Imaging aspects in reno-urinary pathology Flashcards
Retroperitoneal space
Limits (Anterior,posterior)
2 compartments
Limits – anterior: posterior parietal peritoneum
– posterior: fascia transversalis
◼ Lateral compartment ◼ perirenal space ◼ anterior pararenal space ◼ posterior pararenal space ◼ Median compartment
Lateral compartment
spaces
- Anterior pararenal space
- Perirenal space
- Posterior pararenal space
Anterior pararenal space
◼ posterior parietal peritoneum
◼ anterior perirenal fascia (Gerota)
◼ contains pancreas, duodenum, ascendent colon, descendent colon and fat
Perirenal space
◼ anterior perirenal fascia (Gerota)
◼ posterior perirenal fascia (Zuckerkandl)
◼ contains fat and kidney
Posterior pararenal space
◼ posterior perirenal fascia (Zuckerkandl)
◼ fascia transversalis
◼ contains fat
◼ comunicates with anterior pararenal space (caudal)
Median compartment
Vessels – aorta, ICV
◼ Diafragmatic insertion
◼ Lymph nodes (N < 1 cm)
Normal anatomy - kidneys Position Dimensions Contours Orientation
Position – T11-T12 – L3-L4
– mobile în inspiration and ortostatism
◼ Dimensions – 8-12 cm longitudinal (21⁄2-31⁄2 vertebras)
– 6-7 cm transversal
◼ Contours – smooth convex inadult
– slightly policyclic < 5 y child (fetal
lobulation)
◼ Orientation – longitudinal axis convergent to T10
– renal hilum anteriorly orientated
Normal anatomy – excretory system
- Pyelocaliceal system,
- ureters,
- urinary bladdder,
- urethra (with i.v. Iodine contrast media)
5.Hodson line (interpapilary) imaginary line through the periphery of PCS
◼ Parenchimal index – ratio between distance Hodson line to ext. contour /transvers diameter (normally ~ 1⁄2 in the m)
Pyelocaliceal system (PCS)
◼ caliceal cups – concave in profile/circle in orthograde view
◼ caliceal ducts– minor and major
◼ renal pelvis – triangular shape
– projected Bazy-Moyrand quadrant
Ureters
intermitent and tranzitory opacification
(normal peristaltic)
◼ lombar – paralel to lombar spine
◼ iliac – projected on the sacral and iliac bones
◼ pelvic – oblique trajectory towards urinary bladder
◼ intramural – projected in Robert-Gayet quadrant
Urinary bladder (UB)
◼ inf. limit projected above the pubic bone
◼ variable shape depending on the filling degree
◼ max. volume 400-500 ml
◼ anatomic neighbours – uterus/prostate
Urethra
◼ male – posterior (prostatic + membranous)
– anterior (bulbar + penian)
◼ female – short, 2-3 cm
Imaging methods
◼ Ultrasound (US) ◼ Kidney urinary bladder radiography (KUB) ◼ I.v. pielography (IVP) ◼ Computerised tomography (CT) ◼ Magnetic resonance imaging (MRI) ◼ Renal scintigraphy ◼ Angiography ◼ Special methods ◼ anterograde/retrograde pielography ◼ anterograde/retrograde uretrography
Reno-urinary US – normal
◼ Probes 3,5 Mhz (adult), 5Mhz (children),7,5-10 Mhz (endorectal, endourethral)
◼ Kidneys – homogeneous parenchima, hypoechoic in comparison with hepatic/splenic parenchima
–hyperechoic sinus
◼ Doppler US – blood flows measurements
◼ Urinary bladder – anechoic content (fully filled)
– wall thickness under 2 mm
– sonic “window” for uterus and prostate
◼ Endorectal –prostate examination
◼ Very useful for interventional (drenaige, biopsy) – real time
Reno-urinary US
Indications and Limits
◼ Indications ◼ obstructiv sindr. ◼ renal or urothelial mass sindr ◼ prostate hipertrophy (endorectal) ◼ renal artery stenosis (Doppler) ◼ renal/IVC thrombosis (Doppler) ◼ interventional
◼ Limits
◼ air/bone presence
◼ operator dependent
KUB
◼ technical – last 2 ribs ( sup.)
- pubic symphisis (inf.)
◼ Look for ;
◼ calcifications – reno-urinary (renal parenchima,
lithiasis, prostatic … )
- extraurinary ( arteries, gallblader, pancreas, lymph nodes..)
◼ renal shadows - position, dimensions,contours, intensity
◼ psoas muscle shadow
