Skip to main content Accessibility help
×
Home
Hostname: page-component-888d5979f-x5hg2 Total loading time: 0.456 Render date: 2021-10-26T00:35:26.503Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

61 - Kidneys, ureter and bladder CT

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Royal Free Hospital, London Deanery, London, UK
John Curtis
Affiliation:
University Hospital Aintree, Liverpool, UK
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
Get access

Summary

Introduction

‘This is an unenhanced low-dose CT scan of the kidneys, ureter and bladder in axial/coronal/sagittal view.’

Summary

  1. AAir: perforation from GI or urinary system

  2. BBlood: high-density haemorrhage from tumour, trauma or obstruction

  3. CCalcifications: renal, collecting system, ureteric, bladder calculi, prostate calcification

  4. DDilatations: renal or ureteric obstruction

Checklist: ‘KUBE’

Kidney

• Site – horseshoe or ectopic kidney

• Size – masses, obstruction (calculi), reflux

• Content – stones, staghorn calculi

Ureter

• Site – on psoas: mass/lesion

• Size – obstruction:

• unilateral = calculi, ureteric or bladder tumour, stricture from previous surgery

• bilateral = bladder outflow obstruction

Bladder

• Air (dark): trauma, instrumentation or fistula to bowel (e.g. Crohn' s disease) or infection

• Calcification of wall: schistosomiasis, TB infection, post radiation

Everything else

• Retroperitoneal and peritoneal spaces

• The 3 Fs – fat inflammation, fluid collection (e.g. urinoma) and “fast” (acute) haemorrhage

• Prostatic calcification may be detected on a KUB radiograph and is usually a sign of chronic inflammation

Quick look

• Bowel dilatation

• Free fluid, collection or air

• ‘ Dirty fat ’ around other organs, e.g. liver, gall bladder, pancreas

Tips

The scan is specifically an unenhanced ‘grainy’ low-dose scan looking for calculi.

CT KUB scans are good for artefacts – e.g. stents, calcifications and air – but lack of contrast limits diagnosis of solid organ pathology.

However, ‘dirty’ -looking fat or fluid around solid or hollow organs suggests inflammation, which requires a post-contrast scan.

If a ureteric cancer is suspected CT IVU should be requested (a delayed phase post-contrast scan). Contrast fills the renal pelvis, ureter and bladder, highlighting any mass or filling defects.

The commonest findings in exams are calcifications and secondary signs of obstruction (hydronephrosis or hydroureter).

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 469 - 470
Publisher: Cambridge University Press
Print publication year: 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Send book to Kindle

To send this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

Available formats
×