Percutaneous treatment of urine leaks in renal transplantation patients

The data on post-renal transplantation urine leaks in 23 patients were retrospectively reviewed to assess the role of percutaneous urine-diverting procedures in their treatment. The leaks were confirmed by means of antegrade pyelography, and either a nephrostomy catheter or a nephroureteral stent was placed. Nephrostography was performed frequently to evaluate leak closure. Urinary diversion was continued for an average of 68 days. Leak closure was documented in 20 of 23 (87%) cases. In four patients, concomitant infection or multiorgan failure precluded adequate therapy. One patient developed a ureteral stricture after the urine-diverting procedure and required surgical correction. The results suggest that percutaneous urine-diverting procedures are a definitive treatment for post-renal transplantation urine leaks.

Magnetic resonance imaging of adrenal cortical carcinoma

Five cases of adrenal cortical carcinoma examined with magnetic resonance (MR) are presented. Clinical histories, computed tomographic (CT) scans, and final pathologic findings were reviewed in each case. All masses were hypointense compared to the liver on T1-weighted images and became hyperintense compared to the liver on T2-weighted images. Signal intensity of adrenal masses, fat, and liver were measured. Adrenal/liver and adrenal/fat signal intensity ratios were then calculated. All the masses were readily identified with MR. The MR also demonstrated displacement or invasion of adjacent organs, as well as liver metastases. The inferior vena cava was also identified in each case. Even though there were no consistent MR findings to diagnose adrenal cortical carcinomas accurately, superior blood vessel identification and multiplanar capabilities may make MR the imaging modality of choice in evaluating the extent of disease and in planning surgical excision.

Imaging of abdominal aortic aneurysms

There is no single correct approach to evaluate aortic aneurysm. Variations in individual cases, equipment availability, technical expertise, and surgeons' preference frequently dictate the workup. Sonography is optimal for screening and follow-up in uncomplicated cases. CT is excellent in preoperative and postoperative evaluation of aneurysms and their potential complications. Angiography is used to determine visceral-branch involvement and define variations in vascular anatomy, although its routine preoperative use is controversial. MR imaging has emerged as a powerful tool to visualize and stage aneurysms.

Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography

Eleven women with a history of infertility and uterine leiomyomas underwent magnetic resonance (MR) imaging of the pelvis prior to myomectomy. Nine also underwent preoperative pelvic ultrasonography (US), and ten underwent hysterosalpingography. All studies were interpreted prospectively by independent observers. With each imaging modality, the location (one of 11 anatomic segments), size, and appearance of detected uterine leiomyomas were determined and compared with surgical and histologic findings. Among the nine patients who underwent both MR and US, the sensitivity (85%) and accuracy (94%) of MR imaging for abnormal segments was significantly better than that of US (sensitivity = 69%, P = .015; accuracy = 87%, P = .043). For the ten patients who underwent both MR and hysterosalpingography, the sensitivity (91%) and accuracy (96%) of MR imaging was better than that of hysterosalpingography (sensitivity = 18%, P = .0005; accuracy = 72%, P = .0005). The specificities of the three modalities did not significantly differ (100%, 97%, and 98% for MR, US, and hysterosalpingography, respectively). These data suggest that MR imaging is superior to US or hysterosalpingography for preoperatively locating uterine leiomyomas.

Magnetic resonance imaging in staging of renal cell carcinoma

From this preliminary study, the authors conclude that MRI adds little to the diagnosis of renal cell carcinoma, but may be very helpful in staging it.

Suburothelial hemorrhage: the value of preinfusion computed tomography

Suburothelial hemorrhage of the renal pelvis is a well documented complication of anticoagulant therapy. The urographic and CT features of this complication have been described; however, previous reports have included only contrast-enhanced CT. We report a case in which preinfusion CT, with careful evaluation of the attenuation coefficient, was essential in the diagnosis of suburothelial hemorrhage.

MR imaging of xanthogranulomatous pyelonephritis

The magnetic resonance (MR) appearance of a case of xanthogranulomatous pyelonephritis is described and compared with CT and surgical findings. Both CT and MR were comparable in displaying the morphology of this uncommon renal abnormality.

Mycotic aneurysm of the renal artery

Three cases of mycotic aneurysm of the renal artery are presented, all of which manifested similar findings on excretory urography and renal arteriography: small intrarenal aneurysm with distal occlusion, corresponding nephrographic defect or defects on urography and arteriography, and opacification of a normal collecting system. To the authors' knowledge these findings have not been reported previously, and they appear to represent a distinctive combination of findings diagnostic of mycotic aneurysm. The significance of recognizing this pattern, particularly as an aid in establishing an early diagnosis of infective endocarditis, is stressed.

Pararenal pseudocyst (urinoma) as complication of percutaneous nephrostomy

Percutaneous nephrostomy is a well-recognized procedure utilized by the radiologist both as a temporary drainage method for urinary tract obstruction and as the elective therapeutic modality in selected pathologies of the urinary tract. We report a complication not previously mentioned in the literature, urinoma formation.

Renal fascia: its radiographic importance

The renal fascia, commonly known as Gerota's fascia, is a collagenous connective tissue sheath which separates the perirenal fat from the pararenal fat. It may be visualized radiographically and is helpful in the precise localization of abdominal masses. It is also useful in the diagnosis of perinephric hematomas and abscesses and in distinguishing them from intrarenal or subcapsular hematomas and abscesses. The anatomy of the renal fascia is briefly discussed, and representative cases are presented.

Isolated dissecting aneurysm of the renal artery

We report two cases of an unusual cause of the acute onset of hypertension, a spontaneous dissecting aneurysm localized to the renal artery. Also reviewed are 16 reported cases from the literature. The mean age of the 18 patients was 52 years. The majority of these patients were males (78%). Hypertension was a presenting sign in 14 (78%), but was not usually a pre-existing feature. Loin pain, often severe, occurred in eleven patients (61%), whereas gross hematuria was recorded only in two (11%). The right renal artery was involved in ten cases (55%), the left in three (17%), and both in five cases (28%). Atherosclerosis of the renal arteries and the aorta was absent in 69%, and mild in 23%. There has been no report of renal artery rupture; however, vascular occlusion occurs frequently. Medical and surgical approaches to the management of this phenomenon have been reported and are reviewed.

Diverticulum of the female urethra. The value of the post-void bladder film during excretory urography

A simple technique utilizing the post-void film of the bladder during excretory urography is proposed for the diagnosis of female urethral diverticula. This technique provides for the diagnosis of this lesion in patients without clinical manifestations who would not normally undergo cystourethroscopy, retrograde urethrography, or voiding cystourethrography.

Medullary rays. Visualization during excretory urography

The medullary rays are well-defined anatomic structures consisting of bundles of renal tubules which form in the renal cortex and continue through the renal medulla as the medullary striations. These structures are occasionally visualized during excretory urography in abnormal physiologic states characterized by tubular stasis and hyperconcentration of contrast material. Under these conditions, fine striations are visualized which correspond in position and orientation to these structures. The work of others has shown that in tubular stasis, contrast material is hyperconcentrated in the tubules. On microradiography in normal and obstructed kidneys, the highest concentrations of contrast material are seen in the lumen of collecting ducts. Lastly, retrograde injection of contrast material into the medullary rays produces a roentgen image similar to our illustrated cases.

Adrenal and ovarian vein androgen levels and laparoscopic findings in hirsute women

Hirsute women pose a diagnostic dilemma when urinary 17-ketosteroid and serum testosterone levels are normal. To locate the site of androgen excess in 19 hirsute women, blood samples were collested from the left ovarian and adrenal veins via a catheter insertedinto the right femoral vein. Laparoscopy and bilateral ovarian biopsies were also preformed in 18 of the 19 patients studied. Nine women had elevated 17ketosteroid (fivepatients) and/or antecubital serum testosterone (five patients) levels. Fourteen womanhad elevated testosterone concentrations distributed as follows: ovarian vein (six), adrenal vein (one), adrenal and ovarian veins (seven). Androstenedione was elevated in theovarian vein (seven) and both adrenal and ovarian veins (11) in 18 patients. Laparoscopic examinations revealed that less than 50 per cent of the enlarged ovaries could be detected by pelvic examination. Histologic studies suggested that these patients comprised two groups: a group (six patients) who appeared to ovulate and a group (12 patients) who lacked evidence of ovulation.