Spot Diagnosis

Horse-shoe kidney

This case shows a horse-shoe kidney demonstrated well on a CT urogram. The isthmus is well seen (Fig. 2). The morphology of the PC systems and ureters is well appreciated on the urogram images (Figs. 3, 4).

Duplex left kidney

This 25-years old man came with a history of severe left loin pain. A calculus was suspected and since the USG was normal, a CT urogram was performed.

The study showed a duplex left kidey with fusion of the ureters just proximal to the UV junction. There was no pathology. The depiction of the anatomy on the CT urogram was exquisite.

Impacted left uretero-vesical (uv) junction calculus

This 30-years old man had a known left distal ureteric calculus that was being treated by hydrotherapy. He suddenly presented with significant increase in pain. His CT scan (Fig. 1) showed an impacted calculus at the uretero-vesical (uv) junction with mild proximal hydroureteronephrosis. The CT urography images (Figs. 2, 3) showed this well (arrows).

Acute abdomen

Each Wednesday morning, we will put one example of the use of CT in acute abdomen. As a one-top modality, CT can pick up virtually every cause of an acute abdomen, save an ectopic pregnancy.

1. Amebic liver abscess

2. Pyogenic liver abscess

3. Liver abscess

4. Acute cholecystitis

5. Acute choledocholithiasis

6. Acute mild pancreatitis

7. Acute mild pancreatitis with small acute fluid collection

8. Acute severe pancreatitis

9. Acute severe pancreatitis

10. Acute severe pancreatitis with infected necrosis

11. Pancreatitis - aspiration of fluid collections

12. Severe pancreatitis - abscess drainage

Right ureteric calculus with hydronephrosis and delayed function

This is a 36-years old man who presented with loin pain. The CTU shows a right middle third ureteric calculus (arrow in Fig. 1) with mild hydronephrosis and mildly reduced function, seen as reduced parenchymal enhancement (arrow in Fig. 2). The CTU MIP (maximum intensity projection) image shows the calculus (arrow in Fig. 3), the proximal hydroureteronephrosis (arrowhead in Fig. 3) and the reduced function.

CT Urography

CT Urography has almost completely replaced conventional excretory urography, popularly called IVU. With the current multi-slice scanner, especially 64-slice CT scanners, it is possible to obtain high-quality images of the kidneys, ureters and bladder, with angiographic, parenchymal and excretory phases.

Each week Saturday, we will show a different case highlighting the use of this modality. In the meantime, our Inner Spaces newsletter of January 2006 on CT urography is available as well for download.

1. Right ureteric calculus with hydronephrosis and delayed function

2. Impacted left uretero-vesical (uv) junction calculus

3. Duplex left kidney

4. Horseshoe kidney

5. Absent left kidney

6. Renal fracture

7. PU junction injury

8. PU junction injury - post-operative

9. Acute pyelonephritis with a tiny calculus

10. Acute pyelonephritis with incipient abscess formation

11. Emphysematous pyelonephritis

12. Pyonephrosis