Biomedical subjects
Publications and source records attributed to N S Curry.
Isolated congenital macrodactyly, termed macrodystrophia lipomatosa, is a rare entity. It may be confused with plexiform neurofibroma, hemangioma, or lymphangioma. Computed tomography provides an ideal methodology to verify the fatty proliferation of soft tissue that accompanies bone overgrowth and distinguishes this lesion from the others in the differential list.
Small-bore, silicone nasoenteric feeding tubes are increasingly utilized in the critically ill patient to provide nutritional support. The metallic-weighted tips and stiffening introducing stylets create the potential for misplacement with potentially serious consequences. We have reported our experience with 14 patients who had inadvertent tube misplacement, resulting in complications that included pneumothorax, hydrothorax, empyema, mediastinitis, pneumonia, and esophageal perforation. The incidence of radiographically detected abnormal tube position was 1.3 percent. The presence of cuffed tracheostomy or endotracheal tubes did not prevent this occurrence. The institution of enteral feedings should, therefore, be performed according to strict guidelines which include radiographic confirmation of desired position before feedings are initiated, limited and supervised use of stylets, and a need for special precautions in patients who are obtunded or receiving intubated respiratory assistance.
A solitary thrombosed varix of the right renal vein was mistaken preoperatively for a renal tumor. Computed tomography, retrograde pyelography, arteriography, and needle biopsy did not establish the diagnosis. Renal venography would have confirmed the diagnosis of this extremely rare condition.
A patient with Hodgkin's disease received a fractionated 3,740 rad dosage over 4 weeks to a portal that included both kidneys. Three months later a computed tomographic scan obtained 2 hours after intravenous contrast injection demonstrated sharply demarcated, dense, persistent nephrograms corresponding to the irradiated areas. These changes are ascribed to acute radiation nephritis, reflecting tubular stasis and ischemia.
The late computed tomography appearance of a case of acute, irreversible renal transplant rejection demonstrated replacement of normal renal architecture by homogeneous low-density tissue surrounded by a rim of increased attenuation, mimicking abscess or neoplasm. Calcification was not found in the kidney, as in the only previously reported case of long-term renal transplant rejection.
We retrospectively studied nine patients with solitary renal neoplasms that were first visible when smaller than 3 cm in diameter to determine their imaging and pathologic characteristics and clinical course. These neoplasms represented 14% of the total renal neoplasms discovered over a 6-year period, and only one-third were initially identified by screening urography. While seven of the patients had hematuria, most had associated urologic conditions (calculi, prostatism). Two patients had widespread metastases 2 and 4 years after the carcinomas first appeared. The remaining seven patients are alive and well 8 months to 6 years after undergoing nephrectomy, despite the significant delayed diagnosis in three patients. Only one lesion was pathologically benign (an oncocytoma). Two of the renal cell carcinomas were found within the walls of partially calcified renal cysts. Two (22%) of nine neoplasms exhibited aggressive biologic behavior, which suggests that these lesions may have greater metastatic potential than previously thought. We suggest that computed tomography be performed after screening urography and cystoscopy when unexplained hematuria is present.
A 35-year-old woman with tuberous sclerosis and known bilateral renal angiomyolipomas presented with shock due to massive hematuria arising from the left kidney. The cause of bleeding was diagnosed angiographically as arising from a left upper pole renal artery aneurysm within the tumor. Cessation of bleeding and clinical stabilization occurred without deterioration of renal function after superselective embolization of the dorsal segmental renal artery with a single 5-mm Gianturco coil.
Fifty-one patients with documented abdominal abscess cavities were treated by percutaneous abscess and fluid drainage (PAFD). Drainage catheters made of various materials in sizes ranging from 5 through 18 French (Fr) were retrospectively studied and prospectively assigned to patients. No significant difference in the success or failure of PAFD as a function of these factors was found once an 8.3 Fr catheter with 0.045-inch diameter side-holes was reached; catheters larger than this were not associated with improved patient outcome. Failues of PAFD occurred primarily with the presence of phlegmonous collections and cavities with fistulous connection to bowel.
A clinically and radiographically unsuspected ossified renal metastasis from a primary osteogenic sarcoma was identified by computed tomography (CT) and radionuclide bone scan. These imaging modalities play an important adjunctive role in the evaluation and follow-up of patients with primary osteogenic sarcoma.
The visualization of paravertebral venous collateral vessels during excretory urography may be normal when a foot vein has been injected. This finding reflects the abundant intercommunications between the caval, vertebral, and azygos venous systems and should not be mistaken for vena caval occlusion unless strong clinical suspicion of deep venous thrombosis exists.
Bilateral dense rings in the renal medulla were found on noncontrasted computed tomography in a patient with marked hypercalcemia and suspected primary hyperparathyroidism. The rings were not present on plain radiographs and were obscured on contrasted scans, and may represent occult nephrocalcinosis. Associated findings--renal insufficiency induced by hypercalcemia and interstitial nephritis--may be reversible with early recognition of this CT finding.
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Percutaneous interventional procedures can be valuable in the evaluation and treatment of urologic complications of renal transplantation. Thirty-three patients underwent percutaneous procedures, including relief of obstruction by catheter nephrostomy, diagnostic antegrade pyelography with Whitaker testing, aspiration of various fluid collections (lymphocele, hematoma, urinoma, and abscess), and renal artery angioplasty, during a three year period at three institutions, to provide temporizing treatment and anatomic data. Surgical intervention was sometimes avoided, but more often it could be deferred to allow the patient to stabilize prior to surgery. Complications that required surgery occurred in two patients.
Renal sonography was compared with commonly obtained laboratory and pathologic data in 31 patients with systemic lupus erythematosus. Sonography was 95% sensitive in the detection of lupus nephritis, with the major abnormalities being abnormal renal size and cortical echogenicity. Sonography was useful in locating the kidneys for biopsy and in excluding hydronephrosis. However, in the overall evaluation of patients with uncomplicated lupus nephritis, sonography added little information not readily available from laboratory data.
The preliminary radiographs of 783 patients undergoing excretory urography were prospectively surveyed for the presence of abdominally located phleboliths. Two per cent demonstrated typical densities in a periureteral distribution flanking the lumbar spine where they could be confused with ureteral calculi. All these patients were multiparous females and three-quarters of them had pelvic masses (11% of all patients with pelvic masses), suggesting a possible association with gonadal vein thrombi. Altered venous flow with dilatation of ovarian veins, consequent valvular incompetence and stasis may account for the gonadal vein distribution in the pelvic mass cases. Other observed clinical conditions included hepatic disease, portal hypertension and varices. Obstruction and stasis of venous flow in hepatic disease states may lead to phlebolith formation in gastric and mesenteric varices. Unlike pelvic phleboliths, suprapelvic phleboliths are infrequent but may be detected by careful inspection of low kilovoltage films, particularly in the regions closely flanking the lumbar spine. Their presence may be associated with pelvic masses or significant chronic hepatic disease and they may be confused on plain film with ureteral calculi.
We have described two cases of nonoperative removal of obstructing ureteral calculi via a percutaneously placed nephrostomy. Nephrectomy or excessive operative morbidity and mortality may thus be avoided in patients at high risk. Although the number of patients who have been treated in this manner is small, the results are encouraging.
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