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Murphy SM, Browne RFJ, Finn S, Myers E, Crotty P, Grainger R. Non-metastatic primitive peripheral neuroectodermal tumour of the kidney (extraskeletal Ewing's sarcoma) with vena caval tumour thrombus. BJU Int 2015; 92 Suppl 3:e44. [PMID: 19127638 DOI: 10.1111/j.1464-410x.2003.04059.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S M Murphy
- Departments of Urology, Adelaide and Meath Hospital (Incorporating the National Children's Hospital), AMNCH, Tallaght, Ireland.
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Kok HK, Govender P, Leong S, Browne RFJ, Torreggiani WC. Percutaneous computed tomography-guided oesophageal needle biopsy. Ir Med J 2014; 107:34. [PMID: 24654476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Stunell H, McNeill G, Browne RFJ, Grainger R, Torreggiani WC. The imaging appearances of calyceal diverticula complicated by uroliathasis. Br J Radiol 2011; 83:888-94. [PMID: 20846986 DOI: 10.1259/bjr/22591022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The presence of diverticula arising from the calyceal system is a relatively uncommon urological problem, occurring with an incidence of 2.1-4.5 per 1000 intravenous urogram (IVU) examinations. While the incidence of calyceal diverticula is low, the frequency of stone formation within them is high. We describe the aetiology and clinical presentation and describe the role of imaging with ultrasound, intravenous and retrograde pyelography and CT in diagnosis and planning treatment. We also describe the potential of fluid-sensitive magnetic resonance imaging techniques as a radiation-free alternative to the use of more conventional modalities, such as intravenous urography and retrograde pyelography, in delineating the anatomy of calyceal diverticula before surgical and radiological intervention especially in young patients and pregnant women.
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Affiliation(s)
- H Stunell
- Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Abstract
Renal transplantation is an established treatment for patients with end-stage renal disease. Many causes of graft dysfunction are treatable, making prompt detection and diagnosis of complications essential. Sensitive, noninvasive imaging procedures, which do not use iodinated contrast media, are therefore highly desirable to evaluate graft function. Duplex sonography (US) has traditionally been the initial investigation of graft dysfunction. US offers many advantages, particularly during the postoperative period, when it can be performed portably regardless of renal function and can guide percutaneous procedures. However, US lacks specificity in assessing hydronephrosis, cannot differentiate parenchymal causes of dysfunction, and may have difficulty assessing transplant vessels. Recently comprehensive magnetic resonance imaging (MRI) protocols including MR urography, gadolinium-enhanced MR angiography, and MR renography have evolved as a "one-stop" diagnostic technique in the evaluation of the entire graft and peritransplant region. Multiplanar capabilities enable MRI to identify the site of urinary obstruction and assess renal vessels in their entirety. The evolving technique of MR renography may also differentiate parenchymal causes of dysfunction. By combining these three components into a single examination, further information may be obtained regarding the graft when compared with US and other conventional studies, with improved patient convenience, less morbidity, and a potential cost saving.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin, 24, Ireland.
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Stunell H, Buckley O, Feeney J, Geoghegan T, Browne RFJ, Torreggiani WC. Imaging of acute pyelonephritis in the adult. Eur Radiol 2006; 17:1820-8. [PMID: 16937102 DOI: 10.1007/s00330-006-0366-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 05/14/2006] [Accepted: 06/12/2006] [Indexed: 11/30/2022]
Abstract
The diagnosis of acute pyelonephritis in adults is predominantly made by a combination of typical clinical features of flank pain, high temperature and dysuria combined with urinalysis findings of bacteruria and pyuria. Imaging is generally reserved for patients who have atypical presenting features or in those who fail to respond to conventional therapy. In addition, early imaging may be useful in diabetics or immunocompromised patients. In such patients, imaging may not only aid in making the diagnosis of acute pyelonephritis, but more importantly, it may help identify complications such as abscess formation. In this pictorial review, we discuss the role of modern imaging in acute pyelonephritis and its complications. We discuss the growing role of cross-sectional imaging with computed tomography (CT) and novel magnetic resonance imaging (MRI) techniques that may be used to demonstrate both typical as well as unusual manifestations of acute pyelonephritis and its complications. In addition, conditions such as emphysematous and fungal pyelonephritis are discussed.
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Affiliation(s)
- H Stunell
- Department of Radiology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland
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Abstract
Extratesticular varicocele is a common clinical condition, occurring in up to 20% of the normal adult male population. It is characterized by dilatation of the veins of the spermatic cord and has well-described sonographic appearances. Intratesticular varicocele is characterized by dilated intratesticular veins and is extremely rare. It usually, but not always, occurs in association with an ipsilateral extratesticular varicocele. We describe the sonographic and colour Doppler appearances of this poorly described entity in a middle-aged man referred for evaluation of a painful left testicular swelling.
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Affiliation(s)
- R F J Browne
- Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
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Ho SGF, Phillips AJ, Browne RFJ, Munk PL, Legiehn GM, Yoshida EM, Davis JE, Chung SW, Scudamore CH. Recurrent hepatocellular carcinoma after liver transplantation mimicking post-transplantation lymphoproliferative disorder. Australas Radiol 2005; 49:315-8. [PMID: 16026439 DOI: 10.1111/j.1440-1673.2005.01449.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Approximately 5% of patients with end-stage cirrhosis undergoing orthotopic liver transplantation have occult hepatocellular carcinoma. Careful follow up is required to detect recurrent tumour, and knowledge of the patterns of recurrence may avoid diagnostic confusion with other malignancies, such as post-transplantation lymphoproliferative disorder. This case report illustrates an unusual presentation of recurrent hepatocellular carcinoma in a 56-year-old man presenting with a para-aortic soft tissue mass, thought clinically and radiologically to represent lymphoma or post-transplantation lymphoproliferative disorder. This case demonstrates that recurrent hepatocellular carcinoma can present late after transplantation as retroperitoneal lymphadenopathy, and should alert physicians and radiologists to be aware of the radiological appearances of recurrence and of the need for early biopsy to avoid diagnostic confusion with other malignancies.
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Affiliation(s)
- S G F Ho
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Browne RFJ, Murphy SM, Grainger R, Hamilton S. CT cystography and virtual cystoscopy in the assessment of new and recurrent bladder neoplasms. Eur J Radiol 2005; 53:147-53. [PMID: 15607867 DOI: 10.1016/j.ejrad.2004.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 01/30/2004] [Accepted: 02/02/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if CT cystography and virtual cystoscopy have a role in the assessment of neoplasms of the urinary bladder. MATERIAL AND METHODS Twenty five adults suspected of having bladder tumours underwent CT cystography. Twenty three had subsequent virtual cystoscopic reconstructions from the axial data. The examinations were reviewed by two radiologists and the findings were correlated with those at conventional cystoscopy. RESULTS Seventeen masses larger than 0.5 cm were identified by CT cystography in 16 patients. Two patients had normal CT cystography, but one had small recurrent neoplasms on conventional examination. Seven patients had nodular mucosal irregularities which were subsequently shown to be neoplastic in three. Accuracy for diagnosis of neoplasm in all patients was 88%. CONCLUSION CT cystography is very accurate at identifying masses larger than 0.5 cm and can show mucosal abnormalities as small as 2 mm. It is minimally invasive and can be diagnostic when conventional cystoscopy is inconclusive. It can indicate appropriate areas for assessment and biopsy at conventional examination. Virtual cystoscopy gave comparable views to conventional cystoscopy, but did not add diagnostic information. It is not likely to replace conventional cystoscopy, but may be helpful in occasional circumstances where the latter is inconclusive, or can not be performed.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Abstract
The diagnosis of urinary tract infection (UTI) in the adult is primarily based on typical patient symptomatology and urinary evaluation for the presence of bacteria and white blood cells. Uncomplicated UTI usually does not require radiological evaluation unless it is recurrent. Imaging should, in general, be reserved for those patients in whom conventional treatment has failed or those who have recurrent or unusually severe symptoms. Patients with conditions predisposing to infection, or complications thereof, such as diabetes mellitus or immunocompromised states, may also benefit from early imaging. If pyonephrosis is suspected, early imaging and possible urgent drainage is also warranted. Intravenous urogram and ultrasound have traditionally been used in the assessment of these patients, allowing detection of calculi, obstruction and incomplete bladder emptying. These imaging techniques, while useful, have limitations in the evaluation of renal inflammation and infection in the adult. Computerised tomography has now become accepted as a more sensitive modality for diagnosis and follow-up of complicated renal tract infection. Contrast-enhanced CT allows different phases of excretion to be studied and can define extent of disease and identify significant complications or obstruction. Nuclear medicine has a limited role in the evaluation of urinary tract infection in adults. Its main role is in the assessment of renal function, often prior to surgery. Magnetic resonance imaging has a limited but increasing role. It is particularly useful in those with iodinated contrast allergies, offering an ionising radiation free alternative in the diagnosis of both medical and surgical diseases of the kidney.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Browne RFJ, Hamilton S. Abdominal ultrasound in the evaluation of the asymptomatic patient with abnormal liver function tests. Ir Med J 2004; 97:49-50. [PMID: 15134270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We retrospectively evaluated abdominal ultrasound studies of 273 asymptomatic patients with abnormal liver function tests over an 18-month period to assess the value of abdominal ultrasound as an initial investigation. In-patients, out-patients and general practitioner referrals were included. 143 (53%) examinations were normal. Those with significant abnormality (n=13, 5%) were referred for further investigation/treatment. Those with alterations in hepatic echogenicity (n=117, 42%) underwent clinical and biochemical follow-up, radiological follow-up or biopsy. 20% of patients underwent further radiological investigation. Ultrasound is a non-invasive, cost effective first-line investigation in the evaluation of asymptomatic patients with abnormal liver function tests.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Browne RFJ, Murphy SM, Torreggiani WC, Munk PL, Marchinkow LO. Radiology for the surgeon: musculoskeletal case 30. Osteochondritis dissecans of the medial femoral condyle. Can J Surg 2003; 46:361-3. [PMID: 14577709 PMCID: PMC3211719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Browne RFJ, Murphy SM, Torreggiani WC, Munk PL. Musculoskeletal case 29. Neuropathic shoulder secondary to syringomyelia. Can J Surg 2003; 46:300, 309-10. [PMID: 12930110 PMCID: PMC3211630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Browne RFJ, Jeffers M, McDermott T, Grainger R, Mulvin D, Gibney RG, Torreggiani WC. Technical report. Intra-operative ultrasound-guided needle localization for impalpable testicular lesions. Clin Radiol 2003; 58:566-9. [PMID: 12834642 DOI: 10.1016/s0009-9260(03)00145-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To describe a new technique of intra-operative ultrasound-guided needle localization of impalpable intratesticular lesions. MATERIALS AND METHODS Three patients with impalpable testicular lesions identified on ultrasound underwent needle localization under ultrasound guidance. The procedure was performed in the operating theatre under general anaesthetic using a 7.5-8 MHz linear array probe and a portable ultrasound machine. Under direct guidance, a 21 G needle was placed through the centre of the lesion allowing resection and immediate frozen section analysis. RESULTS In two patients malignancy was confirmed and an orchidectomy was performed. In one patient a benign lesion was detected obviating the need for orchidectomy. CONCLUSION Patients presenting with impalpable testicular lesions can pose a diagnostic dilemma and orchidectomy is often performed. We describe an ultrasound-guided intra-operative localization technique enabling direct pathological examination so surgical approach can be re-evaluated in the presence of a benign lesion. This is particularly important in the case of a solitary testicle in order to preserve testicular function.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Browne RFJ, Murphy SM, Torreggiani WC, Hogan B, Munk PL. Musculoskeletal case 27. Primary hyperparathyroidism-induced brown tumour of the third metacarpal. Can J Surg 2003; 46:122, 150-1. [PMID: 12691351 PMCID: PMC3211690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Murphy SM, Connolly P, Browne RFJ, Quinlan J, Torreggiani W, McElwain JP. Computed tomography wire localisation-assisted operative retrieval of a migrated symphysis pubis plate from the ischiorectal fossa. Ir Med J 2003; 96:25-6. [PMID: 12622053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We report an unusual case of migration of a metal plate from the symphysis pubis to the left ischiorectal fossa, and a technique of using pre-operative CT guided wire localisation of the plate as a successful method of assisting plate retrieval.
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Affiliation(s)
- S M Murphy
- Department of Orthopaedic Trauma and Reconstructive Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24.
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Affiliation(s)
- R F J Browne
- Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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