Cardiovascular radiology. Cardiac alterations during intravenous urography.

Electrocardiographic monitoring of 406 patients undergoing intravenous urography was performed before, during, and after the examination. Major cardiac arrhythmias and ischemia were encountered frequently (18%) in those with cardiac disease but also occurred (5%) in the healthy individual with no history of heart disease. Rapid higher dose (28-g iodine) bolus injections result in more cardiac alterations than the slower but larger (42-g iodine) infusion method, whereas the smaller (14-g iodine) bolus injections have the least cardiac effect. Ectopic ventricular beats, the most common abnormality, are usually transient but remain the most potentially lethal of the effects of intravenous contrast media on the heart.

Primary leiomyosarcoma of ureter.

The tenth case of primary leiomyosarcoma of the ureter is reported, and previous cases are summarized. It is the first example studied by percutaneous pyelography and ultrasonography. The former was more informative than retrograde ureterography. The ultrasonic study suggested a cystic lesion rather than the solid tumor encountered. Nephroureterectomy, selective para-aortic node dissection, and radiotherapy were used, but distant metastasis and death ensured fifteen months later.

Lower moiety hydronephrosis in duplicated kidneys.

Because of the high incidence of lower pole reflux in complete duplications, decreased, delayed, or absent function in a hydronephrotic lower pole moiety is usually initially attributed to reflux nephropathy. Obstruction occurs commonly in the upper pole moiety due to an ectopic ureteral orifice or ureterocele. However, obstruction is not uncommon in the lower pole segment. Here, the etiologies are more numerous and, on occasion, result in confusing presentations. Eleven cases of obstruction involving the lower pole moiety are discussed. Pathologic entities involved include ureteropelvic junction obstructions in both complete and incomplete duplications, calculi and epithelial tumors obstructing the lower system at various levels, and an ectopic upper pole ureterocele compressing and obstructing the ureteral orifice to the lower pole.

Crossed renal ectopia in children.

Nine children were treated with crossed fused renal ectopia, and in 8 there were serious other urinary tract malformations which were surgically correctable. The finding of crossed fused renal ectopia warrants complete urologic investigation including cystogram and cystoscopy to rule out surgically correctable pathology in the urinary tract.

Polycystic kidneys without radiologic enlargement.

Polycystic kidneys in adults usually appear in the middle years and are described as large kidneys with most of their parenchyma displaced by a large number of cysts. Often the diagnosis is excluded if the intravenous pyelogram reveals kidneys of normal size. This report describes a patient with normal sized polycystic kidneys discovered at an advanced age.

Impressions on floor of female bladder: "the female prostate".

The "female prostate" denotes an impression on the base of the female bladder resembling the enlarged male prostate radiographically. Though the finding is widely recognized, confusion exists as to its significance. The differential diagnosis is moderately extensive, and includes retroverted uterus, anterior vaginal tumors, urethral and bladder floor tumors, benign and malignant bony pelvic lesions, urethral diverticulum, and postsurgical changes. Several cases are presented illustrating the previously mentioned causations. An impression on the floor of the female bladder should not be routinely dismissed as inconsequential without thorough evaluation.

Ultrasonic inaccuracies in diagnosing renal obstruction.

Renal ultrasound is an excellent screening examination for suspected urinary tract obstruction. Its usefulness is based on the ability to detect hydronephrosis. However, it must be recognized that a significant number of conditions exist which can mimic or produce dilatation of the collecting system without urinary tract obstruction. Similarly, obstruction without hydronephrosis, although infrequent, exists. Situations causing either false positive or false negative renal sonograms are discussed. Renal sonography suggesting hydronephrosis should be followed with additional diagnostic studies to confirm or exclude obstruction. Similar persistence should be used when obstruction is strongly suggested clinically, and ultrasound fails to demonstrate hydronephrosis.

Complications of pediatric percutaneous renal procedures: incidence and observations.

Successful definitive (complete) percutaneous renal procedures in the pediatric age group were performed in 97 per cent of antegrade pyelograms, in 94 per cent of ureteral perfusions (Whitaker test), in 98 per cent of nephrostomies, and 100 per cent of both retroperitoneal fluid drainages and renal aspiration biopsies. Significant complications, or those necessitating specific treatment or prolonged hospitalization, were 1.1 per cent. 0.7 per cent, 15.2 per cent, 0 per cent, and 0 per cent, respectively, for the above procedures. Not surprisingly, certain operators are more adept than others at successfully performing procedures and at avoiding some but not all complications (see Tables 2 and 3). Proper training, experience, and adherence to basic principles are important. However, there were no deaths, no kidneys lost, and no transfusions or operations required as a result of any complication from the pediatric percutaneous renal procedures; correction of any existing blood coagulation disorder is necessary prior to their performance to avoid potentially fatal hemorrhage.

Acute renal infections.

Most adults with uncomplicated acute pyelonephritis pose no diagnostic or therapeutic problems and recover fully. When imaging is requested in these cases, CT scan with and without contrast enhancement is preferable; however, depending on the condition of the patient and preference of the clinician an IVU, sonogram, or radionuclide scan may also provide adequate information. Patients at higher risk for complications, such as renal or perinephric abscesses with or without PHN and EPN, require aggressive and vigorous clinical and radiologic monitoring. CT scan is superior to other imaging modalities in the investigation of these complications. Interventional percutaneous procedures are established as safe and effective means of controlling or curing the infection in many patients and are often chosen over traditional surgical technique. The radiologist thus is an indispensable member of the management team and should be available for consultation and intervention.

Diagnostic morphologic and urodynamic antegrade pyelography.

Diagnostic antegrade pyelography, with a thin needle, is basically a simple procedure that can be performed relatively rapidly under local anesthesia with few complications of significance. Its role, however, is frequently crucial to subsequent patient management. During morphologic antegrade examination, aspirated urine can be analyzed for tumor cells (cytologic examination), infection (smear, culture), or other biochemical alterations. The use of antegrade pyelography in the demonstration of internal diversion, ureteral fistula, and the site and cause of obstruction is well established. Dynamic antegrade study is crucial in the assessment of many pyeloureteral units in which the issue of current obstruction is equivocal or uncertain. Absolute renal and bladder pressures are obtained simultaneously; these and the calculated differential pressure provide objective data relative to ureteral resistance to urine flow and renal nephron preservation.

Diagnosis and treatment of pyonephrosis.

This article examines current radiologic imaging and interventional techniques used in the diagnosis and initial treatment of pyonephrosis. Included is a review of all pyonephrotic series published in the English literature since 1970. Although the authors found that two thirds of pyonephrotic kidneys are still removed at surgery, there is an increasing emphasis on preservation of renal function. Percutaneous nephrostomy provides an excellent tool for drainage of pus and determination of residual renal function prior to definitive surgery.

Giant hydronephrosis in children.

Twenty pediatric patients with giant hydronephrosis were reviewed. This was defined as a kidney that occupied a hemiabdomen, met or crossed the midline, and was at least 5 vertebrae in length. The majority (16) were cases with ureteropelvic junction obstruction. In 2 cases, the primary pathology was obstructive megaureter. In 2 cases, the infants had severe urethral valves with massive upper tract dilatation. In 6 patients with a normal contralateral kidney, nephrectomy was performed. In one patient with bilateral pathology, one nonfunctioning kidney was removed later. A reconstructive operation was undertaken in 14 of the 20 patients. There was one late death from septicemia in an infant male with urethral valves and bilateral dysplastic kidneys.

Role of abdominal computed tomography in evaluating left upper quadrant masses.

The etiology of abdominal masses in the left upper quadrant may be confusing because of the anatomic relationships of the organs involved. In three representative cases presented, computed tomography (CT) clearly defined masses as being nonurologic in origin, although conventional radiologic diagnostic techniques originally yielded results that suggested a renal or adrenal origin. In two other cases, masses thought to originate from the spleen or retroperitoneum were shown by CT to be renal tumors. In a sixth case, a large mass thought to be of renal origin but not evaluated by CT was found at surgery to be a pancreatic cyst. Abdominal CT is more sensitive than other imaging modalities in clarifying organ relationships and the origin of masses in the left upper quadrant.