Rani Kurnia Perwitasari / 0810713035 / koass Radiologi periode 21-10-2013 s/d 15-11-2013 Normal variation of pelvio-calyceal system : Variations

of the collecting system are numerous. The variations in the gross structure of the renal collecting system are probably as numerous as there are individuals and thus can be liked to fingerprints. The bilateral collecting systems present in any single individual are often similar but are rarely identical and not uncommonly, may be quite different even from one another. Not only do the numbers and position of the minor calices vary between the individuals, but their infundibula may be absent or e tremely elongated. !yson " #$%%&' and (ollinshead #$%)&' The number of minor calices varies from & to *+ but usually there are , to % minor calices in adult -dwards et al #$%)&' described that the renal pelvis are of two types : intrarenal and e trarenal .nson and "cVay #$%)$' pointed out that the e trarenal type of pelvis is larger than the intrarenal type which is small and lies within the renal sinus. /ruce et al #$%0)' highlighted that the renal pelvis may lie partly inside and partly outside the renal sinus. 1ccasinally a pelvis cannot be demonstrated, the ureter dividing into calices. !idio #$%)+' two types of renal pelvis2 brachy type where the ma3or calices are usually long and end in a small renal pelvis2 and the long type where the ma3or calices are usually short and end in a large renal pelvis. 4raves #$%,0' classified the pelvicaliceal arrangement into two primary and two intermediate types based on shape of the pelvis and also on the prominence of the calices.

Rani Kurnia Perwitasari / 0810713035 / koass Radiologi periode 21-10-2013 s/d 15-11-2013

5ampaio #$%%6' Type . is the classic 7 shape, type / the inverted T, type 8 the balloon and type ! the inverted bagpipes. (e classified the arrangement of pelvicaliceal pattern into two main groups . and / which are subdivided into .-9, .-99, /-9 and /-99. 9n group .-9, a ma3or caly from the superior and inferior pole represents the primary divisions of the renal pelvis and mid:one drainage is provided by minor calices draining to the upper and lower ma3or calices radially. 9n .-99 these two calices draining the mid:one cross each other. 9n type /-9 there are a group of minor calices draining into a middle ma3or caly whereas in type /99 there are multiple minor calices draining the mid:one and 3oining the renal pelvis at different points.

Pelvicaliceal System : The pelvis, the upper e panded end of the ureter, shows different shapes depending on the number of ma3or calices draining into it and the angle it makes with the ureter #a' "ulticaliceal or ;adiate type the pelvis is biggest in this category and is characterised by the presence of upper and lower ma3or calices with three or more minor calices draining independently into the pelvis between the two. 9n this category no distinct anterior and posterior divisions of middle caly

Rani Kurnia Perwitasari / 0810713035 / koass Radiologi periode 21-10-2013 s/d 15-11-2013 is seen. 9nfundibula of the minor calices are so short that they open directly into the pelvis. 9n such cases renal tissues drained by these minor calices are inseparable #b' Triangular type or Tricaliceal the infundibulum is longer and resemble the stalk of a cauliflower. <elvic space is moderate in si:e. Three ma3or calices - superior, middle and inferior, formed by the fusion respective minor calices open into it. This is the commonest type of renal pelvis. The position of the middle caly is variable2sometimes located close to the upper caly and at others closer to the lower caly . The three calices are usually of the same si:e. /ut in one-fifth of the tricaliceal the upper ma3or caly was seen as a long thin infundibulum in contrast to the short middle and lower calices #c' 7-shaped pelvis or /icaliceal The pelvic capacity is devoid of any room with long caliceal infundibuli. The pelvis is formed by the convergence of two ma3or calices- the upper and lower, which may or may not be symmetrical and the middle caly is absent. There are different categories in this type also. The classical 7 shape or symmetrical where the two stems of the 7 are symmetrical and each stem #caly ' receiving = to & minor calices from the respective upper and lower :one .9n this type the mid:one is drained by calices which drain into either the upper or lower caly . .symmetrical type in which one of the two infundibuli is much longer and more dominant. 8ross drainage i.e. the minor caly from the lower :one may drain into the upper ma3or caly or vice versa occurred in &> of cases. <atterns that do not fit into these three patterns constituted $+ percent. They were middle ma3or caly draining directly to the ureter and the pelvis looking like direct continuation of the middle caly 2 infundibula or the ma3or calices forming the pelvis appear to be two only in anterior view and three in posterior view2 the middle caly infundibulum may be so short and drain directly on the anterior surface of the pelvis or e treme cross drainage from the opposite poles. 9n one case, a small portion of the anterior surface of the kidney drained into the stem of the middle caly .

Rani Kurnia Perwitasari / 0810713035 / koass Radiologi periode 21-10-2013 s/d 15-11-2013

Rani Kurnia Perwitasari / 0810713035 / koass Radiologi periode 21-10-2013 s/d 15-11-2013