Faculty of Radiology

Excretory
1
OS 214
Laboratory Skills Session: Radiology

Outline:
I. Interpretation of Imaging Results
II. CT Scan
III. Ultrasound
IV. X-Ray

NOTE: NO COPY OF THE PPT WAS GIVEN. HENCE, THE IMAGES IN THIS TRANS ARE STOLEN
PICTURES OF THE PPT.

It is important to develop the skill, early on, in

detecting the most common diseases that one will
encounter in his/her medical practice. With that, we have
been presented with the imaging results of the typical
diseases in the country.

INTERPRETATION OF IMAGING RESULTS

Ptotic or Pelvic Kidney

• Wandering kidney
• The normal level of the kidney is T12 to L3 and the left
kidney is normally higher by 2 cm. Crossed Ectopy
o Sometimes it starts at T11. • Aberrant position of the kidneys and the lateral
o For the ptotic kidney, the level is lower than this. positioning of the calyces.
• On chest X-ray, a pulmonary mass may be seen. Make • There could be formation of kinks and predispose one to
sure that this is not a kidney as there have been cases the formation of stones.
of intra-thoracic kidney. • The two kidneys could be on one side. In this case, both
• Common complaints of pain and dysuria kidneys are lower than the normal level.
• Possible complication is infection.

Renal Cortical Cyst

• On ultrasound, it is hypoehoic.
• On X-ray, it is seen as lucency within the renal shadow,
which is typically increased in this case.
• The overlying bowel segments can be confused as
cysts.
• Claw or Beak Sign where in the calyces are compressed
making them appear like a lobster claw.

Horseshoe Kidney
• The inferior pole of each kidney is connected to each
other.
• Usually, the ureters are normal. However, sometimes,
the ureters might be caught up.
• Possible complication is infection.
• A good exam question but we rarely see it.
Polycystic Kidney Disease
• Multiple cysts
• On CT scan, it is seen as hypodensities that are fluid
filled.
• It can exist by itself or with other diseases.
• Can be found in obese women with hormonal problems.

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 1 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

GU TB
• Waste basket
• It might be TB when one doesn’t know what is going
wrong
• Calcifications are the most common manifestation of TB
in the renal system.
• It can cause strictures.
• If one has GU TB, most probably the patient had already
presented with pulmonary symptoms. However, there
could be cases when there are no pulmonary symptoms
and the TB is already disseminated to the other
systems.

Duplication Anomalies
• The most common congenital anomaly
• Duplication of collecting system
o It could be the pelvocalyx or the ureter.
• Weigert-Meyer Rule
o 2 moieties drained by 2 collecting system
o The lower ureter drains 2/3 of the kidney and is prone
to obstruction.
o The upper ureter drains 1/3 of the kidney and is more
associated with hydronephrosis.

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 2 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

• On X-ray, it can be seen as hypolucencies in the kidney.

• Enlarged renal shadow with air pockets within.
• Normal size of the kidney based on US values is 10-15
cm. In the Philippines, it’s about 6-8 cm. It can be
normal as long as it is within this reference ranges. Start
thinking it’s pathologic when the difference in size in
both kidneys is more than 1.5 cm.

Nephrocalcinosis
• Calcification of parenchyma
o 95% at the medulla
o 5% at the cortex
• Usually, bilateral.
• It follows the shape of the renal pyramids.
• Nephrolithiasis usually conforms to the contour of the
pelvocalyx. If it is of the staghorn type, it is managed
surgically.

Pyelonephritis
• Enlargement of solitary kidney
• Perilesional fat stranding
o Sign of inflammatory process.
o It could be infection or carcinoma

Urolithiasis
• Stone anywhere in the urinary tract
• Staghorn calculus
• Bladder calculus or cystolithiasis
o Pathognomonic sign is lamellated, ovoid/circular,
overlying the urinary bladder within the pelvic cavity.

Renal Abscess
• On CT scan, it can be seen as mixed echoic focus,
heterogeneously enchancing.

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 3 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

Bladder Mass
• There is filling defect.

Bladder Exstrophy
• Widened symphysis pubis
o Normal value is 5 mm. If more than this, check for
Renal Cancer history of trauma.
• Differential is abscess. • Outline of bladder protruding
• Mixed attenuating, heterogeneously enhancing. • If post-partum, the symphysis pubis is normally laxed
• It leads to necrosis giving rise to fluid and solid reaching about 7-10 mm. It will take 2 weeks to 1 month
densities. Hence, there will be hypo- and hyperdensities. before it returns to normal.

Cystitis
• Infection of the bladder
• Irregular lining
• Thickened mucosal lining Bladder Diverticulum
• Christmas tree sign • Outpouching of the bladder
• Can be seen as Mickey Mouse.
• It can lead to urinary tension.
• Symptom is urgency.
• There is urine retention and incomplete emptying of the
bladder.

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 4 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

Prostatomegaly
• Filling defect at bladder base
• Increased incidence among males, age more than 50
and if presenting with dribbling and hesitancy.

CT SCAN

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 5 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

• Used to image the GU system

• Cystonogram can detect stones within the GU tract.
• Done in a cranial to caudad direction.
• Ask the patient to ingest fluids to so the bladder will be
full and can be assessed adequately.
• Hyperdensity
o Whitish and similar to bone
• Isodensity
o Like soft tissue
• Hypodensity
o Gray to dark gray and like fat
• Circle function is used to assess the composition.
o -1000 or lower
 Air
o -40 to -100
 Fat
o0
 Water
o 40 to 80
 Soft tissue
o 50 to 75
 Fresh blood
o 100 to 1000
 Osseous structures
• Ounce/unit is used to characterize densities.
• If the kidney is smaller and no long appear as bean-
shaped, it is more diseased.
• To check cortical thickness, do NOT use CT scan. Use
ultrasound.

ULTRASOUND
• Curvilinear probe is used for deeper structures.
• Linear probe is used for superficial structures.

X-RAY

GREETINGS

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 6 of 7

 Faculty of Radiology
Excretory
1
OS 214
Laboratory Skills Session: Radiology

Tin:

Ricky:

LeeAnn:

Dalvie: Hello! And Yes! Mara is back! Alive na Alive! And oh oh

oh! I am Number 10! I am Number 4 is just soooooo! Pak na Pak!
Haaay. Better than Twilight series. But I still love Twilight. And
Enrique Gil is back! Mula sa Puso Remake! I so love Thia (Pinoy
Power) and Stefano! American Idol Season 10! May GOD BLESS
you all!

Kristina, Richard, Leah, Dalvie THURS, March 10, 2011 Page 7 of 7