Intravenous Pyelogram

Aka: Intravenous Pyelogram, Intravenous Urography, IVP

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II. Indications

  1. Rarely used in modern U.S. practice
    1. Replaced by non-contrast CT (or CT Urogram when malignancy is suspected)
  2. Ureterolithaisis Imaging
    1. Nonpregnant patients where CT is not available

III. Mechanism

  1. Functional renal and ureter study
    1. Serial KUB Abdominal XRays (Kidney, Ureter, Bladder)
  2. Initial Scout Film (prior to IVP dye)
    1. Normal Bladder outline
    2. Normal Kidney outline
      1. Kidney length equivalent to 3-4 lumbar Vertebrae in height
      2. Right Kidney (displaced downward by the liver) is lower than the left
    3. Calcifications
      1. Renal stones (Nephrolithiasis)
      2. Ureterolithiasis
        1. Very difficult to distinguish on plain film from phleboliths (pelvic vein calcifications)
  3. IV Contrast injected and is rapidly excreted by the Kidney (outlining, in white, the urinary system)
    1. Serial XRays performed at 1, 5 and 15 minutes (may require films at 30 and 60 min if delayed)
      1. Progressive descent of the IVP dye through Kidney, ureter and Bladder
    2. Nephrogram (Calyces, infundibulae and renal Pelvis)
    3. Ureters (from ureteropelvic junction to ureterovesical junction)
    4. Bladder

IV. Findings

  1. Nephrogram
    1. Absent Nephrogram (no IV contrast within the Kidney, or section of the Kidney)
      1. Non-functioning Kidney
    2. Delayed Nephrogram (similar appearance to scout film at 5 minutes)
      1. Ureteral obstruction
    3. Hyperdense Nephrogram (excessive whiteness)
  2. Renal collecting system and Ureter
    1. Hydronephrosis and/or hydroureter
      1. Ureteral obstruction (e.g. Ureterolithiasis, ureteral mass, ureteral compression in pregnancy)
    2. Filling defect (white contrast surrounding a black defect)
    3. Contrast leak (e.g. Trauma, collecting system rupture)
  3. Bladder
    1. Bladder Distention (outflow obstruction or Urinary Retention)
    2. Bladder distorted contours (e.g. Bladder mass)
    3. Fistulas (e.g. vesicointestinal, vesicovaginal)

V. Efficacy: Ureterolithiasis

  1. Test Sensitivity: 64 to 87%
  2. Test Specificity: 92 to 94%

VI. References

  1. Ouellette and Tetreault (2015) Clinical Radiology, Medmaster, Miami, p. 37-41
  2. Miller (1998) Urology 52:982-7 [PubMed]
  3. Smith (1996) AJR Am J Roentgenol 166:97-101 [PubMed]

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