Congenital Abnormalities of the Pericardium.

Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities. We review the presentation, diagnosis, and management of congenital absence of the pericardium, pericardial cysts, and diverticula. A summary of multimodality imaging features is provided.

Aberrant subclavian artery pathologies and Kommerell's diverticulum: a review and analysis of published endovascular/hybrid treatment options.

Aberrant subclavian artery (ASA) is one of the most common congenital vascular anomalies of the aortic arch. The incidences of aberrant right subclavian artery (ARSA) and aberrant left subclavian artery (ALSA) are 0.4% to 2.3% and 0.05%, respectively. Approximately 60% of ARSA patients will have a Kommerell's diverticulum at the origin of the ASA. Symptomatic or aneurysmal ASAs need to be treated. Historically, open operation was the favored method to reconstruct ASA anatomy; however, novel endovascular techniques are now available. Following a brief discussion of embryonic development, symptoms, and treatment history of the ASA and Kommerell's diverticulum, the results of a literature review to collect the worldwide experience of endovascular/hybrid treatment of ASA is presented.

[Air-filled cysts of tracheal origin: nosological problems and actual frequency]. / Kystes aériens d'origine trachéale: problèmes nosologiques et fréquence réelle.

Air-filled paratracheal bronchogenic cysts are extremely rare. They are lined by respiratory epithelium. We have operated on 2 patients whose cysts were diagnosed by CT scan: one presenting with bloody sputum and the other with dysphagia. Both patients had a history of neck surgery. Because such cases are rare in the literature, their exact origin, whether tracheocele, diverticulum or other form of air-filled cyst, remains a matter of debate. However, their frequency is probably underestimated because most cause few symptoms and are well tolerated. In a recent radiologic study their prevalence was found to be 2% in patients undergoing CT scan.

[Pyelocalicial diverticula]. / Divertículos pielocaliciales.

OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diagnosis and treatment. METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed. RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography. CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.

[Intraluminal diverticulum of the duodenum]. / Diverticule intraluminal du duodénum.

A case of intraluminal duodenal diverticulum associated with partial situs inversus in a 15 year-old girl is reported. Etiopathogenicity is discussed. The pathological characteristics explain that surgery associated with upper digestive endoscopy had to be performed and why endoscopic excision was not possible in this case.

Medical management of male and female cats with nonobstructive lower urinary tract disease.

This case is typical of recurrent urolithiasis managed by repeated surgery. Retrospective assessment of the disorder indicates the need for quantitative analyses of uroliths removed by cystotomy. Compliance of the owners with recommendations to minimize recurrent urolithiasis might have been beneficial. Results of medical therapy designed to induce dissolution of uroliths in this case are representative of preliminary findings of medical dissolution of naturally occurring struvite uroliths in ten other cats. It is of interest that the uroliths dissolved even though no effort was made to induce diuresis. The underlying cause of UTI in this patient may have been damage to the lower urinary tract induced by previous diagnostic and therapeutic procedures and/or sterile struvite uroliths that compromised local host defense mechanisms. Lack of urease production by the uropathogens suggests that they did not play a causative role in formation of uroliths. The need for preventative therapy of recurrent formation of uroliths after their medical dissolution is worthy of further comment. In this patient, specific measures to prevent urolith recurrence were not initiated because it is a part of a prospective clinical study. In the event uroliths recur, medical therapy designed to induce dissolution of uroliths would be repeated. Need for long-term preventative therapy would be dependent on the time interval between recurrent episodes (weeks, months, or years), and the effectiveness of medical therapy for urolith dissolution. Long-term prophylactic therapy would include urine acidifiers and diets low in magnesium.

Paraureteral diverticula: clinical experience with 17 cases with associated renal dysmorphism.

We report our experience with 17 cases of paraureteral diverticula seen in the last 12 years. These 17 cases represent a particular group of patients with ureteral reflux in that they often had ureteral obstruction too. Early operative intervention is recommended. There is a trend towards renal dysmorphism and dysplasia as the position of the ureteral orifice laterlizes in the diverticulum. A paraureteral diverticulum was considered to be the developmental extravesical expansion of the terminal ureteral end by virtue of the caudally positioned ureteral bud in the wolffian duct.

Abnormalities of the ureteral bud.

The development and incorporation of the ureteric bud into the developing bladder is a complex process, and it is influenced by events occurring at the same time in the development of other systems in the perineum. Knowledge of the embryology of the ureteric bud and associated wolffian duct is the key to understanding the development of the entire genitourinary system. If the normal embryology is understood, the dysembryogenesis that results in many of the common anomalies of the lower urinary system is simplified. Many of the concepts proposed in this discussion are well substantiated, others are more difficult to prove conclusively. It is believed, however, that the embryologic approach provides a simplified understanding of many of the common problems encountered in pediatric urology. The key in clinical practice to the diagnosis and understanding of these defects is the cystoscopic examination. Careful assessment of the orifice's position, appearance, and tunnel length will allow the interpretation of how the abnormality came about, and also provides valuable information concerning the state of the associated renal segment. This in turn allow better therapeutic management of the problem based on the knowledge of the severity of the renal anomaly associated with the abnormality found in the bladder.