Bno Ivp 4z1c43

BNO-IVP Delviana M.

BNO

Nier, Overzicht, Blass

Kidney, Ureter, Bladder

Foto Polos Ginjal, Ureter, Kandung Kemih

IVP

Intravenou s Pyelogram

Pielografi Intravena

IVP  Untuk melihat struktur ginjal, ureter, kandung kemih 

Batu



Tumor



Urinary Tract Infection



Back or Flank Pain



Trauma

 Menggunakan kontras  Resiko alergi dan toxic

Kontraindikasi BNO-IVP 

Riwayat alergi, kontras (Iodine)



Hamil



Menyusui (setelah 2 hari dapat kembali menyusui)



Intrauterine Device



Gangguan fungsi ginjal 

Kreatinin (N=0.5-1.2 mg/dL)



Blood Urea Nitrogen (N =10-20 mg/dL)



BUN : kreatinin ratio (N=6-25)



Diabetes (metformin  asidosis laktat)



Penyakit jantung 

Aritmia

Tahapan Pembacaan IVP 

Menit Ke 0 



Menit Ke 5 





Kontras sudah mengisi ureter dan buli-buli

Menit Ke 30 



Melihat fungsi ekskresi ginjal. N = sistem pelvikaliseal sudah tampak

Menit Ke 15 



Foto polos perut

Foto dalam keadaan berdiri untuk menilai kemungkinan terdapat perubahan posisi ginjal (ren mobilis)

Menit Ke 60 

Melihat keseluruhan anatomi saluran kemih, antara lain filling defectI, hidronefrosis, double system



Pada buli-buli diperhatikan adanya identasi prostat, trabekulasi, penebalan otot detrusor, dan sakulasi

Paska Miksi 

Menilai sisa kontras (residu urin) dan dibvertikel pad buli

Normal

A normal intravenous urography (IVU) with the following films • Scout • Nephrogram • Serial shoots at 5 min interval up to 15 mins of injection of contrast • Prone • Obliques • Full bladder

Significant variation between two normal renal pelves, demonstrated by excretory urography A.Large, extrarenal pelvis B.Narrow, completely intrarenal pelvis, barely larger in caliber than the ureter

Nephrolithiasis

CASE Presentation Left Flank Pain 25/M Scout film (1st) shows large left renal calculus 15 min film (2nd) shows abnormal deviation of the ureter Normally bilateral renal function Case of large renal pelvis calculus with normal function

CASE Presentation Patient came for a routine IVP study for suspected right renal calculus. F On IVP, the left kidney was found in the pelvic fossa with normal function. Pelvic often found of the

kidenys are incidentally on imaging abdomen.

Hydronephrosis Dilatation of the urinary collecting system of the kidney (the calyces, infundibula, pelvic)

CASE Presentation This patient presented with right flank pain for the past 1 month. The patient was advised for an USG which revealed right sided hydronephrosis. A mid ureteric calculus was suspected 30/M 1st image is a scout film which revealed no calculus 2nd film is a radiograph taken after 10 mins of injection of contrast. In this we see a dilated renal pelvis due to kink in the ureter at the level of L3 vertebra. Case

of

ureteric

kink

Hydroureteronephrosis Dilatation of the urinary collecting system of the kidney (the calyces, infundibula, pelvic) and ureter

CASE Presentation Left sided flank pain, USG showed 2 cm calculus in left lower ureter. 30/F IVP shows a left lower ureteric calculus on control film most likely at the vesicoureteric junction (VUJ). The contrast study shows a moderately dilated ureter and the calculus is seen to move up and down. The left ureter has an abrupt narrowing with dilation of the proximal part. The is a stricturous narrowing of the left lower ureter adjacent to the left VUJ causing stasis of urine and thereby predisposing to calculus formation.

Ureterolithiasis

CASE IVP demonstrating dilation of the right renal collecting system and right ureter consistent with right ureterovesical stone

CASE Presentation Right flank pain, ultrasound shows proximal hydroureter and mild hydronephrosis. 30/M Arrows points to a low density calculus Scout : apparently normal with no evidence of calculus 10 min film : right sided proximal hydroureter and mild dilatation of PCS 15 min film : findings are persistent and a filling defect is noted at the L3L4 level Case of right sided midureteric calculus (low density).

CASE Non contrast helical CT scan of the abdomen demostratin g at stone at the right ureterovesi cal junction

CASE Presentation Mild right hydronephosis on ultrasound study. 61/F There are calculus projected on the right transverse process of L4. After contrast injection there is a cut off at the level of the calculus that do not cause completer obstruction, but it causes a mild dilatation of upper ureter. This

case

illustrates

Renal cyst Pelvicaliectasia

SE 57y/F. Right renal cyst and minimal pelvicaliectasia

Nephroptosis (Floating Kidney)

CASE Intravenous excretory urogram (IVU) in 40 yo female witth the complain on mobile mass in the right lower quadrant with standing associated with bilateral flank and back pain that resolved in supine position A. Supine IVU shows kidneys in the normal position, with normal ureters and proximal collecting system B. Standing film shows significat displacement of both kidneys with the right kidney moving onto the pelvis as described by the patient

Bladder stones

Sumber  Webmd.com  Radioopedia.org  Sudoyo dkk. Buku ajar Ilmu Penyakit Dalam Edisi V, Jilid II  David Sutton. Textbook of radiology and imaging Vol 2.  Sagung Seto. Buku bedah urologi  Campbell-Walsh Urology 10th edition

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