Bhaskar Somani, a consultant urological surgeon at Southampton General Hospital, says the UK is sitting on a kidney stone "timebomb" - Although the body tries to pass stones out of the urinary system, they can lodge in the kidney tube and cause severe abdominal and groin pain which, in many cases, can only be corrected through. Multiple filling defects within a ureter, as seen on conventional IVU or CT IVU, have a relatively small differential including: spreading or multifocal transitional cell carcinoma (TCC) vascular indentations multiple ureteral stones (steinstr. There were 5 mm calculi in each of the upper and lower pole calyces of the left kidney (Fig. The differential diagnosis of a radiolucent filling defect in the intrarenal collecting system or renal pelvis may include transitional cell carcinoma, blood clot . . Published . McNicholas MM, Raptopoulos VD, Schwartz RK, et al. The differential diagnosis of collecting system filling defects is given in Table 11.1. Ultrasound alone is insufficient for imaging of hematuria. 1 Since then radionuclide renal imaging in pediatrics has been one of the cornerstones in pediatric nuclear medicine. Images may reveal a clubbed calyx or a filling defect in the PC system or ureter . There was a 5 mm soft tissue mass in the distal left ureter (Fig. A patulous system with decreased peristalsis can result in dilation of the renal collecting system in the absence of a mechanical obstruction in a variety of clinical settings, to include vesicoureteral reflux (VUR), megaureter, and prior mechanical obstruction or infection. demonstrated a radiolucent filling defect in the distal left ureter . Steven B. Oglevie MD, in Vascular and Interventional Radiology (Second Edition), 2006 Access for Diagnostic Interventions. Antibiotics prophylaxis is needed prior to this imaging. It was initially described as a sign of duplication of the collecting system 1 (a slice obtained between the two collecting systems will not demonstrate the normal components o. Filling defect of ureter found on diagnostic imaging. 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. 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 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 . . This patient presented with haematuria. Post contrast imaging showed multiple irregular filling defects within the calyces of both kidneys (Fig. This is the American ICD-10-CM version of R93.41 - other international versions of ICD-10 R93.41 may differ. CTU was performed on 89 patients (55 men, 34 women; age 28-77 years) and 168 collecting systems and ureters were evaluated. TCC left kidney. 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. 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 can help to define the level of urinary tract obstruction. This phase is used to look for filling defects in the urinary collecting system. 1, 2). No dye is injected during the procedure. Subsequent CT (right-hand image) confirmed this - the kidney … 9. 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. Filling defects that are free appear radiolucent when surrounded with positive contrast material. Unclamp PCN of interest. 4.3.4.3. The video of the diagnostic flexiureterorenoscopy . and MRI are other imaging techniques that are used for evaluation of the urinary tract. Radiology - Radiological Society of North America, Inc. 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. Multiple papillae affected in 85%. 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. No sonographic features are specific for TCC, and many filling defects within the renal collecting system and bladder have a nonspecific appearance. Excretory urogram shows a large right kidney w ith a duplicated collecting system. Fluoro intermittently to monitor opacification of renal pelvis/calyces, ureter, and bladder. Percutaneous access may be performed to permit antegrade pyelography. Urinary tract imaging and pathology . 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. of 12 2. 2 [99m Tc]Tc-mercaptoacetyltriglycine ([99m Tc]Tc-MAG3) renography has proven to be a valuable tool guiding clinical . 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. . [ 1 , 12 , 13 ] Cysts are more common and occur in greater number in the proximal ureter. 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 change, homogenous enhancement and extension of tumour toward ureteropelvic junction.5 The difference in management of UTUC versus RCC makes it . Contrast-enhanced ultrasound (CEUS) is a technique that has developed as an adjunct to conventional ultrasound. Türk C, Neisius A, Petrik A, et al. CTU was performed on 89 [38] filling defect seen in the collecting system Diagnostic uncertainty is common, especially where differential diagnoses for filling defects in adults include tumors [9]. AP image from the excretory phase of a vintage intravenous pyelogram (above) shows bilaterally normal appearing renal collecting systems and ureters. 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). 1998;170(5):1261-1267. (preoperative urinary cytology, filling defect and PNV) was done using McNemar's test. European Association of Urology. Abnormal radiologic findings on diagnostic imaging of other urinary organs. Small stones within the urinary collecting system will appear as filling defects on postcontrast images and may simulate a UC. Bone scans use an IV tracer that concentrates in areas of high bone . sloughed papillae cause filling defects in collecting system: "ring sign." • Tissue necrosis leads to blunted or clubbedcalyces. Take images. Axial CT with contrast of the abdomen shows the mass to almost complete fill the base of the bladder. 4.4.4.4. mon reason for urinary tract imaging. . 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. 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]. Urinary tract imaging and pathology . Although conferring no radiation to the patient, MRI is a second-line imaging modality in pregnant women because stones are not directly visible on MRI and only seen as a filling defect in the collecting system. Papillary necrosis in a 60-year-old woman with a history of migraine headaches and use of analgesics. Bone windows reveal a stone obstructing the right kidney at the UPJ. The renal collecting system is divided into 4 segments; renal calyces and infundibula (CI), renal pelvis (RP), upper ureter above the level of the iliac crest (UP), and lower ureter below the iliac crest (LU). 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. Ductogram 4. There is a multilobulated circumferential filling defect in the base of the badder. It is also difficult to discern nondilated. On the 'aft the kidney is small with opacification of calyces which seem to drain only the lower pole. There are three free luminal filling defects present within the urinary bladder including: air bubbles, calculi, and blood clots. Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. Kidney filling defect. Dilatation of the upper pole and mid renal calyces are observed. 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 … UroToday - GU OncToday brings coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of GU oncology and urology. Bone scans use an IV tracer that concentrates in areas of high bone . 23-6). It is clinically important because it is confused with renal parenchymal and collecting system tumors. 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. This is because the contrast material is more opaque than the filling defect. 10. fect ( fil'ing dē'fekt) Displacement of contrast medium by a space-occupying lesion in a radiographic study of a contrast-filled hollow viscus, such as a polyp on a barium enema; also applied to defects in the otherwise uniform distribution of radionuclide in an organ, such as a metastasis in the liver on a 99mTc-sulfur colloid scan. These findings are not specific to TCC. 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. 3-6). 6,10(pp191-192),11 . Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. Never inject against resistance or patient's pain. 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. 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. However, it is useful when the renal collecting system opacifies poorly with intravenous contrast or when there is renal insufficiency. Figure 1. MSubMSub ofof linear fillinglinear filling defect indefect in upper part of ureterupper part of ureter -- additional vesseladditional vessel that pressesthat presses ureter.ureter. Decreasing shadow (filling defect) of collecting system, mammary duct, uterus and uterine tube cavities. Hydronephrosis is the most common congenital abnormality detected by antenatal ultrasound. The patient underwent ureteroscopic biopsy suggestive of a papillary neoplasia, before progressing to a laparoscopic radical . 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 . Although excretory phase imaging may show narrowing of the involved lumen, frank obstruction by submucosal cysts is very rare. Kidney Stone (right kidney obstruction) Delayed CT scan with (1) soft tissue windows and (2) bone windows shows normal excretion of contrast from left kidney (LK) but dilated collecting systemin the right kidney (arrows) with delayed excretion. The collecting system may be better imaged with direct contrast injection than with excretory urography, particularly in cases of high-grade urinary obstruction (Fig. Bernstein RG, Siegelman JS, Tein AB, et al: Huge filling defect in the bladder, caused by intravesical enlargement of the prostate . 4 Diuretic renography can be helpful in these clinical scenarios. 1 x. Pre-contrast CT of the abdomen and pelvis in axial and coronal planes reveal the presence of right staghorn calculi occupying the renal pelvis and various calyces, with fragmentation, and the bigger fragment with 20mm, and a renal stone in the left kidney. sloughed papillae cause filling defects in collecting system: "ring sign." • Tissue necrosis leads to blunted or clubbedcalyces. Renal hypertension Ureterocele. 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. Small subepithelial inflammatory cysts in the renal pelvis and/or ureter characterize pyeloureteritis and ureteritis cystica, respectively.The cysts appear as multiple smooth filling defects most commonly in the proximal one-third of the ureter and are often seen in association with chronic urinary tract infections or stones. Filling defects that are free appear radiolucent when surrounded with positive contrast material. There are three free luminal filling defects present within the urinary bladder including: air bubbles, calculi, and blood clots. Poor visualization of renal collecting system in intravenous urography as an indicator of invasive transitional cell carcinoma in the upper urinary tract. This is because the contrast material is more opaque than the filling defect. It can help to define the level of urinary tract obstruction. It can help to define the level of urinary tract obstruction. Hematuria, lumbar pain, hypertension, urinary infection, and renal calculi are most prevalent. Urothelial tumors are multifocal in 10-20% of cases and, therefore, should be high on the differential diag . the . 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. 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. A 75-year-old man was referred to our urology service with painless haematuria. Rimlike calcificationof necrotic papilla occurs. 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. Imaging characteristics associated with failure of nonoperative management in high-grade pediatric blunt renal trauma. An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses Differential diagnosis The differential diagnosis for a renal cortical defect includes 1,2: renal scarring re. 4. o If using gravity drip, open vent on tubing adjacent to bottle. Filling defect of renal pelvis found on diagnostic imaging. . In 1995, Rothpearl et al described MR urography for the purpose of imaging the renal system. We tracked immediate complications and tract seeding on follow-up imaging. heterogeneous calculi filling renal pelvis with low Hounsfield units (+120HU), which was very atypical for a calculus on CT imaging. Materials and methods: We conducted a retrospective study to evaluate 326 . 21.10). Multiple papillae affected in 85%. urinary organs, specified NEC R93.49. ICD-10-CM Diagnosis Code R93.49. Right and left renal collecting systems are assessed separately (hence most CTU's will yield results for two renal collecting systems). Antopol-Goldman (AG) lesion is a benign condition characterized by flank pain, hematuria, and radiologically detected filling defect in the renal pelvis. 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. AJR Am J Roentgenol . 6). Previous studies examining patients with hematuria have been based on traditional EU techniques. Nuclear imaging measures the uptake of various labelled radioactive isotopes. Radiology 92:1447-1452, 1969. Rimlike calcificationof necrotic papilla occurs. European Association of Urology. On MRI, the matrix stones have hypointense signal in T1-weighted images, with . . A 16-detector-row scanner (Sensation 16 . Türk C, Neisius A, Petrik A, et al. Excretory phase CT urography for opacification of the urinary collecting system. 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 . Imaging Key Information. Radioisotope renography was first described in 1956. His IVP (intravenous pyelogram, also known as an IV Urogram) shows normal opacification of the collecting system of the right kidney. Axial excretory phase CT image (wide window) shows a . 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. A filling defect is apparent in the left lower quadrant of the bladder. No other renal tract calcification was identified. Overview of imaging modalities. There is also a calyceal diverticulum in the inferior calyceal group of the right . 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. . We describe a case of known stone former presenting with loin pain and recurrent urinary tract infections who was diagnosed with a matrix stone. Ultrasound alone is insufficient for imaging of hematuria. Nuclear imaging measures the uptake of various labelled radioactive isotopes. 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. Filling defect of bladder found on diagnostic imaging. and MRI are other imaging techniques that are used for evaluation of the urinary tract. Journal. 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. distend the collecting system and ureter. • Fill upper tract collecting system with contrast. EU remains the standard of reference for noninvasive visualization of intraluminal filling defects in the collecting systems and urothelial abnormalities. 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. Analysis was separated based on lesion appearance: (i) mass infiltrating renal parenchyma, (ii) filling defect in the collecting system, (iii) urothelial wall thickening. 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. 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. A faceless kidney refers to one in which the normal appearance of the renal sinus on cross-sectional imaging is absent. Fig. Both upper . 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. 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. However there is a large filling defect in the left renal pelvis (arrows), suspicious for a neoplasm. G gas in bladder wall or lumen gastroschisis generalized bladder wall thickening genital . The excretory phase of CT urography is the ideal phase for detecting malignancies within the urinary collecting system. Filling defects within the collecting system due to calculi visualized during percutaneous nephrostomy. Overview of imaging modalities. Introduction. (preoperative urinary cytology, filling defect and PNV) was done using McNemar's test. o If hand injecting, use gentle pressure. Case 1: 69 year old man with transitional cell carcinoma of the right renal pelvis, which can be visualized on the corticumedullary phase (A) as enhancing soft tissue against urine in the renal pelvis, or on the delayed phase (B) as a filling defect in the opacified collecting system. A case of known stone former presenting with loin pain and recurrent urinary tract obstruction of collecting... 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