case write-up radiology 2

Identification Data

Name : Wong Kow

Age     : 62 years old

Race   : Chinese

Date   : 8 February 2011

X-Ray No : 7315

Type of Imaging : Intravenous Urography

Positioning : Supine and prone

Clinical History

Patient is a known case of hypertension, benign prostate hypertrophy and compliant to medication. He was referred to radiology department for assessments of delineation of urinary tract. He was complaining of having nocturia 5 times in one night,increase frequency of micturition and also incomplete voiding. He does not complain of having pain during micturition and passing out blood or stone.

Patient Preparation

        i.            No food for 5 hour prior to the examination.

      ii.            Patient should, preferably be ambulant for 2 hour prior to examination to reduce bowel gas.

    iii.            If patient has allergy to contrast medium, consideration  should be given to administer methyl prednisolone orally 12 and 2 hour prior to injection of contrast medium.

Procedure

        i.            Preliminary film taken in supine,full length AP position of the abdomen,in inspiration to make sure adequate bowel preparation and to rule out any urinary calculi.

      ii.            Patient is given Intravenous bolus infusion of contrast media which is Iopamiro 300.

    iii.            5 minute film taken to determine if excretion is symmetrical and is invaluable for assessing the need to modify technique.

   iv.            15-minute film to demonstrate pelvicalyceal system.

     v.            Release film is taken to show whole urinary tract.

   vi.            Post micturition film to assess bladder emptying and to demonstrate return to normal of dilated upper tracts with relief of bladder pressure.

Findings

        i.            Preliminary film: No radiopacity seen along urinary tract

      ii.            Post Contrast :

·        Both kidneys are normal in shape, size and position.

·        Bipolar length  ofRight kidney measures 13.0 cm while left kidney measures 14.5 cm.

·        Left mild hydronephrosis to the distal hydroureter is seen

·        There are also strictures in left distal ureter. Beyond this, ureter is normal.

·        Right pelvicaliceal system and ureter are normal.

·        There is outpouching from the bladder wall in the left side.

·        Both kidneys showed normal contrast excretion.

    iii.            Post micturition : minimal residual urine in the bladder. No hold up of contrast.

Impression

Left mild hydronephrosis and hydroureter due to stricture or recent passing out of calculi in the distal ureter.

Bladder diverticula.