Percutaneous fluoroscopic nephrostomy (PCN) insertion is the standard of management for an obstructed kidney.
Fluoroscopic nephrostogram with iodinated contrast medium has long been established for imaging of the renal tract following nephrostomy insertion.
The use of contrast-enhanced ultrasound (CEUS) has extended beyond traditional uses,
and the possibility to delineate percutaneous tubes and drains is now achievable.
We have compared the traditional fluoroscopic nephrostogram using iodinated contrast agents with CEUS nephrostogram to ascertain the accuracy,
utility and convenience of the CEUS nephrostogram.
Methods and Materials
for whom fluoroscopic nephrostogram were indicated,
(with or without ureteric stent placement) were included.
The standard conventional nephrostogram was performed immediately prior to the CEUS nephrostogram.
The CEUS nephrostogram technique involved diluting 0.2ml of SonoVue™ with 40 ml of normal saline and introduced into the renal collecting system via the nephrostomy tube.
Digital cine-clips and still images of the CEUS nephrostogram examination were recorded to allow accurate retrospective comparison by two independent reviewers to the reference standard.
12 nephrostograms in 10 patients were performed (6F,
The median age of patients was 64 years,
with a range of 29-91 years.
The most common causes of obstruction were ureteric calculus and malignancy (pelvic/bladder).
The renal pelvicalyceal system was visualized in both CEUS and fluoroscopic nephrostograms in 11/12 (92%) with one nephrostomy tube identified as being misplaced.
Both CEUS and conventional fluoroscopic imaging demonstrated the ‘misplaced’ tube lying outside the kidney – this was excluded from the final analysis of ureter delineation.
Our preliminary results suggest that CEUS nephrostogram is a feasible method to confirm the correct positioning of the nephrostomy tube within the collecting system,
to image the ureters and determine if there is satisfactory drainage into the bladder.
CEUS nephrostogram is a suitable alternative for the traditional nephrostogram in children where radiation dose plays a role,
patients with contraindications to iodinated contrast agents or if the procedure needs to be performed at the bedside.
Bachmann Nielsen M,
ter Haar G,
The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications.