Transcript Radiology course

Radiology course
UROGENITAL
Anatomy
Kidney-ureter-bladder
Case courtesy of Dr Ian Bickle, Radiopaedia.org
Kidney-ureter-bladder
http://radiopaedia.org/articles/horseshoe-kidney
http://radiopaedia.org/articles/horseshoe-kidney
Horseshoe-kidney
• Horseshoe kidneys are the most common
type of renal fusion anomaly. They render the
kidneys susceptible to trauma and are an
independent risk factor for the development
of renal calculi and transitional cell carcinoma
of the renal pelvis.
• Horseshoe kidneys are found in approximately
1 in 400-500 adults and are more frequently
encountered in males (M:F 2:1)
http://radiopaedia.org/articles/horseshoe-kidney
Ectopic Kidney
Pelvic kidney (sometimes
known as sacral kidney) is a
kidney that is seen fixed in the
bony pelvis or across the spine .
Pelvic ectopia is seen in 1 in
2100-3000 autopsies. It is
considered the most common
form of renal ectopia .
http://radiopaedia.org/articles/pelvic-kidney
Kidneys
•
The kidneys are paired retroperitoneal
organs that lie at the level of the T12 to L3
vertebral bodies.
•
Each kidney is normally 10-12 cm in length,
3-5 cm in width and weighs 150-260 g.
The left kidney is usually slightly larger than
the right.
•
The kidneys are located on the posterior
abdominal wall, with one on either side of
the vertebral column. The long axis of the
kidney is parallel to the lateral border of
the psoas muscle.
•
The kidney itself can be divided into renal
parenchyma, consisting of renal cortex and
medulla, and the renal sinus containing renal
pelvis, calyces, renal vessels, nerves,
lymphatics and perirenal fat.
Kidneys
Kidneys
Case courtesy of Dr Ian Bickle, Radiopaedia.org
CT
Arterious phase
Venous phase
Equilibrium phase
MR, basal sequences
MR, basal sequences
MR
T2-wighted MR
MR
T1 weighed, without MdC
T1 weighed, arterious phase
T1 weighet, portal phase
T1 weighet, equilibrium phase
Kidneys
Ecografia
Eco-Doppler
Ureters
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The ureter begins its descent to
the bladder by running along the
medial aspect of the psoas
muscle. Here, the ureter lies
anteriorly and slightly medial to
the tips of the L2-L5 transverse
processes.
It enters the pelvis anteriorly to the
sacroiliac joint at the bifurcation
of the common iliac vessels and
then courses anteriorly to the
internal iliac artery down the
lateral pelvic sidewall.
At the level of the ischial spine it
turns forward and medially to
enter the posterolateral wall of
the bladder, where it runs an
oblique 1-2cm course, before
opening into the bladder at the
internal ureteric orifice
Ureters
Bladder
•
The bladder has a triangular shape
with a posterior base, an anterior
apex and an inferior neck with two
inferolateral surfaces
•
The trigone is a triangular area of
smooth mucosa found on the
internal surface of the base. The
superolateral angles are formed by
the ureteric orifices and the inferior
angle is formed by the internal
urethral orifice.
•
The urethra arises from the neck of
the bladder and is surrounded by the
internal urethral sphincter.
Bladder
http://radiopaedia.org/articles/urinary-bladder
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Voiding Cystourethrogram (VCUG), also Micturating
Cystourethrogram (MCUG), is a technique for visualizing a
person's urethra and urinary bladder while the
person urinates (voids).
Under fluoroscopy (real time x-rays) the radiologist watches
the contrast enter the bladder , by a urinary catheter, and
looks at the anatomy of the patient.
If the contrast moves into the ureters and back into
the kidneys, the radiologist makes the diagnosis
of vesicoureteral reflux, and gives the degree of severity a
score.
The exam ends when the person voids while the radiologist is
watching under fluoroscopy. It is important to watch the
contrast during voiding, because this is when the bladder has
the most pressure, and it is most likely this is when reflux will
occur.
post voiding image is obtained to see how much urine is left
within the bladder (residual urine), which is useful to evaluate
bladder contraction dysfunction
Micturating Cystourethrogram
Micturating Cystourethrogram
Micturating Cystourethrogram
Micturating Cystourethrogram
Micturating Cystourethrogram
Micturating Cystourethrogram
Bladder
http://radiopaedia.org/articles/urinary-bladder
Bladder
http://radiopaedia.org/articles/urinary-bladder
Female Urethra
• The female urethra is a simple tube that extends from the
internal urethral orifice of the bladder to the external
urethral orifice in the vestibule of the vagina. It has a much
simpler course, structure and less lose prone to disease
than the male urethra.
• Gross anatomy
• The female urethra measures approximately 4cm in length.
It is embedded in the anterior vaginal wall and runs with
the vagina through the urogenital hiatus.
• The female urethra begins at the internal urethral meatus
at the bladder neck and opens in the vestibule of the
vagina, 2.5cm below the clitoris. Paraurethral glands line
the urethra at the external urethral meatus.
Male Urethra
• The male urethra measures, on average, 18-20cm in
length.
• It commences at the internal urethral orifice in the
trigone of the bladder and opens in the navicular fossa
of the glans penis at the external urethral meatus,
which is the narrowest part of the urethra.
• The male urethra can be divided into anterior and
posterior portions. The anterior urethra is composed of
the penile and bulbar urethra to the level of
the urogenital diaphragm. The posterior urethra is
composed of the membranous and prostatic urethra.
Male urethra
Gynaecology System
Uterus
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The uterus is a hollow, thickwalled, muscular organ that lies
in the lesser pelvis.
The uterus has an inverted pear
shape. In the adult, it measures
about 7.5 cm in length, 5 cm
wide at its upper part, and
nearly 2.5 cm in thickness.
The uterus is divisible into two
portions: body and
cervix. About midway between
the apex and base, is a slight
constriction known as
the isthmus. The portion above
the isthmus is termed the body,
and that below, the cervix. The
part of the body which lies
above a plane passing through
the points of entrance of the
uterine tubes is known as
the fundus.
http://radiopaedia.org/articles/uterus
Isterography
Uterus
http://radiopaedia.org/articles/uterus
Uterus
http://radiopaedia.org/articles/uterus
Uterus
Ovaries
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The ovaries are paired organs of the female
reproductive and endocrine systems. They lie
within the ovarian fossa on the posterior wall of
the true pelvis.
The ovaries are ovoid in shape and measure
approximately 1.5-3.0 x 1.5-3.0 x 1.0-2.0 cm.
•
The suspensory ligament of the ovary runs from
the side wall of the pelvis to the ovary. The
ovarian vessels run in this ligament.
•
Each ovary is attached to the back of the
broad ligament by the mesovarium, which is
continuous with its outer coat.
•
Despite all its attachments, the ovary is very
mobile. it is frequently found behind the uterus
in the pouch of Douglas and have a variable
relationship with the uterus
http://radiopaedia.org/articles/ovaries
Ovaries
http://radiopaedia.org/articles/uterus
Ovaries
http://radiopaedia.org/cases/simple-ovarian-cysts-1
Ovaries
http://radiopaedia.org/cases/simple-ovarian-cysts-1
Ovaries
http://radiopaedia.org/cases/simple-ovarian-cysts-1
Male Reproductive System
•
The prostate gland is the largest male accessory gland and
provides approximately 30% of the volume of seminal fluid. It
typically weighs between 20-40 grams with an average size
of 3 x 4 x 2cm.
•
The prostate is comprised of 70% glandular tissue and 30%
fibromuscular or stromal tissue.
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The prostate gland is an inverted pyramid that surrounds the
proximal urethra, which traverses the prostate close to its
anterior surface. The base of the prostate is in continuity with
the bladder. It ends at the apex at the urogenital diaphragm .
http://radiopaedia.org/articles/prostate
Male Reproductive System
Male Reproductive System
Prostate
The prostate is comprised of
three distinct zones with
different embryologic origins:
-peripheral zone
-central zone
- transition zone
http://radiopaedia.org/articles/prostate
Prostate
Central zone (CG) and Peripheral zones (PZ)
http://radiopaedia.org/articles/prostate
Seminal Vesicles
•
The seminal vesicles are paired
accessory sex glands of the male
reproductive system. The seminal
vesicle produces over two-thirds
of the ejaculate and is very high in
fructose.
The seminal vesicle is actually a
10-15cm long tubular structure but
is coiled tightly so it only meaures
4-5cm in length. It is located
superiorly and posteriorly to the
prostate.
•
The excretory duct of the seminal
vesicle unites with the vas
deferens to form the ejaculatory
http://radiopaedia.org/articles/prostate
duct.
Seminal Vesicles
http://radiopaedia.org/articles/prostate
Testicle
• The testes (sing. "testis" or "testicle") are the
main male genital organs, and are contained
within a sac called the scrotum.
• The testes are responsible for production of
sperm and testosterone.
http://radiopaedia.org/articles/testes
Testicle
• The normal testes have a homogenous, moderately
echogenic pattern. A testicle is surrounded by a thin
echogenic fibrous band, which represents the visceral
component of the tunica vaginalis and the tunica albuginea.
Radiology course
UROGENITAL
Anatomy