duringVCUG(betterseeninthelateral
projection).

222. Case 28

223. Urachal carcinoma
•Thereisaheterogeneouslyenhancing
masslocatedinanteriorthewallofthe
bladderwithintravesicalextension,with
theappearancesofextensionintourachal
remnants.

224. Case 29

225. Intraperotoneal urinary bladder
rupture
•Intraperitoneal
–Usuallybladderdomerupture
–Contrastinparacolicguttersandbetweenloopsof
smallbowel
–Extravasatedcontrastappearslessconcentrated
thanthatseeninextraperitonealrupture
•Extraperitoneal
–Usuallyatbladderbaseanterolaterally
–Extraluminalcontrastintoperivesicalspace(simple)
–Extensionofextraluminalcontrasttothethigh,
scrotumorperineum(complex)

226. •Intraperitonealrupturerequires
surgical repair while
extraperitonealinjuriesare
treatedconservativelywitha
bladdercatheter.

227. Case 30

228. Pelvic lipomatosis
•Invertedpear-shapedorteardrop
bladder.

229. Case 31

230. Caylyceal diverticulum
complicated by uroliathesis

231. Case 32

232. Calyceal rupture on
right side

233. Case 33

234. Left ureteric stricture

235. Case 34

236. Failure renal transplant with
calcified kidneys
•Irregularamorphouscalcificdensities
overlyingtheleftandrightiliac
fossa,consistentwithknownfailed
priorrenaltransplants.

237. Case 35

238. Mega ureter
•Acongenital(primary)megauretercausesofan
enlargedureterwhichareintrinsictotheureter,rather
thanasaresultofamoredistalabnormality;e.g.
bladder,urethra.Itincludes:
•Obstructedprimarymegaureter
•Refluxingprimarymegaureter
–althoughvesicouretericreflux(VUR)isacauseof
primarycongenitalmegaureteritisusuallyconsidered
separately
•Non-refluxingunobstructedprimarymegaureter

239. •Inallthreetypestheureterisenlarged(>7mm)
•Inobstructiveprimarymegaureternarroweddistal
ureterusuallyjustabovethevesicouretericjunction
(VUJ).Thedistalureterabovethisnarrowed
segmentismostdilated(similartoachalasia).There
isassociatedhydronephrosisandactiveperistaltic
wavescanbeseenonultrasound.
•Inrefluxingprimarymegauretervesicoureteric
refluxisdemonstrated.
•Innon-refluxingunobstructed primary
megaureter,thereisabsentoronlyaminordegree
ofhydronephrosis.

240. •Secondarymegaureter
–Posteriorurethralvalves:oftenbilateral
hydroureter/hydronephrosis
–Ureteraldiverticulum
–Urolithiasis
–Duplexcollectingsystemwithrefluxintolower
polemoiety

241. Case 36

242. Retroperitoneal fibrosis
with medial ureteric
deviation

243. Case 37

244. Hutch diverticulum
•Hutchdiverticulaarecongenitalbladder
diverticula,seenatthevesicouretericjunction,in
theabsenceofposteriorurethralvalvesor
neurogenicbladder.
•Theyarethoughttoresultfromaweaknessin
thedetrusormuscleanterolateraltotheureteral
orifice.

245. Case 38

246. Urethral rupture
•Retrograde urethrogram
(RUG) demonstratescontained
extravasationofthecontrastatthe
levelofthemembranousurethra
consistentwithatraumaticinjury.

247. Case 39

248. Small urinoma
following stab

249. Case 40

250. Ureteral leak and
urinoma

251. •Urinomas,oruriniferousfluid
collections,areurinecollectionsusually
foundintheretroperitoneum,most
commonlyintheperirenalspace,asa
consequenceofrenaltractleakage
causedbyurinaryobstruction,trauma,or
post-instrumentation.

252. Thank you