ug-dr.bunyamin-revisi-4-2011.ppt
TRANSCRIPT
Department of Radiology, Faculty of Medicine Padjadjaran
University-Hasan Sadikin Hospital
andung
• $ % $&' l(m)ar *erte)ral )od!
• Re+(m)et : Th -/ % 0$
• Ma1. e1+(r"io ' +m or -&' *erte)ral
)od! o ere+t ,o"itio
III. Iteral Ar+hite+t(re 2 E1teral +orte1 : -/ mm thi+ke""
3 Real +or,("+le
3 Co*ol(ted t()(le"
3 Se,arated )! +ol(m" o# 4ertii
3 Iterlo)ar& ar+(ate& ad iterlo)(lar arter!
2 Real el*i" :
U0TRASOUND O6 T7E KIDNEY
URETER • A)o(t /' +m log • Retro,eritoeal • I ,el*i+ : Co*e1 ,o"teriorl! ad laterall! • At i"+hial ",ie )ed #or8ard ad mediall!
%%9 lo8er ,ortio o# )ladder • Diameter *aria)le : more or le"" mm • Three ormal +o"tri+tio :
2 Uretero,el*i+ ;(+tio
2 Uretero *e"i+al ;(+tio
3 Aterior : ()i+ "!m,h!"i"
3 o"terior )et8ee )ladder ad re+t(m :
2 Male : d(+t(" de#ere" ad "emial *e"i+le"
2 6emale : Uter(" ad *agia
URETHRA 2 6emale : Short& < +m& diameter mm 2 Male : ro"tati+ ,ortio : elogated& $ +m
Mem)rao(" ,ortio
Real *ei" : arallel real arter!
/. 6lak ai
'. 7!,erte"io
. rotei(ria
@. Dri))lig
$. I#lammatio
PREPARATION
2 Clear li(id diet 2 6a"tig a#ter midight 2 4o8el +lea"ig
SKIN TEST OF CONTRAST MEDIUM
PLAIN FILM ABDOMEN
COMPRESSED OF ABDOMEN
#or ,atiet le"" tha - ,o(d 4G
2 - % / ,o(d 4G : - ++
Ne,hrogra,hi+ ,ha"e : - mi(te
2 Cotra"t i *a"+(lar ad real t()(le"
2 7!,er*a"+(lar ma"" : i"ode"
el*o+al!+eal o,a+i#i+atio : /&' 2 $ mi(te
Dela!ed o,a+i#i+atio :
2 o*erh!dratio
2 h!,ote"io
FILMING SEQUENCE
• - mi(te : Ne,hrogram ,ha"e • Ureteral +om,re""io • ' mi(te : +olle+tig "!"tem • -' % $ mi(te : (reter • mi(te : )ladder • o"t *oidig %%9 2 a""age o# +otra"t aget
2 Sim,tom o# lo8er (riar! tra+t
2 S(",e+ted "toe • No (reteral +om,re""io :
2 S(",e+ted "toe
2 A+(te a)dome
2 0arge a)domial ma""
2 Aorti+ ae(r!"m
re,aratio i" the "ame a" #or itra*eo("
(rogra,h!
mai,(latio
Ti, o# +atheter itrod(+e ito real ,el*i"
' % - ml o,a(e medi(m i;e+ted thro(gh
(reteral +atheter to e*al(ate ,!el(m ,!elogram
Githdra8 +atheter : to *i"(alizatio (reter
Retrograde ,!elogra,h! o le#t +olle+tig "!"tem
"ho8" moderate h!droe,hro"i" ad h!dro(reter 8ith a
tort(o(" +hage o# (reter. The arro8" idi+ate the "ite
+om,re""ed )! the ,ro"theti+ re"er*oir.
RETROHRADE URETR7O CYSTOHRA7Y
-' 2 / ml +otra"t aget i;e+ted ito di"tal (rethra )! i"ertio "mall +atheter to #ill (rethra ad the to #ill )ladder
o"itio ,o"tero2aterior& le#t aterior o)li(e ad right aterior o)li(e
2 o"t i#lammatio
Figure 1. Retrograde urethrogram shows a focal smooth indentation (arrow) on the anterior aspect of the proximal bulbous urethra by the compressor nudae muscle
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 2a. Affect of patient positioning on the appearance of the urethra during retrograde urethrography
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 2b. Affect of patient positioning on the appearance of the urethra during retrograde urethrography
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure !a. +ntact but stretched posterior urethra following blunt trauma (type + urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure !b. +ntact but stretched posterior urethra following blunt trauma (type + urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &a. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &b. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &c. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure a. -osterior urethral rupture extending through the urogenital diaphragm to inole the bulbous urethra following blunt trauma (type +++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure b. -osterior urethral rupture extending through the urogenital diaphragm to inole the bulbous urethra following blunt trauma (type +++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure a. (a) Retrograde urethrogram obtained in a 2'year'old man with bladder base in,ury following blunt trauma (type +a urethral in,ury) shows extraperitoneal contrast material
extraasation that extends from the eleated bladder base and surrounds the proximal urethra
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure b. (a) Retrograde urethrogram obtained in a 2'year'old man with bladder base in,ury following blunt trauma (type +a urethral in,ury) shows extraperitoneal contrast material
extraasation that extends from the eleated bladder base and surrounds the proximal urethra
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %a. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %b. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %c. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1a. Anterior urethral in,ury following blunt trauma (type urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1b. Anterior urethral in,ury following blunt trauma (type urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 12. -rostatic urethrorectal fistula in a patient who sustained both a urethral disruption and a rectal in,ury in an automobile accident
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1!a. 5rethral in,ury caused by insertion of a foreign body into the external meatus
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1!b. 5rethral in,ury caused by insertion of a foreign body into the external meatus
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
©2004 by Radiological Society of North America
Figure 2a. $tricture of the bulbous urethra with urethrocutaneous fistulas (watering can perineum)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Figure 2b. $tricture of the bulbous urethra with urethrocutaneous fistulas (watering can perineum)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
I. Ne,hro+al+io"i" : 2 +orti+al
2 ("(al! "mall& m(lti,le
2 Ca ,ho",hate
0(+et +al+(li : 2 C!"tie
2 Uri+ a+id
2 athie
7!droe,hro"i" :
2 Cal!+e" markedl! +l() "ha,e2 Cal!+e" markedl! +l() "ha,e
2 Dilated ,el*i"2 Dilated ,el*i"
Etiolog! : -. Stoe.
$. Aomalo(" *e""el"
<. a.Re#l(1 #rom (riar! )ladder → i#e+tio
).Re#l(1 #rom (reter to real ,el*i"→ i#e+tio
'. T(mor.
Urogram :
Di"tal Cal+(l("
2 Cali+eal "!"tem ",la!ig
2 Shar, margiatio
-. A+(te ,!eloe,hriti"
2 6o+al or di##("e atte(atio itrareal +olle+tig "!"tem
2 Dimii"hed +otra"t e1+reatio
2 Re#le1 dilatatio o# either itra ? e1tra real +olle+tig "!"tem
2 Tra"iet *e"i+o(reteral re#l(1
/. Chroi+ !eloe,hriti"
2 0o"" o# real o(tlie
2 Kide! di",la+emet
2 S+olio"i"
2 6lak "tri,e i#iltratio
Ci+atri+ial +hage i the i#(di)(lar ,ortio"
o# "e*eral o# the +al!+e"& 8ith "light
dilatatio o# the +al!+e" ad ,el*i".
The +hage" are ,redomiatl!
lo+alized to the "(,erior ,ole regio
o# the right kide!
O)"tr(+tig Stoe
RENAL PARENCHYMAL ABSCESS
2 O+a""ioal! )oe ad ;oit
2 7ematogeo(" ",read
2 KUB :
2 (+tate +al+i#i+atio"
Ureteral T()er+(lo"i" : 2 i,e"tem 2 4eadig 2 Irreg(lar ? "tri+t(re
4ladder T()er+(lo"i"
2 O++a"ioal! a""o+iated 8ith
2 "toe
2 Chroi+ i#e+tio
2 DM
2 7o(rgla"" +o#ig(ratio
2 Sa++(lar dilatatio
2 0arge h!,otoi+
RENAL TUMOR 2 I#at ? Childre : 2 GilmJ" t(mor 2 Ad(lt Hra8itz t(mor :
2 7igh *a"+(lar
2 ol!+!temia& h!,er+al+emia& #e*er
2 Di",la+ed (reter
E1+retor! (rogram Retrograde ,!elogram.
U,,er ,ole +ar+ioma i*adig the ,erihilar regio ad
di",la+ig the (,,er (reter laterall!
Car+ioma o# the kide!
Car+ioma i*adig +al!1 Tra"itioal +ell +ar+ioma& ,rimar!
i the real ,el*i"& gro8ig o(t8ard
to i*ol*e the real +orte1
a. Cot("io.
a. el*i+ r(,t(re.
a. A*(l"io o# *a"+(lar ,edi+le
-. Arter!
/. >ei
$. 4oth.
2 4roaded ,"oa" "hado8
#ra+t(re o# the kide!.
The Elogatio o# the "(,erior ,ole
+al 1 at the #ra+t(re "ite
Real arteriogram
Ne,hrogram ,ha"e E1+retor! ,ha"e "ho8ig the e"+a,e
o# +otra"t age
IV UROGRAM : 2 Noe to +om,lete la+k o# real #(+tio 2 Cotra"t e1tra*a"atio
2 Real h!dro+ele : I+rea"ig de"it! real +orte1
URINARY BLADDER TRAUMA : 2 Itra?e1tra,eritoeal e1tra*a"atio
2 Itra,eritoeal : Dog ear" a,,eara+e.
2 E1tra,eritoeal : a""o+iated 8ith ,el*i+ #ra+t(re
andung
• $ % $&' l(m)ar *erte)ral )od!
• Re+(m)et : Th -/ % 0$
• Ma1. e1+(r"io ' +m or -&' *erte)ral
)od! o ere+t ,o"itio
III. Iteral Ar+hite+t(re 2 E1teral +orte1 : -/ mm thi+ke""
3 Real +or,("+le
3 Co*ol(ted t()(le"
3 Se,arated )! +ol(m" o# 4ertii
3 Iterlo)ar& ar+(ate& ad iterlo)(lar arter!
2 Real el*i" :
U0TRASOUND O6 T7E KIDNEY
URETER • A)o(t /' +m log • Retro,eritoeal • I ,el*i+ : Co*e1 ,o"teriorl! ad laterall! • At i"+hial ",ie )ed #or8ard ad mediall!
%%9 lo8er ,ortio o# )ladder • Diameter *aria)le : more or le"" mm • Three ormal +o"tri+tio :
2 Uretero,el*i+ ;(+tio
2 Uretero *e"i+al ;(+tio
3 Aterior : ()i+ "!m,h!"i"
3 o"terior )et8ee )ladder ad re+t(m :
2 Male : d(+t(" de#ere" ad "emial *e"i+le"
2 6emale : Uter(" ad *agia
URETHRA 2 6emale : Short& < +m& diameter mm 2 Male : ro"tati+ ,ortio : elogated& $ +m
Mem)rao(" ,ortio
Real *ei" : arallel real arter!
/. 6lak ai
'. 7!,erte"io
. rotei(ria
@. Dri))lig
$. I#lammatio
PREPARATION
2 Clear li(id diet 2 6a"tig a#ter midight 2 4o8el +lea"ig
SKIN TEST OF CONTRAST MEDIUM
PLAIN FILM ABDOMEN
COMPRESSED OF ABDOMEN
#or ,atiet le"" tha - ,o(d 4G
2 - % / ,o(d 4G : - ++
Ne,hrogra,hi+ ,ha"e : - mi(te
2 Cotra"t i *a"+(lar ad real t()(le"
2 7!,er*a"+(lar ma"" : i"ode"
el*o+al!+eal o,a+i#i+atio : /&' 2 $ mi(te
Dela!ed o,a+i#i+atio :
2 o*erh!dratio
2 h!,ote"io
FILMING SEQUENCE
• - mi(te : Ne,hrogram ,ha"e • Ureteral +om,re""io • ' mi(te : +olle+tig "!"tem • -' % $ mi(te : (reter • mi(te : )ladder • o"t *oidig %%9 2 a""age o# +otra"t aget
2 Sim,tom o# lo8er (riar! tra+t
2 S(",e+ted "toe • No (reteral +om,re""io :
2 S(",e+ted "toe
2 A+(te a)dome
2 0arge a)domial ma""
2 Aorti+ ae(r!"m
re,aratio i" the "ame a" #or itra*eo("
(rogra,h!
mai,(latio
Ti, o# +atheter itrod(+e ito real ,el*i"
' % - ml o,a(e medi(m i;e+ted thro(gh
(reteral +atheter to e*al(ate ,!el(m ,!elogram
Githdra8 +atheter : to *i"(alizatio (reter
Retrograde ,!elogra,h! o le#t +olle+tig "!"tem
"ho8" moderate h!droe,hro"i" ad h!dro(reter 8ith a
tort(o(" +hage o# (reter. The arro8" idi+ate the "ite
+om,re""ed )! the ,ro"theti+ re"er*oir.
RETROHRADE URETR7O CYSTOHRA7Y
-' 2 / ml +otra"t aget i;e+ted ito di"tal (rethra )! i"ertio "mall +atheter to #ill (rethra ad the to #ill )ladder
o"itio ,o"tero2aterior& le#t aterior o)li(e ad right aterior o)li(e
2 o"t i#lammatio
Figure 1. Retrograde urethrogram shows a focal smooth indentation (arrow) on the anterior aspect of the proximal bulbous urethra by the compressor nudae muscle
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 2a. Affect of patient positioning on the appearance of the urethra during retrograde urethrography
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 2b. Affect of patient positioning on the appearance of the urethra during retrograde urethrography
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure !a. +ntact but stretched posterior urethra following blunt trauma (type + urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure !b. +ntact but stretched posterior urethra following blunt trauma (type + urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &a. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &b. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure &c. -osterior urethral rupture aboe the intact urogenital diaphragm following blunt trauma (type ++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure a. -osterior urethral rupture extending through the urogenital diaphragm to inole the bulbous urethra following blunt trauma (type +++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure b. -osterior urethral rupture extending through the urogenital diaphragm to inole the bulbous urethra following blunt trauma (type +++ urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure a. (a) Retrograde urethrogram obtained in a 2'year'old man with bladder base in,ury following blunt trauma (type +a urethral in,ury) shows extraperitoneal contrast material
extraasation that extends from the eleated bladder base and surrounds the proximal urethra
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure b. (a) Retrograde urethrogram obtained in a 2'year'old man with bladder base in,ury following blunt trauma (type +a urethral in,ury) shows extraperitoneal contrast material
extraasation that extends from the eleated bladder base and surrounds the proximal urethra
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %a. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %b. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure %c. 3ladder nec4 urethral in,ury (type +) in a 2'year'old woman
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1a. Anterior urethral in,ury following blunt trauma (type urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1b. Anterior urethral in,ury following blunt trauma (type urethral in,ury)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 12. -rostatic urethrorectal fistula in a patient who sustained both a urethral disruption and a rectal in,ury in an automobile accident
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1!a. 5rethral in,ury caused by insertion of a foreign body into the external meatus
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Figure 1!b. 5rethral in,ury caused by insertion of a foreign body into the external meatus
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
©2004 by Radiological Society of North America
Figure 2a. $tricture of the bulbous urethra with urethrocutaneous fistulas (watering can perineum)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Figure 2b. $tricture of the bulbous urethra with urethrocutaneous fistulas (watering can perineum)
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
Kawashima A et al. Radiographics 2!"2!#$1%&'$21
©2004 by Radiological Society of North America
I. Ne,hro+al+io"i" : 2 +orti+al
2 ("(al! "mall& m(lti,le
2 Ca ,ho",hate
0(+et +al+(li : 2 C!"tie
2 Uri+ a+id
2 athie
7!droe,hro"i" :
2 Cal!+e" markedl! +l() "ha,e2 Cal!+e" markedl! +l() "ha,e
2 Dilated ,el*i"2 Dilated ,el*i"
Etiolog! : -. Stoe.
$. Aomalo(" *e""el"
<. a.Re#l(1 #rom (riar! )ladder → i#e+tio
).Re#l(1 #rom (reter to real ,el*i"→ i#e+tio
'. T(mor.
Urogram :
Di"tal Cal+(l("
2 Cali+eal "!"tem ",la!ig
2 Shar, margiatio
-. A+(te ,!eloe,hriti"
2 6o+al or di##("e atte(atio itrareal +olle+tig "!"tem
2 Dimii"hed +otra"t e1+reatio
2 Re#le1 dilatatio o# either itra ? e1tra real +olle+tig "!"tem
2 Tra"iet *e"i+o(reteral re#l(1
/. Chroi+ !eloe,hriti"
2 0o"" o# real o(tlie
2 Kide! di",la+emet
2 S+olio"i"
2 6lak "tri,e i#iltratio
Ci+atri+ial +hage i the i#(di)(lar ,ortio"
o# "e*eral o# the +al!+e"& 8ith "light
dilatatio o# the +al!+e" ad ,el*i".
The +hage" are ,redomiatl!
lo+alized to the "(,erior ,ole regio
o# the right kide!
O)"tr(+tig Stoe
RENAL PARENCHYMAL ABSCESS
2 O+a""ioal! )oe ad ;oit
2 7ematogeo(" ",read
2 KUB :
2 (+tate +al+i#i+atio"
Ureteral T()er+(lo"i" : 2 i,e"tem 2 4eadig 2 Irreg(lar ? "tri+t(re
4ladder T()er+(lo"i"
2 O++a"ioal! a""o+iated 8ith
2 "toe
2 Chroi+ i#e+tio
2 DM
2 7o(rgla"" +o#ig(ratio
2 Sa++(lar dilatatio
2 0arge h!,otoi+
RENAL TUMOR 2 I#at ? Childre : 2 GilmJ" t(mor 2 Ad(lt Hra8itz t(mor :
2 7igh *a"+(lar
2 ol!+!temia& h!,er+al+emia& #e*er
2 Di",la+ed (reter
E1+retor! (rogram Retrograde ,!elogram.
U,,er ,ole +ar+ioma i*adig the ,erihilar regio ad
di",la+ig the (,,er (reter laterall!
Car+ioma o# the kide!
Car+ioma i*adig +al!1 Tra"itioal +ell +ar+ioma& ,rimar!
i the real ,el*i"& gro8ig o(t8ard
to i*ol*e the real +orte1
a. Cot("io.
a. el*i+ r(,t(re.
a. A*(l"io o# *a"+(lar ,edi+le
-. Arter!
/. >ei
$. 4oth.
2 4roaded ,"oa" "hado8
#ra+t(re o# the kide!.
The Elogatio o# the "(,erior ,ole
+al 1 at the #ra+t(re "ite
Real arteriogram
Ne,hrogram ,ha"e E1+retor! ,ha"e "ho8ig the e"+a,e
o# +otra"t age
IV UROGRAM : 2 Noe to +om,lete la+k o# real #(+tio 2 Cotra"t e1tra*a"atio
2 Real h!dro+ele : I+rea"ig de"it! real +orte1
URINARY BLADDER TRAUMA : 2 Itra?e1tra,eritoeal e1tra*a"atio
2 Itra,eritoeal : Dog ear" a,,eara+e.
2 E1tra,eritoeal : a""o+iated 8ith ,el*i+ #ra+t(re