Intravenous urography has been used as the primary imaging technique for the diagnostic evaluation of urinary tract for several years. With development of more competitive imaging modalities [1] and apprehension about the adverse effects of contrast media and radiation, intravenous urography is going to disrepute. Conditions that arise outside the urinary tract also result in urinary tract obstruction and may go unnoticed with intravenous urography alone. It is therefore important, to determine the cause and level of obstruction by an effective protocol. Material and MethodsPatients with complaint of vague abdominal pain were examined by ultrasonography (USG) and 25 of those with features of dilated pelvi calyceal system were taken up for further evaluation by intra venous urography (IVU), computerised tomography (CT) and magnetic resonance urography (MRU). Images were reviewed by radiologists who were blinded to the results of the other investigative modalities.Ultrasonography of the kidneys, ureter and bladder region was done with a 3.5/ 5 MHz curved array probe of LOGIC 200 pro series -GE system. Patients were examined with full bladder. If there was a suspicion of hydronephrosis, (Table 1) then they were re-examined after evacuation of the bladder. This was done to exclude the possibility of pseudohydronephrosis [2]. The proximal ureter was best visualised in a coronal oblique view, using the kidney as a window. The distal ureter was seen supra-pubically through the full bladder. The urinary bladder was scanned trans-abdominally.After obtaining the plain radiograph of the abdomen in an adequately prepared patient, ionic/ non-ionic contrast medium (Trazograf 76%/ Omnipaque 300) was injected intravenously (0.3-0.6 mg/Kg body weight) for intravenous urography. Nonionic contrast medium (Omnipaque 300mg/ml) was used in children, elderly, asthmatics, diabetics and other high-risk patients. Serial radiographs of the abdomen were obtained at five minutes, 15 minutes and 30 minutes after intravenous injection of contrast in supine position. If no obstruction was detected, the examination was concluded with a full and post void radiograph of the bladder. Additional delayed radiographs were obtained up to 24 hours when indicated.CT was performed on single slice helical system (Hi Speed CT/I GE ). Non-contrast CT (NCCT) was done to start with which was followed by contrast enhanced CT (CECT). Ionic / non-ionic intravenous contrast medium (Trazograf 76% / Omnipaque 300) was administered as the bolus dose of 0.3 -0.6 mg per Kg body weight by hand injection. Consecutive slice thickness of 4-10 mm axial scans was obtained. Delayed scans were done depending upon the cases. Oral water soluble iodinated contrast was administered, when staging of disease in carcinoma cervix or urinary bladder was required. Diagnosis of calculus was made when high-density lesion (HU 200-600) was detected along the course of the urinary tract. The level of obstruction was established after studying the serial scans and reconstructed 3D images.MRU...
Monitor displays are an integral part of today's radiology work environment, attached to workstations, USG, CT/MRI consoles and PACS terminals. For each modality and method of use, the correct display monitor needs to be deployed. It helps to have a basic understanding of how monitors work and what are the issues involved in their selection.
Superior mesenteric artery (SMA) branch aneurysms are extremely rare (Jorgensen, 1985). Only 40 cases have been reported in the literature up to 1980 (Mourad et al, 1987). Most are diagnosed after rupture into the mesentery, the intestinal lumen or the peritoneal cavity (Reuter et al, 1968; Jorgensen, 1985). Occasionally they are found by arteriographic studies. Only one case diagnosed by ultrasound has been reported in the literature (Grech et al, 1989).
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