Unusual radiological presentation of renal cell carcinoma

We present an unusual case of renal cell carcinoma in a 59-year-old Saudi male less than 3 cm in size showing a pelvicalyceal filling defect on excretory urography and retrograde pyelography. Renal stones and blood clots were excluded by ultrasound and computerized tomography scanning. A urothelial tumor was initially diagnosed; finally surgery revealed a papillary renal cell carcinoma

value of radiology in the diagnosis and management of indwelling ureteric catheter encrustation

To stress the value of radiology in the diagnosis and management of encrustations forming on indwelling double-J ureteric stents introduced prior to extracorporeal shock wave lithotripsy [ESWL]. King Fahd Military Medical Complex; Dhahran Radiology and Urology Departments. All patients in whom there were difficulties with stent removal after lithotripsy. Seven of 40 patients [17.5%] developed encrustation, five on the lower J of the stent and two at both ends Fluoroscopy was done in all patients in whom there was difficulty with stent removal to assess mobility and confirm the site of possible encrustation. Plain abdominal radiography and tomography were helpful in showing opaque encrustation while excretory urography was needed for radiolucent ones. Ureteric stenting is used during ESWL to allow easy passage of stone fragments and facilitate internal drainage of urine. Encrustation may develop on stents and cause obstruction or difficulty to removal. Radiology helped in the early diagnosis of encrustation and its further management

Computed tomography in the localization of parathyroid glands in primary hyperparathyroidism

Twenty three patients with a diagnosis of primary hyperparathyroidism [PHP] were treated at Jordan University Hospital [JUH] between June 1984 and June 1990. After establishing the diagnosis of PHP clinically and biochemically, localization of the diseased gland [s] was attempted by computerized tomography [CT] in 15 patients. CT findings were later correlated with the surgical and pathological results. In 10 patients, the surgical and pathological findings corresponded to those reported by CT. Identification of parathyroid tumours on CT scan was made retrospectively in three patients. In two other patients the diseased glands did not correspond to the CT findings. The accuracy of CT localization in this study is 66.6% prospectively and 86.6% retrospectively

Radiologic evaluation of obstructive jaundice using ultrasonography, computerized tomography and percutaneous transhepatic cholangiography

Ultrasound [US] and percutaneous transhepatic cholangiography [PTC] were performed in 21 patients while computerized tomography [CT] in 8 patients. We found US and CT comparably accurate in differentiating obstructive from non obstructive jaundice. The precise level of obstruction was identified by US in 95%, by CT in 88% and by PTC in 100%, while the cause of obstruction was accurately predicted by US in 52%, by CT in 88% and by PTC in 86% of cases. Associated abnormalities were perfectly described by CT in 100% and only in 55% of patients with US. The author believes that US is suitable to screen for biliary dilatation and to determine the level of obstruction while CT helps to verify the cause of obstruction and associated findings. PTC which is an invasive procedure should be reserved to cases with high obstruction, when US and CT are equivocal and if the surgeon is considering biliary drainage or bypass surgery

Intra-arterial digital subtraction angiography [IA-DSA] in the evaluation of cerebrovascular disease

The author examined 40 patients with intraarterlal digital subtraction angiography [IA-DSA] via the femoral approach [Seven patients] and flush aortic arch study [DSA-AA] to investigate extracranial carotid occlusive disease, the rest had selective common carotid injection [DSA-SC] to evaluate cerebro-vascular disease. Arch injection [DSA-AA] was successful in 86% of cases, while setectlve catheterlzation of the common carotid artery [DSA-SC] was possible in 94% of patients with successful delineation of both extra and intracranlal vessels. Superior Images with excellent vessel opacification, free of movement artefact and superimpositlon were possible with DSA-SC and to a lesser extent with DSA-AA. The iodine/load per case was markedly low averaging 5.25 gm for DSA-SC and 10.5 gm for DSA-AA. A considerable improvement in the diagnostic value, and reduction in the procedure time and iodine load was achieved when IA-DSA techniques were used

Anaphylactic reactions during intravenous urography

Out of 4261patients from the Jordan University Hospital and Al-Islamic Hospital, Amman Jordan, five patients developed serious anaphylactoid reactions after intravenous injection of iodinated radiographic contrast medium [RCM] within the past 18 months. Two patients were above 55 years of age with a history of ischemic heart disease, two others gave a history of allergy; one to fish and the other to RCM [urografin] [R] and the 5th patient was a young female without a previous history of allergy or significant illness. In this retrospective study, the present situation concerning the aetiology of RCM reactions, dangers, precautions and treatment are thoroughly discussed

Intravenous digital subtraction angiography in the preoperative evaluation of renal cell carcinoma

Intravenous digital subtraction angiography [IVDSA] was performed in 5 patients with renal cell carcinoma presenting with a solitary renal mass to assist in the preoperative evaluation to document the number of renal arteries present with the relative vascularity of the tumour, and to record tumour extension into the renal vein or inferior vena cava. The IDVSA findings were compared with computed tomography [CT] as well as the surgical and pathological results. IVDSA was found to be relatively non-invasive, safe and accurate. It offers unique information and is complementary to CT in the evaluation of a renal mass