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A case presentation on IVP
Speaker - Dr.Sachin
Guide- Dr.Kirti Rana Chaturvedi
•A patient Bheraram 10 year male child
presented to pediatric emergency with c/o
Abdominal pain since 9 days which increases
day by day.
•No h/o fever and vomiting.
•No significant past history and family history.
Patient is referred to Radiology department
for USG Abdomen.
•Right pyonephrosis with ureteritis
•Right ureteric calculus (~ 19mm in mid part of ureter)
•Left renal calculi (~10 mm )
•Left hydro nephrosis
•Other findings are - Mild hepatomegaly and multiple enlarged
mesenteric lymph nodes.
For confirmation of USG abdomen report IVP has been
•Normally excreting both kidney.
• Right ureteric calculus
• B/l renal calculi
• Left ureter holds contrast in 30 min film with abrupt cut off
and in 2 hr film contrast wash away s/o
?left ureteric stricture ? Aberrant vascular structure
-Left mild hydroureteronephrosis.
An intravenous pyelogram (IVP) is a special x-ray
examination of the kidneys, bladder, and ureters.
It is also called Intravenous Urogram.
An Intravenous Pyelogram can show the size, shape, and
position of the urinary tract, and it can evaluate the
collecting system inside the kidneys.
Intravenous Pyelogram can be done as a emergency
Procedure without any preparation.
Indications of IVP
An abdominal injury.
ureteric fistulas and strictures
Bladder and kidney infections.
Blood in the urine.
Flank pain (possibly due to kidney stones).
•Advantages of IVP
•-Detailed anatomy of the collecting systems
•-Demonstration of major calcification
•-Sensitive for acute obstruction
Limitations of IVP
• -It depends on kidney function
• -Do not differentiate solid or cystic lesion
• -Requires contrast medium and radiation.
• -Missing small stones.
• -Quality of study may be limited by inadequate bowel
preparation, bowel ileus, swallowed air and technician
• -Inconvenience of a long filming sequence.
how is it performed ?
During Intravenous Pyelogram, a dye called contrast material is
injected into a vein into the patients arm. A series of X-ray pictures is
then taken at timed intervals.
The test should be done in a X Ray Department where a doctor is
available as on occasions the contrast can cause severe reactions
which may lead to medical emergencies.
What is the Preparation Required for the
The patient may need to be fasting for 8 to 12 hours before the
The Patient also may need to take a laxative the evening before the
test and possibly have an enema the morning of the test to make sure
that the bowels are empty.
The standard plain radiographic imaging of the
urinary tract is the
KUB (kidneys, ureters and bladder), which
I. a full length abdominal film and
II. an upper abdominal (cross-kidney) film
•taken with the patient supine using a low
voltage technique (60-65 kV) to maximise
1. The full length film
o in inspiration
o a 35 x 43 cm cassette
o positioned with the lower border at the symphysis pubis to ensure
the urethra (particularly the prostatic urethra)
2. The cross-kidney film
o in expiration
o a 24 x 30 cm cassette
o with the lower border 2.5 cm below the iliac crests
“The study typically includes that portion of the anatomy from the level
of the diaphragm to the inferior pubic symphysis
The outline of several anatomical structures can be seen
on the KUB
1. the KUB is a relatively unreliable diagnostic tool
2. principal use is in the assessment of urinary tract
3. It is, however, extremely unreliable in the diagnosis
of ureteric calculi, with an accuracy of only around
LOCM 370 (LOCM = Low osmolar contrast material)
Adult dose = 50 – 100 ml
Pediatric dose = 1ml for each kg
Post contrast IVP films
•(A) Immediate(Nephrogram phase)
•(B) 5 min (Secretory phase)
•(C) 15 min film with compression
producing calyceal distension;
•(D)30 min film (Ureterogram phase)
•(E) 45 min film (Cystogram phase)
•(F) Post voiding film
Immediate film (Nephrogram phase)
•A.P. view of the renal areas to show the nephrogram, i.e.
the renal parenchyma opacified by the contrast medium
in the renal tubules.
• (taking it after injection equals about 10 to 14 seconds
which is the approximate arm-to-kidney time).
30 minutes film (Ureterogram
Is there any collecting systems and ureters dilatation or
filling defect? (normal ureter filling is rarely demonstrate
the whole ureter from proximal to distal as there is a
peristaltic wave )
•45 minutes film (Cystogram phase) :
•-Bladder size and shape
•-Contrast is filling the bladder or not
•-Bladder surface is smooth or rough
•-Is there any diverticlula, filling defect or prostate
•Post voiding film :
•-Contrast left on upper tract? (normally there is
no contrast left on upper urinary tract on post
IVP REPORTING FORMAT
• Technique : an IVP was performed following the intravenous administration
• The scout films demonstrates—
• Bony shadowing
• Bowel gas pattern-adequates or inadequates bowel preparation.
• Renal shadowing
• Psoas shadowing
• Any evidences of masses or organomegaly.
• Any radiopaque calculi visible in the kidney or along the ureteral tracts.
• Following the uneventful administration of …….cc”s of omnipaque 300
intravenously, the nephrograms and pyelograms are prompt and
bilateral. Kidneys are normal in size, shape and axis. There are no
• There is no dilatation or filling defects of the renal calyces or pelvis
bilaterally. The ureter are normal in course or calibre, without any
• The bladder is normal in size, shape and contour. No filling defects are
• There is no significant post void residual.
• Impression- normal IVP.
• Dilation of Left
Renal Pelvis and
Calyces Above the
system and ureters
Ectopia on the
Left Kidney and
calyces by cysts in
• a Non-opacified partly obstructing ureterocele surrounded by opacified urine in the bladder
• A later full length film shows opacification of the distended upper moiety ureter running
down to the opacified ureterocele
length of the
Benign prostatic hyperplasia. White = bladder. Dark = benign
enlargement of prostate, pushing down on inferior bladder
showed no obstructive
uropathy, but symmetric
diverticula could be seen
near both ureteral
orifices (arrows). These
lesions, known as Hutch
diverticula, are usually
congenital rather than
occurring as a result of a
neurogenic bladder or an
infection or obstruction
cell carcinoma of
the urinary bladder.
Dilated left lower
the right ureter
caused by complete