The Usefulness of T2-weighted MR Urography and Contrast Enhanced MR Urography in the Evaluation of Obstructive Uropathy: Comparisonal Study with Antegrade Pyelography1

PURPOSE: To compare the efficacy of contrast-enhanced and T2-weighted magnetic resonance urography (MRU) for the depiction of obstruction and evaluation of the causes of obstructive uropathy with that of antegrade pyelography. MATERIALS AND METHODS: Twenty-five patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) and antegrade pyelography (AGP) were included in the study. We performed MR urography, comprising half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging and 3-D fast imaging with steady state precession (3-D FISP) T1-weighted imaging after gadolinium enhancement and compared the quality of the images of both the HASTE and 3-D FISP MRU techniques in terms of their depiction of the dilated pelvocalyceal system, and the level, type, and causes of obstruction. RESULTS: In terms of anatomical depiction of the pelvocalyceal system (p=0.002) and the causes of obstruction (p=0.003), T1-weighted MRU using 3D-FISP was significantly better than T2-weighted MRU using the HASTE sequence. Regarding level of obstruction, T2-weighted MRU using the HASTE sequence and contrastenhanced T1-weighted MRU using 3D-FISP showed an accuracy of 76% (19/25) and 84% (21/25), respectively. In terms of type of obstruction, the accuracy of T2-weighted MRU and T1-weighted CEMRU was 72%(18/25) and 88% (22/25), respectively. CONCLUSION: T2-weighted MRU and T1-weighted CEMRU provided both anatomical information and that relating to impaired renal function. The two modelities played a complementary role and their use could decrease the unnecessary use of invasive diagnostic examination for the evaluation of obstructive uropathy.

Percutaneous Catheter Drainage of Complicated Traumatic Perirenal Hematoma: Case Report

A perirenal hematoma very commonly occurs after trauma. Treatment differs according to the degree of renal injury, though many cases are managed conservatively and complications are rare. We report two cases in which successful treatment of a perirenal hematoma involved percutaneous catheter drainage; in one there was bowel obstruction, and in the other the hematoma was infected.

Percutaneous Removal of Foreign Bodies by Gooseneck Snare Technique in the Common Bile Duct and T-tube Tract: A Report of Two Cases

Although the presence of foreign bodies in the common bile duct and T-tube tract is uncommon, it is because of recent developments in endoscopic biliary intervention and percutaneous choledochoscopic procedures that they are found with increasing frequency in the biliary tree. We report two cases in which foreign bodies in the biliary tree were successfully removed using the percutaneous gooseneck snare technique. In one patient a plastic biliary stent was malfunctioning and could not be removed under endoscopic guidance, while in the other, a plastic guidewire had been inserted into the T-tube tract during percutaneous choledochoscopy for the treatment of a common bile duct stone.

HRCT Findings of Scrub Typhus

PURPOSE: To evaluate high-resolution CT (HRCT) findings of scrub typhus. MATERIALS AND METHODS: We retrospectively reviewed the HRCT scans of 26 serologically confirmed scrub typhus patients. One underwent follow-up HRCT scanning. RESULTS: Twenty-three (88.5%) of the 26 patients showed abnormal findings. All 23 had lung parenchymal lesions; a small amount of pleural effusion was seen in 11 patients, and lymphadenopathy in six. The predominant parenchymal lesion was thickening of interlobular septae and the axial and intralobular interstitium (n=16). Most lesions were located in both lower lung zones. Other findings were ground-glass attenuation (n=11) and focal parenchymal consolidation (n=8). In one patient, parenchymal lesions were resolved on follow-up HRCT scanning. CONCLUSION: HRCT findings of interstitial thickening, abnormally increased parenchymal attenuation, pleural effusion and lymphadenopathy with typical clinical symptoms were diagnostic of scrub typhus.

Transcatheter Arterial Embolization of the Pseudoaneurysm and Aneurysm: The Usefulness and Therapeutic Effect according to Embolic Materials

PURPOSE: To evaluate therapeutic effect according to embolic materials, and the usefulness of transcatheter arterial embolization (TAE) in the treatment of pseudoaneurysm and aneurysm. MATERIALS AND METHODS: We evaluated 12 patients who since 1987 had suffered arterial pseudoaneurysm or aneurysm. Ten were males and two were females, and their ages ranged from 10 months to 67 years (mean 34 years). The arteries involved were the superficial temporal (n=3), the renal (n=3), the hepatic (n=2), the gastroduodenal (n=2), the persistent sciatic (n=1), and the superior gluteal artery (n=1). All patients underwent diagnostic arteriography and TAE with gelfoam particles, coil, and detachable balloon, or a combination of these. Follow-up, of between three and 74 months duration, involved computed tomography, angiography, ultrasound, and the evaluation of clinical symptoms. RESULTS: All patients were treated successfully with TAE and there was no recurrence during the follow-up. Seven patients (58.3%) were treated only coils; the site of their aneurysm or pseudoaneurysm was the superficial temporal (n=2), the renal (n=2), the gastroduodenal (n=2), or the superior gluteal artery (n=1). Four patients (33.3%) with a small pseudoaneuysm arising from the distal branch of a small artery-the hepatic (n=2), the superficial temporal (n=1), or the renal (n=1)-were treated with gelfoam particles, and a pseudoaneurysm of the hepatic artery too small for the insertion of a coil was embolized completely with gelfoam particles. A detachable balloon was used in one case with a huge pseudoaneurysm arising from the persistent sciatic artery, in which embolization with a large coil was not effective. CONCLUSION: TAE is safe and effective in the treatment of arterial pseudoaneurysm and aneurysm. Coil was the preferred material, but for a small pseudoaneurysm arising from the distal branch of a small artery, gelfoam was preferred . For the embolization of a huge pseudoaneurysm, a adtachable balloon was useful.