Normal KUB-IVPGUT Viewbox

Ma. Mercedes Victoria M. Tanchuling

What is it?

Intravenous Pyelogram• Assessment of the urinary tract through the

injection of a radio-opaque dye, after which a series of films are taken over a span of 15-20 minutes

• Gives excellent anatomical images of the pelvicalyceal systems and an indication of renal function

Indications & Preparation

• Lumbar pain, hypertension, palpable abdominal mass, hematuria (>10 RBC/hpf)

• Prior to IVP, the patient must be:– NPO 8 hours prior to the study– Laxatives for cleansing

• BUN/Crea must be checked to make sure patient can clear the contrast media

• Check for history of asthma and allergies must be verified in order to avoid possible allergic reaction with the contrast media

Types of Contrast

• Ionic – more allergenic– hyperosmolar– cheaper (~P400)

• Non-ionic– hypoallergenic– less osmolar– more expensive (~P1500)

Patient Preparation• Night before the exam:

– Very light supper– At 7PM, let patient take in 4 Dulcolax tablets and 60cc

castor oil.– From 7PM onwards, NPO but patient can still drink 1

glass of water per hour until 12 midnight.– At 5AM, rectal suppository• Patient should empty bladder before the procedure• All films should be taken at deep expiration

Procedure

• Contrast media is injected into the arm intravenously, excreted by the glomerular filtration

• X-ray films are taken at the following intervals:– 3 minutes (supine)– 5 minutes (supine)– 10-15 minutes (prone) COMPRESSION APPLIED– Post-void(upright)

BONES VISCERA COLLECTING SYSTEMBONES VISCERA

•Psoas Line obliterated? Retroperitoneal mass

•Liver

•Spleen

•May show : metscortical thinningdegenerative changes

•Pelvis•Vertebrae

COLLECTING SYSTEMVISCERA

•Bean Shaped, smooth outline

10-15 cm long, 5cm across, 2.5cm thick

T12-L3 Left > Right by 0.5cm Right lower than Left

by 2cm Calyces are cupped,

not splayed

KIDNEYS• Normally hard to see!

•8mm diameter, vertical descent parallel to vertebra

3 areas of narrowing:1. Ureteropelvic junction – most common place

of obstruction

2. Ureterovesical junction3. Bifurcation of the iliac vessels

URETERS•Regular smooth appearance and complete voiding

•Smooth mucosa; ovoid

•Dome is round in males, flat in females (due to uterus)

BLADDER

Inject contrast material

3 minutes

• More or less an opacification of the intrarenal collecting system

kidneys and upper

collecting system

visualized

5 minutes

contrast is seen passing through the calices and pelvis

contrast is seen passing through the calices and

pelvis

5 Minutes

5 Minutes

Pelvis and ureters opacifying

10 Minutes

10 Minutes, oblique view

Ureteral filling

Check for stones!

20 minutes

1.full bladder has very smooth borders2.“dapat bilog na”

full bladder has very smooth borders

Post-void

to check urinary retention

<50 cc

you can still see some degree of

contrast in various areas of the GU system

References

Adam, Dixon. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed.

Brant and Helm. Fundamentals of Diagnostic Radiology. 3rd ed.

Dyer, RB et al. Intravenous Urography: Technique and Interpretation. Journal of Radiographics, Volume 4:21, August 2001.