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Imaging the Urogenital System

Imaging the Urogenital System. Tony Pease, DVM, MS Assistant Professor of Radiology North Carolina State University. Reading. Thrall Chapters 42-46. Prostate Gland. Not visible radiographically in normal dogs Enlarges with age, especially if intact Causes for enlargement Cysts

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Imaging the Urogenital System

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  1. Imaging the Urogenital System Tony Pease, DVM, MS Assistant Professor of Radiology North Carolina State University

  2. Reading • Thrall Chapters 42-46

  3. Prostate Gland • Not visible radiographically in normal dogs • Enlarges with age, especially if intact • Causes for enlargement • Cysts • Infection • BPH • Cancer

  4. MILD PROSTATOMEGALY

  5. TRIANGULAR REGION OF FAT AIDS IN MAKING THE DIAGNOSIS

  6. SOMETIMES SEE THE PROSTATE GLAND IN THE PELVIC CANAL ON THE VD

  7. Radiographic evidence of mineralization • Cancer • Chronic prostatitis • In castrated male • Cancer until proven otherwise

  8. Mineralized prostate tumor with metastasis to medial iliac LN

  9. Enlarged - Castrated Normal – Castrated 17 x 20 mm 11mm Tumor 26 x 32 mm

  10. Paraprostatic cyst Two circular soft tissue opacities in the caudal abdomen

  11. Kidneys • Retroperitoneal Organs • Right kidney cranial to the left • Left kidney more variable in location. • Size on VD Dog: 2.5 – 3.5 x length of L2 Cat: 2.4 – 3.0 x length of L2

  12. Kidneys • Cranial pole of the right kidney • Difficult to see • Silhouettes with caudate lobe of liver • With lack of fat • Difficult to see either kidney

  13. Normal dog

  14. Normal dog

  15. Normal Cat

  16. Normal Cat

  17. Mass Effect - Kidney • Kidney masses • Ventral displacement of intestine • Especially colon • A normal size kidney • Still can have disease

  18. Bilateral renal enlargement Right kidney Right kidney Left kidney Left kidney • Lymphoma • FIP • Hydronephrosis

  19. Small Kidneys + Mineralization Line is 2.4x L2

  20. Small Kidneys + Mineralization Line is 2.4x L2

  21. Excretory Urography • Improves morphologic assessment • Poor test of function • Iodinated water-soluble contrast medium • Blood flow • Glomerular filtration • Tubular reabsorption of water

  22. Glomerulus Afferent arteriole I I I I I I I I I I I I I I I I I I I I I I I I I I I I Tubule I I I I I I I H20 I I H20 I I I I I I I I I Iodine concentration increases in tubule as H2O is resorbed

  23. Excretory Urogram • Contrast medium • Ionic water soluble • Non-ionic if patient is compromised • Contraindications • Azotemia + dehydration • Pheochromocytoma • Multiple myeloma • Prior allergic reactions to C.M.

  24. Excretory Urogram Standard Protocol • Survey radiographs • Inject contrast medium rapidly • 400mg Iodine per pound • Approximately 1 ml per pound • Usually do not exceed 50 ml

  25. Projections • Immediate VD radiograph • Vascular phase • Lateral and VD radiographs at 5 minutes • Nephrogram and pyelogram phases • Lat and VD radiographs at 20 and 40 min. • Urogram phase

  26. T=0 T=5 T=20

  27. Urinary tract rupture Left ureter rupture Dilated left renal pelvis & proximal ureter Bladder rupture Loss of serosal detail.

  28. Pyelonephritis • Blunt diverticulae • Dilated pelvis

  29. Misshapen & Pyelonephritis Hydronephrosis

  30. Ultrasound of hydronephrosis

  31. Vaginography Gartner’s duct

  32. Technique • General anesthesia • Foley catheter placed inside labia • Labia clamped to seal outlet • Contrast medium infused • Resistance will often be encountered

  33. Normal Retrograde Vaginogram Vagina Vestibule Urethra

  34. Ectopic Ureters Vagina Ectopic ureters Vestibule Urethra

  35. Urinary Bladder • Easier to evaluate with ultrasound • Very few radiographic urinary tract studies are performed • If suspect bladder problem • Carefully consider relative merits • Radiography versus ultrasonography

  36. Urinary Bladder • To identify significant bladder problems in survey radiographs is unusual • Stones • Gas in wall; rare

  37. Urethral Calculi “BUTT SHOT” useful to assess entire urethra

  38. Emphysematous cystitis • Diabetes (glucosuria) with secondary bacterial infection

  39. Urinary Bladder • Contrast Examinations • Positive contrast cystogram • Put contrast medium in bladder • Negative contrast cystogram • Rarely used • Don’t use room air; use CO2 • Double contrast cystogram • Useful for mucosa assessment

  40. Cystography Double Contrast Cystogram Positive Contrast Cystogram

  41. Urinary bladder masses

  42. Urinary Bladder – Contrast • Double Contrast Cystogram necessary to evaluate bladder mucosa. • Assess: • Serosal margin • Mucosal margin • Bladder wall thickness • Luminal filling defects

  43. Ultrasound is better

  44. Positive contrast cystography • Looking for rupture

  45. Air Embolism • More common in cats • Especially those with hematuria Air in C.V.C. Air around bladder neck

  46. Air Embolism Air in P.A. Air in R.V.

  47. What to do! • Put animal in left lateral recumbency • Elevate the tail • This makes the right ventricle the highest point • Traps air before getting to lungs

  48. What not to do! • Scream • Panic • Cry

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