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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_848_Библиотеки_им_академика_М_И_Перельмана
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URETERIC STONES
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Chapter 17: Genitourinary
83
Figure 3: This is a digital skiagram of KUB region anteroposterior view with upper part of pelvis showing a radiopaque shadow in left paravertebral
Figure 4: This is a digital skiagram of KUB region anteroposterior view with upper part of pelvis showing a radiopaque shadow in right pelvic region
region at level of L
suggestive of right sided lower ureteric calculus
vertebra suggestive of left sided midureteric calculus
4
ierential Diagnosis
D
On basis of X-ray:
Calcied lymph nodes
Fecoliths/Phleboliths.
ey Points
K
Common locations for ureteric stone (usually at sites of
physiological constrictions of ureter)
At pelviureteric junction (PUJ)
At pelvic brim
Entry of ureter into bladder (Vesicoureteric junction).
(Crossing of iliac vessels)
84
Section 3: X-rays
URINARY BLADDER STONE (VESICAL CALCULUS/CYSTOLITH)
Figure 5: This is a digital skiagram of KUB region anteroposterior view with upper part of pelvis showing two radiopaque shadows in pelvic cavity at the
Figure 6: This is a digital skiagram of KUB region anteroposterior view with upper part of pelvis showing a radiopaque shadow in pelvic cavity at the
level of coccyx and pubic symphysis suggestive of multiple urinary bladder calculi
level of coccyx suggestive of urinary bladder calculus
ierential Diagnosis
D
Calcied bladder polyp
Calcied lymph nodes
Phleboliths.
ey Points
K
Removed surgically by either open cystolithotomy or
cystoscopy assisted removal of bladder stone.
Chapter 17: Genitourinary
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
INTRAVENOUS UROGRAPHY (IVU)
85
Figure 7: This is a digital intravenous urogram showing normal pelvicalyceal system of both kidneys with normal
ureters with normal excretion of dye in the bladder in the last lm suggestive of a normal intravenous urogram
Figure 8: This is a digital intravenous urogram showing two radiopaque shadows in paravertebral region on the right side
just below the costal margin in early secretory phase of intravenous urogram suggestive of right sided renal calculi
86
Figure 9: This is a digital intravenous urogram showing cystogram and post-void lms with a radiopaque density in midureter on right side and the other
radiopaque density at pelviureteric junction on left side with prominent pelvicalyceal system in bilateral kidneys with minimal passage of contrast into
the bladder suggestive of bilateral ureteric calculi with bilateral hydronephrosis
Section 3: X-rays
ndication
I
To check function of kidneys
Anatomical or congenital anomalies of kidneys, ureters
and bladder
Nephrolithiasis or ureteric stone.
ontraindications
C
Allergy to contrast media
Severe cardiac illness
Renal insuciency (Serum creatinine levels more than
1.5 mg/dl)
Suspected urinary tract trauma.
imitations
L
Depends on kidney function
Does not dierentiate solid vs cystic lesion
May miss small stones.
ethod
M
Oral purgative and anti-atulent tablets are given in the
night before the procedure
A digital X-ray of KUB region is done without injecting
contrast
Urogran 76% (sodium diatrizoate) is then injected
intravenously and serial X-ray lms are taken to visualize
following phases:
Time Phase Visualize
10–30 sec Nephrogram phase Contrast in renal
tubules
5–15 min Secretory phase Filling of pelvi-
calyceal system
30 min Ureterogram phase Filling of ureters
45 min Cystogram phase Filling of urinary
bladder
After micturition Post-void lm Residual urine
Chapter 17: Genitourinary
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
URETHROGRAMS
It refers to the radiographic study of the urethra using iodina ted contrast media and is generally carried out in males.
ndications
I
Pelvic trauma
Urethral strictures
Urethral diverticula
Urethral stulas
Problems in urinary stream
Urethral foreign bodies.
TYPES
Retrograde Urethrography/Ascending Urethrography
Urethra is studied with instillation of contrast into distal or anterior urethra
Dye is given through a Foley catheter whose tip is in the navicular fossa and balloon inated outside to make a seal
Helpful in visualizing anterior urethral abnormalities.
87
Figure 10: It is a retrograde urethrogram in AP view and left oblique view showing normal anterior urethra with multiple narrow patchy contrast lled
areas in posterior urethra suggestive of multiple partial urethral strictures in posterior urethra
88
Section 3: X-rays
Micturating Cystourethrography/Descending Urethrography
Posterior urethra is studied during micturition by instilling the dye in the bladder directly
Dye can be given either through a Foley catheter inserted per urethrally into the bladder or it can be directly instilled
into bladder through a suprapubic approach with the help of a syringe
Helpful in visualizing posterior urethral abnorma lities, bladder abnormalities and to diagnose vesicoureteral reux
(VUR) in children.
Figure 11: It is a micturating cystourethrogram in AP view and left oblique view showing dilated contrast lled posterior urethra and
minimal contrast in bulbar and penile part of urethra suggestive of a urethral stricture at junction of bulbar and membranous urethra
Chest
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CANNON BALL METASTASES
Chapter
18
Cannon ball metastases refers to large, well-circumscribed, round pulmonary metastases that appear like a cannon ball.
Figure 1: This is a digital skiagram of chest PA view showing multiple round opacities in both lung elds suggestive
ierential Diagnosis
D
Carcinoma lungs
Miliary tuberculosis
Fungal infections
Occupational lung diseases
Tropical eosinophilia
Sarcoidosis
Rheumatoid nodules.
of cannon ball metastases in bilateral lungs
ey Points
K
Spread to lungs occur via hematogenous/lymphatic/
intrabronchial/direct spread
It indicates advanced disease and mainly palliative
treatment is advocated
It is important to take history of a known carcinoma.
90
Section 3: X-rays
HEMOTHORAX DUE TO CHEST INJURY
Figure 2: This is a digital skiagram of chest PA view showing fracture of 4th and 5th rib on left side of chest along with blunting of
ierential Diagnosis
D
Pleural eusion
Empyema thoracis
Hydropneumothorax.
left side costophrenic angle post-trauma suggestive of left sided hemothorax
ey Points
K
Always look for associated rib fracture in chest injuries
Flail chest: When 2 or more ribs are fractured at 2 or more
points, then that segment of rib cage shows paradoxical
movement during respiration (moves outwards with
expiration and inwards with inspiration)
Intercostal drainage or thoracotomy may be required in
such patients.
Miscellaneous
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WANGENSTEENRICE INVERTOGRAM
Chapter
19
It is an X-ray investigation in which a metal object is taped
over the anal dimple, the child is held upside down and an
X-ray of the pelvis is taken in a lateral view.
ndication
I
Anal atresia.
Figure 1: This is a digital invertogram in AP and lateral view showing a signicant distance (calculated on computer) between the coin placed on the
anal dimple and the rectal gas shadow suggestive of anorectal anomaly
92
Section 3: X-rays
Figure 2: Similar type of invertogram as described previously.
TYPES
High lesions - Rectum ends above the level of levator
ani complex. The coin-gas shadow distance is more
than 2 cm.
Low lesions - Rectum ends below the level of levator
ani complex. e coin-gas shadow distance is less than
2 cm.
ey Points
K
This is only useful 6–12 hours after birth as this is the time
gas needs to reach the distal rectum.
The distance between coin and rectal gas shadow is
calculated on a computer and not on the actual X-ray.
Low lesions are treated with perineal anoplasty.
High lesions require initial protective colostomy followed
by posterior sagittal anorectoplasty (PSARP) 4–8 weeks
later.
FISTULOGRAM/SINOGRAM
Fistulograms and sinograms are imaging scans used to
look at a passage in the body. A stulogram shows a stula
and a sinogram shows a sinus tract.
SINUS
It is a blind ending tract, usually lined with granulation
tissue that leads from an epithelial surface into the
surrounding tissue, often into an abscess cavity.
FISTULA
It is an abnormal communication between the lumen
of one viscus and the lumen of another viscus or the
body surface. In other words, stula is an abnormal
communication between two epithelial lined surfaces.
ethod
M
The tip of a small plastic cannula is inserted into the
external opening of suspected sinus/stula and contrast
dye (usually urogran) is pushed through it.
Serial X-ray lms are taken to identify the course of tract.
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