Ultrasonic evaluation of the unilateral nonvisualized kidney.

There are several techniques for evaluating the nonvisualized kidney. Nephrotomography may be helpful in those patients who have some remaining renal function. Radionuclide renal flow and imaging studies are more sensitive than nephrotomography in detecting hydronephrosis, the most common cause of unilateral renal nonvisualization, but also require some renal function to be of diagnostic value. Diagnostic ultrasound, since it is independent of renal function, is an even more sinsitive indicator of urinary obstruction, detecting those cases where no functioning renal parenchyma is present. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion. When ultrasonography demonstrates a solid mass in the renal fossa, angiography is recommended for definitive diagnosis. When no kidney is identified renal venography may be useful in differentiating between a small nonfunctioning kidney and renal agenesis.     

Technetium-99m DMSA imaging and the obstructed kidney

Although several authors have claimed that the function of an obstructed kidney could be overestimated on Tc-99m DMSA imaging, the clinical importance of such an overestimation has not been well documented. Partial obstruction of one ureter was created in a rat, and a relative Tc-99m DMSA uptake was obtained 4 hours after intravenous injection. By puncture of the isolated obstructed kidney, it was shown that the function of that kidney was overestimated by at least 17%.     

Peyronie's disease. Ultrasonic evaluation

Peyronie disease, or Induratio Penis Plastica, is characterized by the presence of one or more fibrous plaques at the albuginea penis, on the cavernous bodies or on the intercavernous septum. First of all, Induratio Penis Plastica etiology is described, and its clinics and therapy. Past imaging methods are then considered (i.e. conventional radiology, xerography), and current ones (i.e. conventional radiology, cavernosography, CT and US). The authors report on their 4-year (1983-1987) experience with US in 62 males. Various different probes were employed, especially small-part 7.5 MHz probes. The results are similar to those reported in international literature. The use of high frequency probes allows the evaluation of focal hypoechoic lesions even in the early phase of the disease, thus helping make therapy more effective.     

Ultrasonic evaluation of renal calculi.

Nine patients with radiographic evidence of renal calculi were evaluated with gray scale renal ultrasonography. A characteristic "sonic shadow" caused by the calculus was adequately demonstrated in each case. This paper discusses the advantage of ultrasound in evaluating the presence of nonopaque and opaque renal stones.     

Transosseous access for decompression of an obstructed pelvic kidney

We report a case of an obstructed pelvic kidney which was decompressed using a transosseous access route. The patient presented with obstructive uropathy and fever, necessitating decompression. Initial access was gained to the kidney by traversing the ilium, allowing subsequent retrograde placement of a double-J ureteric catheter.     

Hydronephrosis of the lower pole of the duplex kidney: another renal pseudotumor.

Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.     

Ultrasonic evaluation of radiographic opacities of the chest.

The nature of pleural based radiographic opacities in the chest can be uncertain; however, ultrasonic examination provides a reliable means of distinguishing solid from fluid-containing lesions. It is superior to both fluoroscopy and radiography in accurately localizing loculated fluid collections for thoracentesis and can be performed with commercially available gray scale contact scanning equipment. Cases representing a spectrum of clinical applications are discussed.     

Ultrasonic evaluation of the scrotum

Ultrasonography has proved to be a highly useful method for detecting testicular lesions, correlating them with clinical findings, and indicating whether scrotal masses are caused by fluid or by solid tissue. It has not been possible, however, to distinguish spermatic cord torsion from epididymitis.     

Ultrasonic evaluation of the scrotum

Ultrasonography has proved to be a highly useful method for detecting testicular lesions, correlating them with clinical findings, and indicating whether scrotal masses are caused by fluid or by solid tissue. It has not been possible, however, to distinguish spermatic cord torsion from epididymitis.     

The contribution of computed tomography to the evaluation of the obstructed ureter

Computed tomography (CT) has been found to make a valuable contribution to the diagnosis of the etiology of ureteral obstruction when routine urography and pyelography have not been diagnostic. We believe CT can replace more invasive techniques such as antegrade pyelography and even retrograde pyelography in the evaluation of many of these cases. This presentation will summarize our experience with the use of CT to evaluate the etiology of ureteral obstruction, indicate those disease processes likely to be encountered, emphasize the limitations of the technique, and indicate the place CT has in the study of these patients.     

Common carotid artery occlusion: evaluation with duplex sonography.

PURPOSETo demonstrate the efficacy of carotid duplex ultrasound to diagnose common carotid artery occlusion (CCAO) and to define the clinical features of CCAO.METHODSWe reviewed 5400 carotid duplex ultrasonograms obtained over a 7-year period for suspected carotid artery disease. In cases of CCAO, medical records were reviewed.RESULTSThirteen cases (0.24%) of CCAO were diagnosed by carotid duplex ultrasonography, including five cases of isolated CCAO. Seven cases were proved by cerebral angiography. Cerebral angiography failed to demonstrate patent internal carotid arteries in two cases of isolated CCAO. Mean age of onset was 67 +/- 9 years. The main clinical presentation was stroke in nine cases (69%). The most common vascular risk factors were hypertension (62%) and heart diseases (54%). Three patients had a history of radiation therapy to the neck. Two of five patients with isolated CCAO had major stroke, with good recovery in one, whereas five of eight patients with CCAO had major stroke; among them, only one had good recovery.CONCLUSIONPatients with isolated CCAO may have a better outcome than patients with CCAO. Duplex sonography, particularly with color-coded flow imaging, provides an accurate examination to define the patency of the arteries distal to the carotid bifurcation. The clinical features of CCAO are similar to those of internal carotid artery occlusion except for the low prevalence of CCAO.     

Ultrasonic cholangiography. Gray-scale B-scan evaluation of the common bile duct.

Gray-scale B-scanning permits evaluation of major portions of the bile ducts, especially those with significant dilatation. Injection of contrast material containing microscopic air bubbles through a T-tube with simultaneous ultrasonography detected multiple echoes filling in the previously echo-free area which represented the common bile duct, outlining both the duct and portions of the major tributaries. Reflections could be obtained from stones within the duct. Follow-up examinations after surgery could be used to demonstrate shrinkage of the duct. Jaundice due to extra- or intrahepatic obstruction was successfully differentiated noninvasively.     

Ectopic pregnancy: duplex Doppler evaluation

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.