Emphysematous pyelitis and emphysematous pyelonephritis characterized by computerized tomography.

We report three cases of emphysematous pyelonephritis, all of them associated with perinephric emphysema, and one case of emphysematous pyelitis to demonstrate the value of computerized tomography (CT) in both diagnosis and patient management. The differentiation between air in the collecting system (emphysematous pyelitis), air within the parenchyma (emphysematous pyelonephritis), and air in the perinephric space (perinephric emphysema) may have significant prognostic (survival) and therapeutic (medical vs surgical) implications. Computerized tomography is currently the best method for demonstrating intrarenal air and for characterizing the location of that air (intracalyceal, intraparenchymal, perinephric, or pararenal).

Renal arteriovenous fistula--angiographic and sonographic correlation.

We report a case of a markedly enlarged inferior vena cava and a cystic structure simulating a hydronephrotic kidney in the clinical setting of hypertension with cardiomegaly, congestive heart failure and a flank bruit. Ultrasonographic findings with the aid of angiography were highly suggestive of a renal arteriovenous fistula or malformation.

Urologic manifestations of sickle hemoglobinopathies.

We analyzed the renal radiographic changes in the sickle hemoglobinopathies in 92 patients, in 70 of whom the specific hemoglobin type was documented by electrophoresis. The following conclusions have been drawn: (1) Approximately 50% of patients with SS hemoglobin have renal enlargement (both on roentgenograms and at autopsy), while only a small proportion of patients with the other hemoglobinopathies show renal enlargement; (2) slightly more than one half of patients with each type of hemoglobinopathy have calyceal changes; and (3) these calyceal changes do not fall into a specific pattern with respect to hemoglobin type.

Renal carbuncle: the use of ultrasound in its diagnosis and treatment.

The use of ultrasound in the diagnostic and therapeutic management of 5 patients with renal abscesses is described. A spectrum of ultrasonic findings was noted, with the majority of the lesions being anechoic (3 cases). However, a few lesions showed a mixed pattern (2 cases). Ultrasonic aspiration of abscess fluid for culture and sensitivity obviated an operation in 1 case. For the first time, ultrasonically guided, percutaneous, indwelling catheter drainage of a renal carbuncle is reported. Since the patient had failed to respond to systemic antibiotic therapy this technique saved the patient from undergoing an operation. The clinical and ultrasonic findings in the 6 previous case reports of abscesses are reviewed.

Perforated duodenal ulcer and pneumomediastinum.

Two cases of anterior wall perforation of a duodenal ulcer, resulting in pneumomediastinum and pneumoperitoneum, are presented. The literature regarding perforation of the gastrointestinal tract with associated mediastinal emphysema is reviewed.