8/14/2017. Kidney location & visualization. Brief Review with tips & Case Based Illustrations. Size = x L2. Size =
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1 Dr. Russell Tucker, DACVR Brief Review with tips & Case Based Illustrations Kidney location & visualization K9 Kidneys: T13-L1 L2-L4 Kidney visualization K9 Kidneys: T13-L1 L2-L4 Size = x L2 L2 Kidney visualization Size = x L2 1
2 IV iodinated contrast (15min) 880mg I/kg (400mg I/lb) give as bolus Superimposed - Rt & Lt kidneys superimposed but not in contact Opacification of kidneys, ureters & urinary bladder +flank band compression Ectopic ureter w/ air in bladder to help visualize the entrance 7 year old M/C miniature schnauzer Previous history of urinary blockage 7 year old M/C miniature schnauzer Previous history of urinary blockage a) Bladder stones b) Kidney stones c) Urethral stones d) All of above a) Bladder stones b) Kidney stones c) Urethral stones d) All of above 2
3 7 year old M/C miniature schnauzer Previous history of urinary blockage 8 year old FS mix Recurrent UTI s Urethral Calculi ~ pull legs forward * evaluate entire urinary system Renal Calculi feces over both kidneys 8 year old FS mix K9 Recurrent UTI s Enema to clean out colon 8 year old FS mix K9 Recurrent UTI s Barium painted on nipple 5-10 cc/kg (cats ½ volume) 2-5 cc/lb Bone/water Liver/water Fat/water Air/air positive contrast Bone/fat Liver/fat Fat/fat Water/water negative contrast Palpate while distending bladder! double contrast 3
4 center squares identical, but look different gray shades in the different surrounding backgrounds Horizontal beam Fluoroscopy exam: ruptured bladder Deflated bladder on US Requires positive contrast to visualize Retrograde urethrography Normograde urethrography 1. Uniform kidney opacification 2. Diverticula & renal Normal nephrogram pelvis excretion 3. Proximal ureters peristalsis of ureters Helpful to have bladder distended Dose dependent on size 4
5 Uniform enhancement 1. nephrogram phase ~ symmetric kidneys 0-10 min Ureter opacification min 2. pyleogram phase +/- compression band occlusion Bladder filling Ureter entering trigone 3. clearance phase min compression applied: - left & right ureters Early phase Collection phase Clean out colon before IVP performed! Severe hydronephrosis & hydroureter R L Transverse at bladder Dorsal reconstruction Sagittal reconstruction Severe hydronephrosis & hydroureter! R L 5
6 Dribbling urine for 1 year, especially when sleeping or relaxed Dribbling urine for 1 year, especially when sleeping or relaxed left right Nuclear Scintigraphy Tc-99m attached to agent filtered by kidneys Dynamic acquisition (0-3mins) create composite image: Dark = TC-99m accumulation Rt kidney >>> Lt kidney L Kid R Kid Legs forward Dorsal view Dribbling urine for 1 year, especially when sleeping or relaxed Dribbling urine for 1 year, especially when sleeping or relaxed RK CT 3-D volume recon LK Misshapen left kidneyhydronephrosis Bladder Dribbling urine for 1 year, especially when sleeping or relaxed Dribbling urine for 1 year, especially when sleeping or relaxed Misshapen left kidneyhydronephrosis Misshapen left kidneyhydronephrosis Left hydroureter Left hydroureter Left ectopic ureter 6
7 Enlarged right kidney? Ureter stone obstruction Enlarged right kidney Enlarged right kidney a) Ultrasound b) Excretory urography c) Exploratory surgery d) Renal biopsy or FNA right kidney & ureter Enlarged right kidney a) Renal ultrasound b) Excretory urography c) Exploratory surgery d) Renal biopsy or FNA 7
8 TCC Urethra Resource for contrast exams: Handbook of Veterinary Contrast Radiography- by Seth Wallack (2003) -Indications -Contraindications -Contrast agents & Doses -Exam descriptions -Interpretations Amazon.com Or $50 soft cover text 8
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