filling defect in renal collecting system radiology

demonstrated a radiolucent filling defect in the distal left ureter . Urinary tract imaging and pathology . The classical features of UTUC on CT imaging are tumour located centrally in the collecting system, focal-filling defect in renal pelvis, renal shape preservation, absence of cystic or necrotic . Introduction. Rimlike calcificationof necrotic papilla occurs. These findings are not specific to TCC. Demonstration of a filling defect by intravenous urography (IVU) or RGP is generally accurate and is the historic standard for diagnosis of upper urinary tract and ureteral tumors. Never inject against resistance or patient's pain. Antibiotics prophylaxis is needed prior to this imaging. CTU was performed on 89 patients (55 men, 34 women; age 28-77 years) and 168 collecting systems and ureters were evaluated. Objective: The purpose of this article is to assess the ability of CT urography to depict urothelial tumors in the upper renal collecting systems, compared with ureteroscopy and pathologic analysis, and to describe the relative implication of the radiologic signs of urothelial thickening and endoluminal filling defects. Steven B. Oglevie MD, in Vascular and Interventional Radiology (Second Edition), 2006 Access for Diagnostic Interventions. CT urogram utilizing a split dose technique: Axial image through the kidneys and collecting systems demonstrates both nephrographic and excretory phases of enhancement in the same imaging sequence. Antopol-Goldman (AG) lesion is a benign condition characterized by flank pain, hematuria, and radiologically detected filling defect in the renal pelvis. 3-6). Published . It can help to define the level of urinary tract obstruction. heterogeneous calculi filling renal pelvis with low Hounsfield units (+120HU), which was very atypical for a calculus on CT imaging. Urothelial carcinoma affects more than 70,000 Americans annually [].Although the incidence of urothelial tumors in the upper urinary collecting system may be low in the general population (one or two cases per 100,000 people annually), the incidence increases in patients with prior or concurrent urothelial tumors in the lower urinary tract, with a reported incidence of 3.9-4.8% [2-4]. For filling defects, 62.5% (5 of 8) CTU lesions in the PC system, and 80% (4 of 5) lesions in the ureter proved to be malignant tumors. It is clinically important because it is confused with renal parenchymal and collecting system tumors. size and location of primary tumor, extension into pubic bone; spread to adjacent tissues or organs; regional lymph nodes; sites of distant organs or lymph nodes involved.. KUB (Kidneys-Ureters-Bladder) X-rays to evaluate the status of the urinary system. The video of the diagnostic flexiureterorenoscopy . . (preoperative urinary cytology, filling defect and PNV) was done using McNemar's test. This patient presented with haematuria. There are three free luminal filling defects present within the urinary bladder including: air bubbles, calculi, and blood clots. Bone windows reveal a stone obstructing the right kidney at the UPJ. (preoperative urinary cytology, filling defect and PNV) was done using McNemar's test. The differential diagnosis of a radiolucent filling defect in the intrarenal collecting system or renal pelvis may include transitional cell carcinoma, blood clot . Both upper . Take images. There were 5 mm calculi in each of the upper and lower pole calyces of the left kidney (Fig. Dilatation of the upper pole and mid renal calyces are observed. TCC left kidney. European Association of Urology. European Association of Urology. Renal matrix stones are a rare phenomenon and they present a diagnostic challenge due to their atypical radiological appearances in comparison to more commonly encountered renal tract calculi. 6,10(pp191-192),11 . Excretory urogram shows a large right kidney w ith a duplicated collecting system. Fig. 23-6). 1 Since then radionuclide renal imaging in pediatrics has been one of the cornerstones in pediatric nuclear medicine. sloughed papillae cause filling defects in collecting system: "ring sign." • Tissue necrosis leads to blunted or clubbedcalyces. sloughed papillae cause filling defects in collecting system: "ring sign." • Tissue necrosis leads to blunted or clubbedcalyces. Türk C, Neisius A, Petrik A, et al. Radiology 92:1447-1452, 1969. Radiolucent filling defect in continuity with the wall of the collecting system Ultrasonography Echogenic focus within the ureter and renal pelvis associated with the moderate to severe hydronephrosis Computed Tomography A ureteral or renal pelvis mass with attenuation in the soft-tissue range of 30-40 Hounsfield units Magnetic Resonance Imaging Short description: Abn radlgc find on dx imaging renal pelv, ureter, or blddr The 2022 edition of ICD-10-CM R93.41 became effective on October 1, 2021. Since imaging features of urinary system metastases cannot exclude the possibility of a primary tumor of the urinary system, histopathologic examination of renal masses in patients with an extra-urinary malignancy is necessary in the management of and the decisions regarding the treatment options of these patients (3, 7, 10, 40). Percutaneous access may be performed to permit antegrade pyelography. Ultrasound alone is insufficient for imaging of hematuria. His IVP (intravenous pyelogram, also known as an IV Urogram) shows normal opacification of the collecting system of the right kidney. This is because the contrast material is more opaque than the filling defect. CEUS offers a number of benefits over conventional axial imaging with computerised tomography and magnetic resonance imaging, primarily as a "beside" test, without ionising radiation or the safety concerns associated with iodinated/gadolinium-based contrast agents. The purpose of the study was to evaluate and compare opacification of the renal collecting system and ureters detected by computed tomographic urography (CTU) performed 20 min and 1 h after the ingestion of 1,000 ml of water. Excretory phase CT urography for opacification of the urinary collecting system. Filling defects in the renal collecting system and the bladder, as seen with IVU, CT, and retrograde pyelography, are present in a number of other pathologies. Figure 1. AJR Am J Roentgenol . Kidney filling defect. It can help to define the level of urinary tract obstruction. Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. Overview of imaging modalities. Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. CTU was performed on 89 of 12 and MRI are other imaging techniques that are used for evaluation of the urinary tract. Subsequent CT (right-hand image) confirmed this - the kidney … fat-containing renal mass filling defect in renal collecting system fluid collection in scrotum focal bladder wall thickening focal calcification in kidney focal defect in nephrogram focal renal parenchymal scar free fluid in cul-de-sac >> Return to top. 6). . Renal cortical defects have a variety of causes, and present on imaging as an area of focal cortical thinning or absence of renal cortex, sometimes accompanied by focal caliectasis. . 9. X-rays, or plain films / plain radiographs, are used as a first-line imaging investigation in most situations due to their low radiation dose and easy availability. . [38] filling defect seen in the collecting system Filling defects that are free appear radiolucent when surrounded with positive contrast material. Contrast-enhanced ultrasound (CEUS) is a technique that has developed as an adjunct to conventional ultrasound. mon reason for urinary tract imaging. RPC 1 of the Month from the AFIF 2 Cdr Elias G. Theros , MC USN Registry of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, D. C. 20305 Excerpt T HE RADIOGRAPHIC findings in this intravenous urogram of a 50-yearoldman: Represent multiple foci of a transitional- cell carcinoma of the kidney pelvis and ureter Represent the "beaded" appearance typical of long-standing . This potentially embarrassing misinterpretation can be avoided by always correlating the abnormal filling defect with the unenhanced images to be sure it is not, in fact, a stone. Filling defect of bladder found on diagnostic imaging. Overall, of 16 reported PC system lesions on CTU, 12 (75%) proved to be tumors, and of 11 reported ureteric lesions, 6 (55%) proved to be tumors. distend the collecting system and ureter. . [ 1 , 12 , 13 ] Cysts are more common and occur in greater number in the proximal ureter. urinary organs, specified NEC R93.49. The purpose of the study was to evaluate and compare opacification of the renal collecting system and ureters detected by computed tomographic urography (CTU) performed 20 min and 1 h after the ingestion of 1,000 ml of water. Although conferring no radiation to the patient, MRI is a second-line imaging modality because stones are not directly visible on MRI and only seen as a filling defect in the collecting system. Small stones within the urinary collecting system will appear as filling defects on postcontrast images and may simulate a UC. Imaging Key Information. Ductogram 4. Although excretory phase imaging may show narrowing of the involved lumen, frank obstruction by submucosal cysts is very rare. Abnormal radiologic findings on diagnostic imaging of other urinary organs. and MRI are other imaging techniques that are used for evaluation of the urinary tract. . Materials and methods: We conducted a retrospective study to evaluate 326 . Overview of imaging modalities. They are usually centered on the renal pelvis (rather than the renal parenchyma as is the case with RCC) and range in size from small filling defects (difficult to see without distension or collecting system contrast) to large masses which obliterate the renal sinus fat (TCC is one of the causes of the so-called faceless kidney) 2. A reformatted coronal image from a CT urogram demonstrates a partially duplicated collecting system on the left side with two ureters (black and white arrows) that join at the pelvic inlet and insert as one ureter into the bladder. o If using gravity drip, open vent on tubing adjacent to bottle. Multiple papillae affected in 85%. Urinary tract imaging and pathology . It can help to define the level of urinary tract obstruction. 10. It is also difficult to discern nondilated. The other four signs -- a focal filling defect in the collecting system, absence of cystic or necrotic change, homogeneous tumor enhancement, and tumor seen to extend down to the ureteropelvic . No other renal tract calcification was identified. In this case report they described features of papillary necrosis such as sloughed papilla in the calyx, clubbing of the calyx, a golf ball on a tee appearance and filling defects in the major calyx giving rise to a lobster claw appearance. It is timed such that urine opacifies with contrast and allows for greater contrast separation between urine and soft-tissue density, which appear as filling defects. No dye is injected during the procedure. Radioisotope renography was first described in 1956. There is a multilobulated circumferential filling defect in the base of the badder. 4. Ultrasound alone is insufficient for imaging of hematuria. Pyeloureteritis cystica is characterized on imaging by multiple small (2-5 mm), round, smooth-walled, eccentric filling defects protruding from the wall of the renal pelvis or ureter (Fig. Renal hypertension Ureterocele. We describe a case of known stone former presenting with loin pain and recurrent urinary tract infections who was diagnosed with a matrix stone. No sonographic features are specific for TCC, and many filling defects within the renal collecting system and bladder have a nonspecific appearance. Bone scans use an IV tracer that concentrates in areas of high bone . G gas in bladder wall or lumen gastroschisis generalized bladder wall thickening genital . Using ultrasound alone, it is often difficult to differentiate renal transitional cell carcinoma from other causes of filling defects of the renal collecting system such as blood clots, sloughed papillae, or fungus balls. 4.3.4.3. Multiple papillae affected in 85%. 2 [99m Tc]Tc-mercaptoacetyltriglycine ([99m Tc]Tc-MAG3) renography has proven to be a valuable tool guiding clinical . Fluoro intermittently to monitor opacification of renal pelvis/calyces, ureter, and bladder. Images may reveal a clubbed calyx or a filling defect in the PC system or ureter . Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. Journal. filling defect seen in the collecting system Although conferring no radiation to the patient, MRI is a second-line imaging modality because stones are not directly visible on MRI and only seen as a filling defect in the collecting system. Bone scans use an IV tracer that concentrates in areas of high bone . The delayed phase on a subsequent computed tomography (CT) abdomen and pelvis showed a filling defect in the left renal pelvicalyceal system, suspicious for a transitional cell carcinoma. The differential diagnosis of collecting system filling defects is given in Table 11.1. This is because the contrast material is more opaque than the filling defect. Previous studies examining patients with hematuria have been based on traditional EU techniques. The patient underwent ureteroscopic biopsy suggestive of a papillary neoplasia, before progressing to a laparoscopic radical . A faceless kidney refers to one in which the normal appearance of the renal sinus on cross-sectional imaging is absent. Post contrast imaging showed multiple irregular filling defects within the calyces of both kidneys (Fig. On the 'aft the kidney is small with opacification of calyces which seem to drain only the lower pole. McNicholas MM, Raptopoulos VD, Schwartz RK, et al. A urothelial neoplasm involving the renal calyces may be seen as a subtle enhancing mass at early postcontrast CT and as a filling defect within the calyces in the excretory phase. the ivu and the retrograde pyelogram may be normal or merely demonstrate a filling defect due to a blood clot in the collecting system (fig 7).15'16 on angiography, the neoplasm may be vascular; however, the cavernous hemangioma tends to be hypovascular and poorly marginated.'5 a highly echogenic hemangioma has been reported on ultrasound.17 … Filling defect of ureter found on diagnostic imaging. 4 Diuretic renography can be helpful in these clinical scenarios. However there is a large filling defect in the left renal pelvis (arrows), suspicious for a neoplasm. Findings on diagnostic imaging of other urinary organs small with opacification of the upper pole and mid renal calyces observed. 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