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INTRAVENOUS UROGRAPHY AND ANGIOGRAPY

In what urologic conditions is intravenous urography useful?
Hematuria
Suspected renal obstruction
Pain arising from the urinary tract
Evaluation of postsurgical complications
Recurrent urinary infection
Evaluation of congenital anomalies
Suspected renal calculus disease
Trauma
 
What types of contrast material are available?
Ionic and nonionic
 

What are the risks of intravenous contrast.material?

Allergic reaction and renal toxicity.
 
Who is at ris~ for an allergic contrast reaction?
Those with a prior history of contrast reaction or Of other severe allergies and asthma.
 
Which diseases place patients at high risk for renal toxicity from intravenous contrast material?
Diabetic nephropathy, multiple myeloma, hyperuricosuria, amyloidosis, preexisting chronic renal failure.

 
What is the usual film sequence for urography?
1. Plain film-the kidneys, ureters, and bladder (KUB) must be visualized to evaluate calcifications and bony structures.
2. 1 minute-the nephrogram visualizes the renal parenchyma.
3. 5 minutes--early visualization of the upper collecting system (calices, pelvis, upper ureter).
4. Tomograms-performed to assess renal outlines and fine calcifications. Routine on patients >40 years old and used selectively below age 40.
5. 15/20 minutes-late visualization should include the lower ureters and bladder.
 

What tricks are useful to improve the diagnostic yield?
I. Delayed films-to assess the level of obstruCtion in hydronephrotic kidneys.
2. Plain tomograms-before contrast, these are used to assess renal calcifications.
3. Ureteral compression-a compression band surrounding the lower abdomen,helps to fill the upper ureters better.
4. Prone films--demonstrate better visualization of the pelvic portion of the ureters.
5. Oblique films-help to visualize abnormalities in three dimensions.
6. Postvoid film-provides a better assessment of bladder pathology and residual urine.
 
What features of the IV urogram are useful diagnostically?
1.Plain film-to assess bony structures and any calcifications
2. Nephrogram-to assess function (normal, delayed, or not visualized) .
3. Tomograms--to assess renal outlines for the presence of a mass and to assess smaller calcifications within the kidney
4. Early films-to assess upper collecting system for hydronephrosis, filling defect, distorted calices, malposition, mass
5, Late films-to assess ureter for filling defects, dilation, constriction. The bladder should be assessed for size, filling defects, mucosal pattern (thickened, trabeculated), and shape (teardrop: pelvic lipomatosis; Christmas tree: neurogenic bladder).
 

. What is the differential diagnosis of a filling defect in the bladder?
Stone, tumor, blood clot, middle lobe prostate, foreign body, ureterocele, fungus ball.
 
 

What is the differential diagnosis of a filling defect in the ureter?
Stone, tumor, blood clot, inflammation, fibroepithelial polyp.

 
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