Radiology.Academy.Sk

Neuro Review
Appendix
Spleen
Stomach
Kidneys
Kidney
Pancreas
Pelvic congestion syndrome
Liver
Biliary
CT Abd Epiploic Appendagitis
Fractures Wrist
Wrist
Diffuse periosteal reaction
Signs in Uroradiology
Male breast
MRI Breast Indications
CT Head Cerebellar Mass
Biopsies
Diagnostic mammography
Screening mammography
Mammo Pearls
ACR Appropriateness Criteria Breast Cancer Screen
AVM types
CT Orbits
CT Abd NL
Chiari Malformations
Vesicoureteral Reflux (VUR)
Elbow
XRAY Abdominal Series

Abdomen
Cardio
Chest
Dictation Templates
General
GU
Mammography
MSK
neuro
Neuroradiology
NM
Nuclear Medicine
Pediatric
Physics
Ultrasound
Upload

Pelvicaliectasis

Uretero-Pelvic Junction Obstruction (UPJ)

Is the most common cause of pelvicaliectasis w/o associated ureteral dilatation. Usually diagnosed prenatally. Most common congenital obstruction of the urinary tract. 1:1000, Boys > Girls, Left > Right, may coexist w/ VUR, Uretero-Vesical Junction (UVJ) Obstruction, MCDK

Crossing vessel

Segmental lower pole renal artery or vein may cross UPJ and cause "vascular UPJO": (intermitent hydronephrosis found usually in older children)
Imaging: US, VCUG, Scintigraphy in infants

Ultrasound

Degree of dilation
  • Mild: pelvis only
  • Moderate: pelvis and calyces
  • Severe: pelvis, calyces and parenchymal thickening

The Society for Fetal Urology - SFU - US grading system for postnatal hydronephrosis
  • SFU grade 0: normal
  • SFU grade 1: pelvis only seen
  • SFU grade 2: pelvis and a few calices seen
  • SFU grade 3: pelvis and all calices seen
  • SFU grade 4: pelvis, all calices and parenchymal thining

Voiding CystoUrethroGram (VCUG)

To determine if hydronephrosis is due to UPJ obstruction or VUR or both and asses contralateral upper urinary tract because there is frequently contralateral VUR with UPJO. UPJO can also coexist w/ ipsilateral VUR as demonstrated by dilution of contrast as it enters pelvis, suggesting there was an unopacified urine before the study begun. Delayed images will show retention of contrast above UPJ.
RNS: Radionuclide Scintigraphy - 99mTc labelled Mercaptoacetyltriglycine (99mTc-MAG3) followed by Lasix. Follow pts for progression, stability or resolution of UPJO.
CT/MRI: incidental findings of pelvicaliectasis or extrarenal pelvis, not a first study to get, order, US+VCUG; good for vascular UPJO - crossing artery
TH: prophylactic abx, surgery (Hynes-Anderson pyeloplasty) or nephrectomy Postoperative imaging: 6 wks after, US, RNS, IVU (intravenous urography)