Diagnostic usefulness of post-void film in intravenous urogram.

A survey was sent to urologists to assess their subjective evaluation of the post-void film in the intravenous urogram (IVU). Most of the urologists believed that the post-void film should be a routine part of all IVUs, particularly in men over forty years of age, and estimated that the film contributed useful information in 30 percent of cases. One hundred fifty IVUs were reviewed to assess the actual value of the post-void film in 119 different patients. In these patients, the postvoid film was seen to give unique information not available by history or films of the filled bladder in only 3 percent of the cases. Therefore, we conclude the post-void film should not be a routine part of every IVU, and should be obtained on an as-needed basis only.

Fracture of the polyethylene acetabular cup in total hip arthroplasties.

Fracture of the acetabular cup is an uncommon complication in total hip arthroplasties, with only six examples described in the orthopedic literature. A patient is presented to illustrate the plain radiographic findings of acetabular cup fracture and to discuss the possible mechanisms involved.

Urinary obstruction in azotemic patients: detection by sonography.

Renal sonography is frequently requested in patients with an elevated or rising creatinine, often with the instruction to "rule out obstruction." A prospective study of patients undergoing renal sonography for newly discovered azotemia (creatinine greater than 1.8 mg/dl) or worsening renal failure was undertaken to evaluate the clinical utility of the sonographic examination. Patients with known obstructive uropathy, renal calculi, renal mass, or hematuria were excluded. In 189 patients, 17 (9%) had hydronephrosis: 11 unilateral (one with a solitary kidney) and six bilateral. Obstructive causes were subsequently established in the solitary kidney and in four patients with bilateral dilatation. These five patients (2.6%) with clinically significant hydronephrosis were shown subsequently to have a clinical history that strongly suggested the presence of urinary tract obstruction. Our data suggest that, in patients without a clinical history that suggests obstruction (such as calculi, bladder outlet obstruction, or pelvic mass), the likelihood of finding bilateral hydronephrosis by sonography is small.

Ultrasound evaluation of uncommon renal transplant complications.

Twenty-five patients who had undergone renal transplants developed uncommon complications that were detected and followed serially with sonography. Two patients developed renal calculi, which produced hydronephrosis in both instances. Other uncommon causes of postoperative hydronephrosis occurred in 5 cases; the causes included ureteral necrosis, ureteral stricture, and a renocutaneous fistula. Eight cases of renal infarction, manifesting 3 different sonographic appearances, were encountered. The presence and disappearance of postoperative gas in the collecting system were documented in 3 patients. The other unusual abnormalities detected involving the transplanted kidney include tuberculosis, pyonephrosis, 3 solitary cysts, a corpus lutem cyst simulating a perinephric fluid collection, and massive urinary ascites.

Sonography of neuroblastoma.

Sonograms of 21 children with neuroblastoma were reviewed with attention to the following sonographic criteria: size, location, internal echo pattern, anechoic areas, and margination. Fourteen primary tumors were evaluated before therapy. All tumors were heterogeneously echogenic; all had poorly defined margins. Tumor calcification was identified in three, and 10 of 14 primary tumors contained discrete anechoic areas ranging from 0.5 to 4 cm in diameter. The average greatest dimension of primary tumor masses was 7.7 cm.

Ultrasonic features of multicystic dysplastic kidney: expanded diagnostic criteria.

The ultrasonographic features of multicystic renal dysplasia in 15 patients (14 children, 1 adult) are described with emphasis on differentiating this condition from hydronephrosis. The most useful ultrasonographic criteria for identifying multicystic kidney include: (a) the presence of interfaces between cysts (accurate in 100% of cases); (b) nonmedial location of the largest cyst (100%); (c) absence of an identifiable renal sinus (100%); (d) multiplicity of oval or round cysts that do not communicate (93%); and (e) absence of parenchymal tissue (73%). The role and usefulness of radionuclide renal scanning are also discussed. Ultrasonography followed by nuclear scintigraphy appears to be a logical diagnostic sequence in the evaluation of neonates with flank masses. Excretory urography is of value in assessing the status of the uninvolved kidney.

Sonography of adrenal pheochromocytomas.

The sonographic features of eight surgically confirmed pheochromocytomas are described and correlated with pathologic findings. The purely solid masses were homogeneous or heterogeneous sonographically. Pathologic examination of the gross specimen provided explanations for the variety of sonographic findings. Two tumors had large cystic components due to old blood. Other hypoechoic areas corresponded to necrosis pathologically. Hyperechoic areas represented hemorrhage. Generally, pheochromocytomas are quite large, sharply marginated, and usually have a significant solid component with or without central necrosis or hemorrhage. Recognition of these features should facilitate their identification on sonography.

Vein of Galen aneurysm - diagnosis by real-time ultrasound.

Transfontanelle ultrasound evaluation of the neonatal ventricles has become commonplace in larger medical centers. We have recently seen two infants in whom vein of galen aneurysm could be diagnosed by this approach.

Improved visualization of the pancreatic tail after maximum distension of the stomach.

Fifty-two computed tomography examinations through the region of the pancreas were retrospectively analyzed to determine if marked stomach distension influenced the visualization of the pancreatic tail. Of the 29 patients who had marked stomach distension, 25 (86%) had displacement of small bowel loops away from the ventral surface of the pancreatic tail. With moderate or minimal stomach distension, there was bowel loop displacement in 37% and 0% of cases, respectively. Marked stomach distension appears to be an effective means of improving visualization of the pancreatic tail.

Ultrasonic features of pyogenic liver abscesses.

Ultrasonic features of 21 surgically confirmed pyogenic liver abscesses in 18 patients were analyzed. Typical lesions were round or ovoid with a discrete, irregular, echo-poor margin. The number and intensity of internal echoes and sound transmission were variable. Such lesions can be aspirated percutaneously for definitive preoperative diagnosis. Pyogenic liver abscesses appear to have more ragged walls and are less frequently elliptical or multilocular than abscesses elsewhere in the abdomen.

Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot.

The medical records and radiographs of the hands, wrists, and feet of 50 patients with psoriatic arthritis and 34 with erosive osteoarthritis were reviewed. Polyarticular arthrutis in psoriatics is often unilateral and the joints of a single ray may be selectively affected. Their erosions ten to occur at the "bare areas" of joints, whereas in erosive osteoarthritis it is the subchondral cortex that is primarily affected. Linear periosteal bone apposition is common in the latter. The distribution of arthritis, sites of bone erosion, and character of periosteal bone apposition form distinctive patterns in these conditions which are important in differential diagnosis.

Large skull defect in a headbanger.

A mentally retarded self-mutilating child developed a large skull defect at the site of repeated trauma. The bony defect involved only the outer table and had smooth bony margins.