MRAD 4218 Module 7 Pathology

Urinary Pathologies

Pyelonephritis: Retrograde Urography

Shows blunting and blurring of the calyces

Pyelonephritis: Intravenous Urography

Demonstrates the right infected kidney

Ureter appears widened and there appears to be a mass in the abdomen

Hazy appearance of the right contrast filled renal pelvis compared to the left

Due to edema

Pyelonephritis: Retrograde Urography

Infected right kidney w/ haziness and dilation of the contrast filled renal pelvis

Pyelonephritis: CT w/ Contrast

Image shows enlargement of the calyceal areas surrounded by edema in the left kidney

Left kidney appearance is quite spotty

Indicates decrease of renal function of the left kidney

Pyelonephritis: CT Non Contrast

Shows edema throughout the right kidney consistent w/ infection

Pyelonephritis: CT w/ Contrast

Coronal image demonstrates the enlargement of the left kidney caused by the infection

Very little functioning of the left kidney

Renal Calculi: Stone sitting on the right transverse process of L3

Renal Calculi: Staghorn Calculus

Taken over the renal pelvis and calyces

Renal Calculi: Intravenous Urography

Timed sequence of images is showing the delayed function of the left kidney due to a stone in the lower ureter (yellow arrow)

Renal Calculi: Image demonstrates the back up of contrast caused by two radiolucent stones (yellow areas) in the ureter

Renal Calculi: Non-contrast CT

Bilateral renal calculi seen within the renal pelvis

Renal Calculi: CT Staghorn Calculi

Demonstrates the entire renal pelvis filled w/ renal calculus, bilaterally

Renal Calculi: Non-contrast CT

Stone in the UVJ, one of the most common sites for renal calculi to get stuck

Hydroureter/Hydronephrosis: Intravenous Urography

Demonstrates bilateral hydronephrosis

The right is more dilated than the left

Hydroureter/Hydronephrosis: Right sided hydronephrosis

Notice the contrast enhancement of the entire kidney - due to the hydronephrosis slowing down the ability to filter out contrast from the blood

No obvious dilation of the ureter

Hydroureter/Hydronephrosis: Retrograde urography

Demonstrates a stone that has caused severe Hydroureteronephrosis

Radiolucent renal calculus seen (yellow arrow)

LPO will help visualize the right distal ureter free from SI of the bladder

Hydroureter/Hydronephrosis: CT w/ Contrast

Demonstrates an obstructive renal calculus in the right renal pelvis (yellow arrow) causing dilation of the calyces

Note the enlargement of the kidney

Hydroureter/Hydronephrosis: CT non contrast

2 coronal slices demonstrating multiple renal calculi (yellow arrows) bilaterally

Red arrow is causing Hydroureteronephrosis

Note the dilation of the right renal pelvis

Hydroureter/Hydronephrosis: CT Hydronephrosis

Massive long standing hydronephrosis caused by a 32mm calculus in the right renal pelvis

Non-functioning kidney

Vesicoureteral Reflux: Massive ureterovesical reflux in this child w/ hydroureteronephrosis bilaterally

Vesicoureteral Reflux:Bilateral reflux w/ a very small bladder in this infant

Vesicoureteral Reflux: Bilateral reflux w/ the right side (yellow arrow) causing hydroureteronephrosis

Left side is only demonstrating hydronephrosis

Irregular outline of the bladder indicates thickening and scarring of the bladder most likely due to repeated bladder infections

Vesicoureteral Reflux: Demonstrates unilateral reflux in adult patient

Cystitis: Cystogram

Demonstrates the roughened inner surface

Cystitis: Pelvis Radiograph

Yellow arrow demonstrates the lucent air within the bladder of this patient w/ Emphysematous Cystitis

Cystitis: Air demonstrated within the bladder wall of this PT w/ Emphysematous Cystitis

Cystitis: Thickened bladder wall

Cystitis: thickened bladder wall

Duplication: Intravenous Urography

Incomplete duplication as the upper and lower ureter unite at the pelvic brim (yellow arrow)

Duplication: Bilateral duplex system

Left side of the ureters merge at the level of L3 = incomplete duplication

Right side has a complete duplication as both right ureters are still seen in the lower pelvis (yellow line) continuing posterior into the bladder

Duplication: Single side duplication on right side w/ ureters uniting at the level of L4/5 joint space

Cystography

Massive left sided hydronephrosis seen w/ duplex collecting system

Ureters are fused just prior to the UVJ

Duplication: Both ureters on both sides fuse prior to entry into the bladder

Multiple cysts seen in both kidneys

Duplication: Incomplete duplication with the ureter uniting

Duplication: Duplication on the left side

Right side demonstrates pyelonephritis

Duplication: Right side duplication

Note the upper pole and ureter demonstrates hydronephrosis/hydroureter due to the insertion site of the ureter - it enters at the prostatic urethra, thus is unable to empty properly

Ectopic Kidney: Thoracic Kidney

Arrow indicates a portion of the kidney above the diaphragm

Note the kidney is mal-rotated as the renal pelvis is pointed more anterior than medially

Ectopic Kidney: Thoracic Kidney

Chest and associated CT demonstrating a thoracic ectopic kidney

Ectopic Kidney: Thoracic Kidney

Intrathoracic right kidney, through a posterior defect at right hemidiaphragm

Ectopic Kidney: Bilateral Pelvic Kidney

Neither kidney ascended from the pelvis

Ectopic Kidney: Right kidney is in normal position, left kidney is in pelvis

Ectopic Kidney: Left kidney partially ascended but still considered pelvic

Ectopic Kidney: Pelvic kidney better visualized in LPO

Ectopic Kidney:Cross fused ectopia

Left kidney has ascended to the right side

Two kidneys are fused together

Ectopic Kidney: Right kidney has crossed and fused to the left kidney

Ectopic Kidney: Not quite into the thoracic cavity but would be considered thoracic based on their location

Horseshoe Kidneys:

Horseshoe Kidneys: AXR demonstrates multiple renal calculi (yellow arrow)

Red arrow indicates a large calculi causing hydronephrosis

Horseshoe Kidneys: Shows hydronephrosis in both kidneys (arrowheads) as well as demonstrating the isthmus (center arrowhead)

Horseshoe Kidneys: Non contrast image shows a 23mm sone in the RT pelvis and a 13mm stone in the LT pelvis

Horseshoe Kidneys:

Ureterocele: Renal calculi present in pelvis on the non-contrast image

Bilateral "cobra heads" seen in the bladder  indicating ureteroceles

The right one is in the same area as the renal calculi

The left ureter has some moderate dilation associated w/ the ureterocele

Ureterocele: Non-contrast image has 2 suspect areas (renal calculi) which confirmed on the contrast image to be sites of bilateral ureteroceles

Notice each of these kidneys is duplex in origin. Therefore the ureters coming from the superior pole would be the ones w/ the ureteroceles

Ureterocele: Bilateral ureteroceles w/ the left being substantially larger than the right

Ureterocele: Bilateral ureteroceles seen, each w/ hydroureteronephrosis

Ureterocele: Ureterocele was an incidental finding

Prolapse right through the UVJ

Ureterocele: Voiding Cystourethrography

Image shows a large ureterocele (yellow arrow) partially obstructing the urethra on this image

Ureterocele: Large renal calculus seen on CT

MR shows that there is a ureterocele present at that site

Prolapse through the UVJ

Renal Hypertension/Stenosis: Renal artery narrowing on the right side (yellow arrows)

Renal Hypertension/Stenosis: Right sided stenosis

Renal Hypertension/Stenosis: PT w/ Fibromuscular dysplasia demonstrating bilateral renal stenoses

Renal Hypertension/Stenosis: String of beads demonstrated on PT w/ Fibromuscular dysplasia

Renal Hypertension/Stenosis: Multiple stenoses areas (red arrows) in both renal arteries

Renal Hypertension/Stenosis: Bilateral stenoses (yellow arrows) seen in this MR image

LT iliac artery stenosis

Renal Hypertension/Stenosis: Unilateral RT renal stenosis demonstrated (yellow arrows)

Renal Hypertension/Stenosis: Left fully occluded renal artery (yellow arrow)

Renal Hypertension/Stenosis: Pre and post stent insertion

Renal Hypertension/Stenosis: Bilateral stenoses w/ stent insertion

Renal Cyst

Renal Cyst: Large renal cyst in the right kidney - somewhat unusual as most times they are found in the lower pole

Renal Cyst: Note the stretched calyces as normal tissue is being stretched by the large cyst in the right kidney

Renal Cyst: Angiography

Note the cyst itself does not fill w/ contrast

The cyst is displacing normal kidney tissues in these images

Renal Cyst: US and CT

Comparative images demonstrating a slightly hyperdense cyst

US demonstrates that it is still fluid filled

Renal Cyst: CT

Tumor does not enhance w/ contrast

Renal Cyst: 2 cysts in the right kidney, one in the left

Renal Cyst: Non-enhancing right lower pole renal cysts

There are some slight linearities within it may indicate that it is multicameral

Renal Cyst: Multiple bilateral cysts

Top image is T1 w/ no enhancement

Bottom image is T2 w/ enhancement of the cysts

Renal Cyst: TYPE IV Cyst

This is malignancy

Note the uneven thickening of the walls

Have enhanced under contrast as per the report

Report also indicated some calcification as well as "eccentric soft tissue components" within the cyst

PKD

PKD: Demonstrates non-enhancing cysts Note all the areas of calcification with the kidneys (yellow arrows)

Notice the cysts in the liver (red arrow)

PKD: Multiple calcification throughout the abdomen representing cyst calcifications in this PKD patient

PKD: Enlarged kidneys with multiple cysts throughout

PKD: Note the multiple cysts in both kidneys

Notice the odd shape these cysts have given the left kidney

PKD: Right kidney very enlarged

Mass of cysts and the tissue surrounding them is non functioning

PKD: In the non contrast scan, the cyst are barely visible

Multiple cysts seen when contrast is introduced

PKD: T1 images show no enhancement

T2 give a great indication of how extensive the PKD

PKD: Massively enlarged distorted kidneys seen on this T2 image

RCC

RCC: Right sided lesion

Notice the non-homogeneous nature of the tumor and the thick, uneven walls of it

RCC: Left sided lesion

Enlarged tumor w/ decreased function, when compared to the right side

Most of the normal structure has been destroyed

RCC: Multiple slices demonstrating an enlarged tumor mass w/ some necrosis in the inferior portion of it

RCC: 4 scan phases

Non-contrast the tumor blends in w/ the rest of the kidney

Necrotic tissue is seen in both the cortical and parenchymal phases

RCC: Demonstrates the necrosis very well

RCC: T+ demonstrates the arterial enhancement of the kidney as well as the non-homogenous density of the tumor

RCC: In the arterial enhancement image, there is very uneven enhancement and an area of necrosis in the lateral margin of the right kidney

RCC: Cyst vs. Tumor

Note the smooth, rounded border of the cyst compared to the tumor which is not as delineated

Bladder Carcinoma: Demonstrates a superficial bladder cancer w/ vascularization seen in the doppler image

Bladder Carcinoma: Two superficial bladder masses

Note they are similar in HU to the bladder wall (yellow arrow)

Bladder Carcinoma: Very small superficial tumor as indicated by the black arrow

Bladder Carcinoma: Invasive bladder cancer

Note the fine line of "crusted" calcification (yellow arrow) as well as the irregular thickened wall on the left side