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Pinto DS, Clode H, Madrazo BL, Paes FM, Alessandrino F. Imaging review of spontaneous renal hemorrhage. Emerg Radiol 2024; 31:515-528. [PMID: 38703272 DOI: 10.1007/s10140-024-02233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Spontaneous renal hemorrhage (SRH) is a diagnostic challenge and a significant cause of morbidity, and sometimes mortality. Early identification is essential to institute lifesaving and reno-protective interventions. In this review, we classify spontaneous renal hemorrhage by location, presentation and etiology. We also discuss the diagnostic approach to renal hemorrhage and optimum imaging modalities to arrive at the diagnosis. Finally, we review strategies to avoid missing a diagnosis of SRH and discuss the pitfalls of imaging in the presence of renal hemorrhage.
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Affiliation(s)
- Denver S Pinto
- Jackson Memorial Hospital, University of Miami, Miami, USA.
| | - Hannah Clode
- Jackson Memorial Hospital, University of Miami, Miami, USA
- Department of Radiology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Fabio M Paes
- Miller School of Medicine, Jackson Memorial Hospital - Ryder Trauma Center, University of Miami, Miami, FL, USA
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2
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Liu HH, Lin Y, Lin G, Wang LJ, Wan YL. Ultrasonography of acute retroperitoneum. Ultrasonography 2024; 43:179-192. [PMID: 38589285 PMCID: PMC11079507 DOI: 10.14366/usg.23232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
The retroperitoneum is an important space in the human body that is often implicated in a range Epub ahead of print of acute medical conditions, some of which can be life-threatening. Ultrasonography may serve as a pivotal first-line imaging technique when assessing patients with suspected retroperitoneal abnormalities. Effective ultrasonography of the retroperitoneum requires a comprehensive grasp of its anatomy, adjacent structures, and potential pathologies. Being well-acquainted with the imaging characteristics of acute conditions can meaningfully assist in an accurate diagnosis and guide subsequent management. This review article summarizes and illustrates the acute conditions involving the retroperitoneum through the lens of ultrasound imaging.
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Affiliation(s)
- Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, Tucheng District, New Taipei City, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Scalia G, Marrone S, Paolini F, Palmisciano P, Ponzo G, Giuffrida M, Furnari M, Iacopino DG, Nicoletti GF, Umana GE. Spinal epidural abscess due to acute pyelonephritis. Surg Neurol Int 2022; 13:159. [PMID: 35509571 PMCID: PMC9062902 DOI: 10.25259/sni_260_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2–L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis. Case Description: A 54-year-old female presented with persistent low back pain and lower extremity weakness accompanied by paresthesias. Previously, she had been hospitalized with the left acute pyelonephritis. The lumbosacral MRI documented a T12/L5 anterior epidural abscess with ring enhancement on the contrast study; the maximum diameter of the abscess at the L2–L3 level contributed to severe cauda equina compression. She underwent a L2/L4 decompressive laminectomy with drainage of the intraspinal/extradural and paravertebral components. Intraoperative microbiological sampling grew Staphylococcus aureus for which she then received targeted antibiotic therapy. Fifteen days later, she was walking adequately when discharged. Conclusion: Thoracolumbar epidural abscesses are rare. They must be considered among the differential diagnoses when patients present with acute back pain, fever, and new neurological deficits following prior treatment for acute pyelonephritis.
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Affiliation(s)
- Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi,” Catania,
| | - Salvatore Marrone
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Palermo, Italy,
| | - Federica Paolini
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Palermo, Italy,
| | - Paolo Palmisciano
- Department of Neurosurgery, UC Health, Cincinnati, Ohio, United States,
| | - Giancarlo Ponzo
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi,” Catania,
| | - Massimiliano Giuffrida
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi,” Catania,
| | - Massimo Furnari
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi,” Catania,
| | - Domenico Gerardo Iacopino
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP “Paolo Giaccone,” Palermo, Italy,
| | | | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
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Boraschi P, Giugliano L, Mercogliano G, Donati F, Romano S, Neri E. Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful? World J Gastroenterol 2021; 27:4143-4159. [PMID: 34326615 PMCID: PMC8311532 DOI: 10.3748/wjg.v27.i26.4143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Luigi Giugliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples “Federico II”, Naples 80131, Italy
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Second Division of Radiology, Azienda Ospedaliero-Universitaria Pisana-University of Pisa, Pisa 56124, Italy
| | - Stefania Romano
- Department of Diagnostic Imaging, Santa Maria delle Grazie Hospital, Naples 80078, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa 56126, Italy
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Huang Q, Li J, Lyu S, Liang W, Yang R, Zhang R, Xiao W, Liu J, Yan S, Zheng L, Chen F. COVID-19 associated kidney impairment in adult: Qualitative and quantitative analyses with non-enhanced CT on admission. Eur J Radiol 2020; 131:109240. [PMID: 32920219 PMCID: PMC7448815 DOI: 10.1016/j.ejrad.2020.109240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To qualitatively and quantitatively assess kidney imapairment in adults with COVID-19 by analysing imaging features on non-enhanced CT (NECT) and possible correlation between renal parenchymal attenuation (RPA) and serum creatinine (SCr) levels on admission. METHODS This study was approved by the local institutional ethics committee. A total of 82 patients with COVID-19 admitted from 10/1/2020∼15/3/2020 were enrolled. RPA and perinephric fat stranding (PFS) were evaluated on NECT imaging. According to the presence of PFS, the patients were divided into two groups: Group A, 38 patients with PFS, and Group B, 44 patients without PFS. Clinical data, including age, gender, clinical classification, SCr levels, and RPA on NECT were analysed. The RPA and SCr of the two groups with COVID-19 were analysed to determine possible difference and correlation. Eighty subjects with no kidney diseases were randomly selected as control group to determine the RPA of normal kidney performed on the same CT scanner. RESULTS Mean age, male to female ratio, number of severe and critical cases, and SCr of Group A were higher than those of Group B. Both mean RPA of Group A and Group B were lower than that of control. Mean RPA of Group A was even lower than that of Group B. A significant weak negative linear correlation between RPA on NECT and SCr in COVID-19 was indicated. CONCLUSIONS Decrease in RPA on NECT was observed in patients with COVID-19 and a weak linear negative correlation with SCr levels was found. The presence of PFS suggested more severe renal impairment in COVID-19. RPA measurements and PFS could be useful in quantitative and qualitative evaluation of COVID-19 associated renal impairment on admission.
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Affiliation(s)
- Qiang Huang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Jian Li
- Department of Electrocadiogram, Affiliated Hangzhou First People's Hospital, College of Medicine, Zhejiang University, 261 Huansha Road, 310006, Hangzhou, Zhejiang, People's Republic of China; Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Shuangzhi Lyu
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Rong Yang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Rui Zhang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Wenbo Xiao
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Jinpeng Liu
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China.
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, Zhejiang, People's Republic of China.
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Vernuccio F, Patti D, Cannella R, Salvaggio G, Midiri M. CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists. Emerg Radiol 2020; 27:561-567. [PMID: 32445022 DOI: 10.1007/s10140-020-01788-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/04/2020] [Indexed: 01/20/2023]
Abstract
Contrast-enhanced CT is not routinely indicated in uncomplicated urinary infections, but it may be necessary in patients with specific risk factors (i.e., diabetes, immunocompromised patients, history of stones, or prior renal surgery) or in patients not responding to antibiotics and in detecting complications of pyelonephritis. CT is the gold standard for imaging assessment of pyelonephritis severity. Imaging appearance of acute pyelonephritis, including focal (i.e., wedge-shaped zones of decreased attenuation or hypodense mass) and diffuse (i.e., global enlargement, poor parenchymal enhancement, lack of excretion of contrast, fat stranding) forms, needs to be differentiated from renal infarction, renal lymphoma, and interstitial nephritis. Chronic pyelonephritis-which appears as focal polar scars with underlying calyceal distortion, global atrophy, and hypertrophy of residual tissue-may mimic at imaging lobar infarcts. This pictorial essay reviews the CT imaging appearance of acute and chronic pyelonephritis, their uncommon subtypes, and their complications, with key features for early diagnosis. Their knowledge is crucial for emergency and abdominal radiologists to avoid misdiagnosis with malignancy and to guide the clinician towards the appropriate medical or surgical treatment.
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Affiliation(s)
- Federica Vernuccio
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G. D'Alessandro, University of Palermo, Palermo, Italy. .,I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina, Italy. .,Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France. .,Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy.
| | - Diana Patti
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Roberto Cannella
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Giuseppe Salvaggio
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital "Paolo Giaccone", Via del Vespro, 129, 90127, Palermo, Italy
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Patiño A, Martinez-Salazar EL, Tran J, Sureshkumar A, Catanzano T. Review of Imaging Findings in Urinary Tract Infections. Semin Ultrasound CT MR 2020; 41:99-105. [DOI: 10.1053/j.sult.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Bonsib SM. Urologic Diseases Germane to the Medical Renal Biopsy: Review of a Large Diagnostic Experience in the Context of the Renal Architecture and Its Environs. Adv Anat Pathol 2018; 25:333-352. [PMID: 30036201 PMCID: PMC6086223 DOI: 10.1097/pap.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The kidney is one of the most complicated organs in development and is susceptible to more types of diseases than other organs. The disease spectrum includes developmental and cystic diseases, involvement by systemic diseases, iatrogenic complications, ascending infections and urinary tract obstruction, and neoplastic diseases. The diagnosis of kidney disease is unique involving 2 subspecialties, urologic pathology and renal pathology. Both renal and urologic pathologists employ the renal biopsy as a diagnostic modality. However, urologic pathologists commonly have a generous specimen in the form of a nephrectomy or partial nephrectomy while a renal pathologist requires ancillary modalities of immunofluorescence and electron microscopy. The 2 subspecialties differ in the disease spectrum they diagnose. This separation is not absolute as diseases of one subspecialty not infrequently appear in the diagnostic materials of the other. The presence of medical renal diseases in a nephrectomy specimen is well described and recommendations for reporting these findings have been formalized. However, urologic diseases appearing in a medical renal biopsy have received less attention. This review attempts to fill that gap by first reviewing the perirenal anatomy to illustrate why inadvertent biopsy of adjacent organs occurs and determine its incidence in renal biopsies followed by a discussion of gross anatomic features relevant to the microscopic domain of the medical renal biopsy. Unsuspected neoplasms and renal cysts and cystic kidney diseases will then be discussed as they create a diagnostic challenge for the renal pathologist who often has limited training and experience in these diseases.
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Zhang P, Dyer RB. The "perinephric cobwebs" sign. Abdom Radiol (NY) 2018; 43:2521-2522. [PMID: 29450604 DOI: 10.1007/s00261-018-1483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pengcheng Zhang
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Murray TE, Lee MJ. Are We Overtreating Renal Angiomyolipoma: A Review of the Literature and Assessment of Contemporary Management and Follow-Up Strategies. Cardiovasc Intervent Radiol 2017; 41:525-536. [PMID: 29260305 DOI: 10.1007/s00270-017-1862-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022]
Abstract
Renal angiomyolipoma (AML) are benign tumours composed of fat, muscle, and disorganised blood vessels. Historic treatment algorithms for sporadic AML based on size fail to consider additional risk factors such as tumour vascularity and pseudoaneurysm formation. As AML is now predominantly incidental, rupture is rare and its mortality low. The recent publication of the largest longitudinal series to date also suggest that growth is uncommon, challenging existing surveillance paradigms. The evidence assessing treatment strategies in AML are reviewed, with particular emphasis on incidental sporadic AML. The relative merits of various AML treatments are discussed, and areas of clinical uncertainty highlighted.
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Affiliation(s)
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland.
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Radiological diagnosis of perinephric pathology: pictorial essay 2015. Insights Imaging 2017; 8:155-169. [PMID: 28050791 PMCID: PMC5265200 DOI: 10.1007/s13244-016-0536-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023] Open
Abstract
The perinephric space, shaped as an inverted cone, sits between the anterior and posterior renal fasciae. It can play host to a variety of clinical conditions encountered daily in the reporting schedule for a radiologist. Lesions may be classified and diagnosed based on their imaging characteristics, location and distribution. A broad range of differential diagnoses can be attributed to pathology sitting within this space, often without clinical signs or symptoms. An understanding of commonly encountered conditions affecting the perinephric space, along with characteristic imaging findings, can illustrate and often narrow the likely diagnosis. The aim of this essay is to describe commonly encountered neoplastic and non-neoplastic entities involving the perinephric space and to describe their key imaging characteristics. TEACHING POINT • Despite often a bulky disease, perinephric lymphoma does not produce obstruction or stenosis. • In primarily fatty masses, defects within the renal capsule likely represent angiomyolipoma. • Consider paraganglioma if biopsy is planned; biopsy may lead to catecholamine crisis.
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Chronic, nonspecific, postinfectious, retroperitoneal fibrosis and ureteral obstruction. Urologia 2016; 83:99-102. [PMID: 26350043 DOI: 10.5301/uro.5000134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. PATIENTS This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. DISCUSSIONS Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. CONCLUSIONS We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection.
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Tonolini M, Rigiroli F, Villa F, Bianco R. Complications of sporadic, hereditary, and acquired renal cysts: cross-sectional imaging findings. Curr Probl Diagn Radiol 2014; 43:80-90. [PMID: 24629661 DOI: 10.1067/j.cpradiol.2013.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Commonly encountered in the general adult and elderly population, in most cases simple renal cysts are confidently diagnosed on imaging studies and do not require further workup or treatment. However, large or growing renal cysts sometimes cause symptoms or signs such as hypertension, palpable mass, flank or abdominal pain, obstructive uropathy, and hematuria, which may indicate the need for minimally invasive percutaneous or laparoscopic treatment. Furthermore, severe complications such as cystic hemorrhage, rupture, or superinfection may occur, particularly in patients with polycystic renal disorders, either hereditary (namely adult polycystic kidney diseases) or acquired in chronic renal failure. This pictorial essay reviews and discusses the cross-sectional imaging appearances of symptomatic and complicated sporadic, hereditary, and acquired renal cysts. Early cross-sectional imaging with multidetector computed tomography or magnetic resonance imaging or both, including contrast enhancement unless contraindicated by renal dysfunction, is warranted to investigate clinical and laboratory signs suggesting retroperitoneal hemorrhage or infection in patients with pre-existent renal cysts, particularly if large, multiple, or hereditary.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Francesca Rigiroli
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
| | - Federica Villa
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
| | - Roberto Bianco
- Department of Radiology, "Luigi Sacco" University Hospital, Milan, Italy
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Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis. ACTA ACUST UNITED AC 2014; 40:1858-70. [DOI: 10.1007/s00261-014-0297-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis. Insights Imaging 2014; 5:677-89. [PMID: 25256564 PMCID: PMC4263803 DOI: 10.1007/s13244-014-0355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 11/25/2022] Open
Abstract
Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) currently represent the mainstay treatment options for the vast majority of patients with urolithiasis, with limited contraindications and high success rates. However, minimally invasive extracorporeal and endourological treatments are associated with a non-negligible morbidity including occasional life-threatening occurrences. These complications represent a source of concern for urologists since they may result in prolonged hospitalisation, need for surgical, endoscopic or interventional treatment, long-term renal impairment, and sometimes even medical malpractice claims. Due to the increasing prevalence of urolithiasis and the large number of therapeutic procedures performed, in hospitals with active urologic practices radiologists are increasingly requested to investigate suspected post-procedural complications following ESWL, PCNL or ureteroscopic stone removal. Based upon our experience, this pictorial essay provides an overview of current extracorporeal and endourological treatment modalities for urolithiasis, including indications and possible complications according to the most recent guidelines from the European Association of Urology (EAU). Afterwards, we review the clinical features and cross-sectional imaging appearances of common and unusual complications with case examples, including steinstrasse, subcapsular, perirenal and suburothelial haemorrhages, severe urinary tract infections (such as pyeloureteritis, pyelonephritis, renal abscesses and pyonephrosis), ureteral injuries and delayed strictures. Teaching points • Extracorporeal lithotripsy, percutaneous nephrolitotomy and ureteroscopy allow treating urolithiasis. • Minimally invasive extracorporeal and endourological treatment have non-negligible morbidity. • Multidetector CT allows confident assessment of stone-free status and postprocedural complications. • Main complications include steinstrasse, bleeding, severe infections, ureteral injuries and strictures. • Imaging triage allows the choice among conservative, surgical, endoscopic or interventive treatment.
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Osman S, Lehnert BE, Elojeimy S, Cruite I, Mannelli L, Bhargava P, Moshiri M. A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol 2014; 42:191-208. [PMID: 24070713 DOI: 10.1067/j.cpradiol.2013.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A clear understanding of the normal anatomy and pattern of disease spread is important in evaluating many retroperitoneal disorders. Primary retroperitoneal tumors are uncommon, accounting for 0.1%-0.2% of all malignancies in the body; 80%-90% of all primary retroperitoneal tumors are malignant. The primary retroperitoneal neoplasms can be divided into solid or cystic masses. The solid neoplasms can be classified according to their tissue of origin into 3 main categories: mesodermal tumors, neurogenic tumors, and extragonadal germ cell tumors. Computed tomography and magnetic resonance imaging play a vital role in the localization, characterization, evaluation of the extent of local invasion, assessment of metastases, and determination of treatment response for these tumors. The diagnosis of a primary retroperitoneal malignancy is often challenging owing to overlap of imaging findings. A definitive diagnosis can be established only at histopathologic analysis. However, knowledge of the important tumor characteristics, growth pattern, and vascularity can assist in narrowing the differential diagnosis.
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Affiliation(s)
- Sherif Osman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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