contrast radiography of bladder and urethra by dr. pavulraj. s
TRANSCRIPT
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CONTRAST RADIOGRAPHY OF
BLADDER AND URETHRA
Dr. Pavulraj.S
M.V.Sc., (Veterinary Pathologist)
Research fellow
National Research Centre of Equines, India
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist, Research Fellow, NRCE, India
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CONTRAST RADIOGRAPHY OF
BLADDER • It is a simple, fast, inexpensive
technique
• Provide valuable diagnostic and prognostic information about bladder disease
• Clinical indications - dysuria, pollakiuria, haematuria
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dog
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Cat
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Cystographic technique • Withheld food for 24 hrs
• Enema given preceding cystography
• All catheters should be sterilized
• Bladder is catheterized
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Contrast media
• Negative contrast media – CO2, Nitrous oxide
• Positive contrast media – water soluble organic iodides 20% - 10 ml per Kg body weight.
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Views • Lateral
• Ventral left dorsal right
• Ventral right dorsal left
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
![Page 8: Contrast radiography of bladder and urethra by Dr. Pavulraj. S](https://reader033.vdocuments.us/reader033/viewer/2022042817/55a71f391a28ab504a8b4773/html5/thumbnails/8.jpg)
Procedure
• Positive contrast cytography is performed by
injecting 20% organic iodides solution in to bladder by urethral catheter
• Double contrast cytography is performed by injecting a small volume of undiluted +ve contrast medium in to a empty bladder
Dose – 1 ml for cat, 3 ml for dog. Followed by bladder distention with –ve contrast medium
• Positive and double contrast procedure is useful than negative contrast cytography
• Double contrast cytography is superior for assessing bladder wall lesions and intraluminal filling defects.
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
![Page 10: Contrast radiography of bladder and urethra by Dr. Pavulraj. S](https://reader033.vdocuments.us/reader033/viewer/2022042817/55a71f391a28ab504a8b4773/html5/thumbnails/10.jpg)
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
![Page 11: Contrast radiography of bladder and urethra by Dr. Pavulraj. S](https://reader033.vdocuments.us/reader033/viewer/2022042817/55a71f391a28ab504a8b4773/html5/thumbnails/11.jpg)
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Radiographic signs
• Irregular mucosal border
• Intramural thickening filling defects
• Extravasation patterns
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Mucosal changes
• Metaplastic, neoplastic, non-neoplastic proliferations.
• Appears as a irregular outline along inside of bladder surface. Ulcers can be identified with a double contrast cystography
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Bladder wall thickening
• Normal thickness – 1 mm • Can use double contrast cytography • Thickening may be due to Cellular infiltrations Fibrous tissue proliferation Hemorrhage Trauma Neoplasia
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
![Page 17: Contrast radiography of bladder and urethra by Dr. Pavulraj. S](https://reader033.vdocuments.us/reader033/viewer/2022042817/55a71f391a28ab504a8b4773/html5/thumbnails/17.jpg)
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Filling defects
• Any thing occupying space with in the bladder alter normal filling. Defect area appear as radiolucent surrounded by +ve contrast medium.
• Size, shape, border, position with in the bladder and attachment to the bladder should be examined.
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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• Free luminal filling defect Air bubbles Calculi Blood clots • Attached luminal filling defect Neoplasia Polyps Blood clots Haemotoma Adherent calculi
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
![Page 21: Contrast radiography of bladder and urethra by Dr. Pavulraj. S](https://reader033.vdocuments.us/reader033/viewer/2022042817/55a71f391a28ab504a8b4773/html5/thumbnails/21.jpg)
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Contrast extravasation patterns from the urinary
bladder
• Traumatic bladder diverticula's
• Urachal anomalies – urachal diverticulum's
• Extravasations to peritoneal cavity
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Pitfalls with cystographic interpretation
• Changes mimic actual pathologic changes • Artifacts – created during cystographic procedures Air bubbles Small -calculi or small luminal filling defects Large – bladder wall thickening Multiple – honey comb appearance • Pseudo filling defects Mistaken as bladder neoplasia It may due to inadequate bladder distension and
external pressure from abdominal structures.
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Contrast radiography of urethra
• Conduit for urine from bladder
• Female - shorter and wider
• Dog – 3 parts
• Cat - 2 parts
• Contrast radiography used in all urethral diseases
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Contrast urethrography
• Water soluble organic iodides 15 % used.
• Balloon tipped catheter used. It is inserted and balloon inflated to prevent reflux of contrast medium
• 10 – 15 ml in dogs. 5-10 ml in cats
• Radiographic exposure should be done at the last 2-3 ml of contrast medium injection
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Views • Lateral
• Right and left ventro-dorsal oblique
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Female animals
• Difficult • Balloon tipped catheter inserted into
urethra then balloon inflated and contrast injected then exposure made during injection
Vaginocystourethrography Balloon tipped catheter placed in
vestibule and inflated to occlude the outflow. +ve contrast medium is injected. Vagina fills first and then urethra fills. But it need general anesthesia
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Radiographic signs Filling defects
1. Intraluminal
Air bubbles – round, smooth margin
Urethral calculi – irregular margin, blurred margin
Blood clots – irregular, poorly defined margin
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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2. Intramural filling defects
Due to neoplasm, inflammation
Irregularity of mucosal surface
Widening or narrowing of lumen
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Extramural filling defects
• Due to compression by masses surround the urethra
• Prostate hyperplasia
• Neoplasm
Mucosal surface will be smooth
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Extra vasation of contrast medium
• Urethral rent near bladder neck – peritoneal cavity
• Urethrocavernous reflux – systemic venous circulation
• Os penis fracture
• Poor catheter manipulation
Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc., Veterinary Pathologist,
Research Fellow, NRCE, India
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Dr.Pavulraj. S., M.V.Sc.,
Veterinary Pathologist, Research
Fellow, NRCE, India