ABSTRACT
Thickening of the gallbladder wall may result from a large spectrum of pathological conditions, intrinsic as well as extrinsic to the biliary tract, and may have different appearances. Accurate diagnosis is usually established after a correlation of imaging findings, laboratory data and clinical history. US remains the initial imaging modality for the evaluation of acute right upper quadrant pain. CT and MRI are complementary to US and have an increasing role in assessing a thickened-wall gallbladder.
Subject(s)
Gallbladder Diseases/diagnosis , Acalculous Cholecystitis/diagnosis , Acalculous Cholecystitis/diagnostic imaging , Adenocarcinoma/diagnosis , Adenocarcinoma/diagnostic imaging , Adenoma/diagnosis , Adenoma/diagnostic imaging , Adenomyoma/diagnosis , Adenomyoma/diagnostic imaging , Cholecystitis, Acute/diagnosis , Cholecystitis, Acute/diagnostic imaging , Cholecystolithiasis/diagnostic imaging , Diagnosis, Differential , Female , Gallbladder/diagnostic imaging , Gallbladder/pathology , Gallbladder Diseases/diagnostic imaging , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed , UltrasonographyABSTRACT
PURPOSE: We evaluate the efficacy and parenchymal consequences of extracorporeal shock wave lithotripsy (ESWL) for staghorn calculi in children. MATERIALS AND METHODS: From 1991 to 1999, 16 young patients 5.5 months to 2 years old and 7 older children 6 to 11 years old were treated for complete (6) or partial (17) staghorn calculi. Infection was the main factor of lithogenesis, particularly in younger children. In 21 patients the stone burden was more than 20 mm. All patients were treated under general anesthesia using a 14 kV. Sonolith 3000 (14) or a 12 to 20 kV. Nova (9) lithotriptor. In 5 of the 7 older children a Double J section sign stent was inserted before treatment. In the younger children group calculi were fragmented after 1 (11) or 2 (5) sessions. Of the 7 older children 3 required 3 (1) and 4 (2) treatment sessions. To assess the long-term effect of ESWL on the parenchyma, dimercapto-succinic acid renal scan was performed the day before and 6 months after therapy in 20 patients. RESULTS: Of the 16 younger children 14 became stone-free (87.5%) and 2 had small asymptomatic residual fragments. Of the 7 older children 5 were stone-free (71.4%) and 2 required additional surgery. No steinstrasse or pyelonephritis occurred after ESWL and no parenchymal or ureteral lesion related to ESWL was identified on conventional dimercapto-succinic acid scintigraphy. At a followup of 9 months to 9 years all patients have normal blood pressure. CONCLUSIONS: ESWL as a first option is safe and appropriate for the treatment of staghorn calculi in children particularly in younger children with infected calculi.
Subject(s)
Lithotripsy , Urinary Calculi/therapy , Adolescent , Child , Child, Preschool , Humans , Infant , Radiopharmaceuticals , Technetium Tc 99m Dimercaptosuccinic AcidABSTRACT
OBJECTIVES: To determine the efficacy of extracorporeal shock-wave lithotripsy (ESWL) in young children and to evaluate, using renal scintigraphy, any possible adverse effects on renal parenchyma. PATIENTS AND METHODS: From January 1991 to October 1998, 19 infants (aged 5-24 months) underwent ESWL for kidney urolithiasis using a Sonolith 3000 (14 kV, Technomed Corp, Lyon, France) or a Nova (14-20 kV, Direx Medical Systems, Paris, France) lithotripter. The treatment and its effects were evaluated using a physical examination, conventional imaging (plain abdominal X-ray and ultrasonography) and renal scintigraphy 24 h before ESWL and again at least 6 months after the last session of treatment. RESULTS: Ten children were rendered stone-free by ESWL after one session and 18 after two sessions. At the follow-up (8 months to 8 years, mean 36 months) no hypertension was recorded and no acquired parenchymal damage was detected with conventional imaging. No scars or significant variation of differential function attributable to ESWL were identified on renal scintigraphy. CONCLUSION: ESWL is clearly effective for treating infant urolithiasis. There were no renal parenchymal lesions associated with ESWL, even in previously damaged kidneys or after the treatment of staghorn calculi. A long-term follow-up (assessing blood pressure) is mandatory and renal scintigraphy before and 6 months after ESWL in infants is recommended to confirm these results in a larger series.
Subject(s)
Kidney Calculi/therapy , Lithotripsy/adverse effects , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Kidney/diagnostic imaging , Kidney/injuries , Male , Radioisotope Renography/methods , Recurrence , Succimer , Treatment OutcomeABSTRACT
AIM: The objectives of the study were to confirm the efficacy of extracorporeal shock wave lithotripsy (ESWL) in infants and children and to evaluate potential long-term renal parenchymal damage by 99m Tc DMSA renal scan. MATERIALS AND METHODS: Between November 1989 and November 1997, 39 children between 10 months and 17-1/2 years of age (average: 7 years) were treated by extracorporeal shock wave lithotripsy for kidney or ureteral stones with a Sonolith 3000 lithotriptor (Technomed Corp). Forty-six stones were treated. Eight metabolic and 11 urological abnormalities were identified. The evaluation of the treatment and its consequences were based on a clinical examination, conventional imaging and a DMSA renal scan performed 24 h before extracorporeal shock wave lithotripsy and at least 6 months after treatment. RESULTS: Treatment was successful (stone fragmented and eliminated) in 84.6% at 3 months after one to four sessions. Sixty-one sessions were necessary and two patients underwent open surgery for failed extracorporeal shock wave lithotripsy. Three recurrences were also retreated. At long term follow-up (6 months to 8 years) no incidents of high blood pressure were observed, nor parenchymal lesions imputable to extracorporeal shock wave lithotripsy. CONCLUSIONS: The efficacy of the extracorporeal shock wave lithotripsy for children is proven. This study also confirms the innocuousness of extracorporeal shock wave lithotripsy for renal parenchyma even in infants. However, long term follow-up and further evaluation with the other categories of lithotriptors are necessary to make definitive conclusions.
Subject(s)
Kidney/injuries , Lithotripsy , Radiopharmaceuticals , Technetium Tc 99m Dimercaptosuccinic Acid , Urinary Calculi/therapy , Adolescent , Age Factors , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Lithotripsy/adverse effects , Lithotripsy/instrumentation , Lithotripsy/methods , Radionuclide Imaging , Treatment Outcome , Wounds and Injuries/diagnostic imaging , Wounds and Injuries/etiologyABSTRACT
OBJECTIVES: This study evaluated the long-term effects of extra-corporeal shock-wave lithotripsy (ESWL) on the renal parenchyma of children using DMSA-Tc 99m scintigraphy. MATERIAL AND METHODS: Between November 1989 and April 1997, twenty-three children wee treated for renal stones using a SONOLITH 3000 lithotriptor (Technomed-Corp. Evaluation of treatment and its consequences was based on clinical examination, conventional imaging and comparison with DMSA-TC 99m renal scintigraphy performed the day before and at least 6 months after treatment. RESULTS: The success rate (fragmented and eliminated stones) was 90% at 6 months. Long-term follow-up did not reveal any alteration of blood pressure or renal function. Scintigraphic examinations did not demonstrate any significant parenchymal lesions attributable to treatment. CONCLUSION: Extracorporeal shock wave lithotripsy is effective in adults and young children. Its safety on the renal parenchyma was demonstrated during this study. However, evaluation of larger series with the use of other lithotriptors is necessary before reaching any definitive conclusions.
Subject(s)
Kidney Calculi/therapy , Kidney/diagnostic imaging , Lithotripsy/adverse effects , Adolescent , Child , Child, Preschool , Humans , Infant , Length of Stay , Prospective Studies , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Dimercaptosuccinic AcidABSTRACT
PURPOSE: To evaluate the efficacy of extracorporeal shock-wave lithotripsy (ESWL) in infants (less than 2-years-old) and study the potential long-term renal parenchymal damage by 99 m Tc DMSA renal scan. MATERIALS AND METHODS: Between November 1993 and February 1998, 12 children underwent ESWL treatment for kidney and ureter urolithiasis with a Sonolith 3,000 lithotriptor (Technomed-Corp). All children were less than 2-years-old. Evaluation of treatment and its consequences was based on clinical examination, conventional imaging (plain abdominal radiography excretory urogram) and a DMSA renal scan performed 24 hours before ESWL and at least 6 months after treatment. RESULTS: Treatment was successful in 84.6% of cases, by achieving stone-free status after one session and 100% after 2 sessions. Long-term follow-up (one month to four years) did not reveal any blood pressure or renal function changes. No acquired parenchymal scar was identified. On DMSA renal scan. CONCLUSIONS: The efficacy of ESWL in treating infant urolithiasis is clearly established. Renal parenchymal damage associated with ESWL did not appear in this study, but long-term follow-up mandatory (blood pressure) and each infant should have a DMSA renal scan before and after ESWL to confirm these preliminary results on a larger series.
Subject(s)
Kidney Calculi/therapy , Lithotripsy , Ureteral Calculi/therapy , Humans , Infant , Kidney/diagnostic imaging , Kidney/pathology , Lithotripsy/adverse effects , Radiography , Radionuclide ImagingABSTRACT
17 children from 18 months to 16 years old were treated by ESWL for calculi of the upper urinary tract using a Sonolith 3000 lithotriptor. 31 calculi (5 to 60 mm) have been treated on 16 renal units and 3 pelvic ureters. The renal parenchyma of all treated kidneys was considered normal on preoperative ultrasound and IVU; 8 patients had a preoperative DMSA. The treatment required 1 to 4 sessions delivering 400 to 3000 shocks per session and 400 to 6000 shocks per treatment at 14 kV. Within three months post treatment, 14 patients (88.23%) were stone free and 3 patients had residual fragments (2 needed further surgical extraction). With a follow up of three months to five years, all patients have a normal blood pressure, serum creatinine and sterile urine. In no instance, IVU or ultrasound revealed a lesion imputable to ESWL. Seven patients had a DMSA six months or more after the last session; 4 of these were normal but the three other patients had a loss of function and an heterogeneous fixation on the treated side. These preliminary results confirm that ESWL is efficient for upper urinary tract calculi destruction in children. However ESWL seems to be susceptible to induce parenchymal damage, detected by DMSA, whose incidence and long term effects particularly on blood pressure need further evaluation.
Subject(s)
Lithotripsy/methods , Urinary Calculi/therapy , Adolescent , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Kidney Diseases/diagnostic imaging , Kidney Diseases/etiology , Lithotripsy/adverse effects , Organotechnetium Compounds , Radionuclide Imaging , Succimer , Technetium Tc 99m Dimercaptosuccinic Acid , Treatment OutcomeABSTRACT
With regard to observations of 6 children with choledochal cysts, the importance of the anatomic data obtained by ultrasonography is emphasized. In the most common types of cystic dilatation of the common bile duct, the precise details concerning the size and place of the extra-hepatic biliary abnormality make ultrasonography the best pre-operative investigation.
Subject(s)
Common Bile Duct Diseases/diagnosis , Cysts/diagnosis , Ultrasonography , Child , Child, Preschool , Cholangiography , Common Bile Duct Diseases/pathology , Cysts/classification , Diagnosis, Differential , Dilatation, Pathologic/diagnosis , Diverticulum/diagnosis , Humans , InfantABSTRACT
The results of ultrasonography recordings in 13 patients with renal abscesses are described: the image of the abscess is that of a cavity, of mixed structural composition, located inside the renal parenchyma. Ultrasonography has great diagnostic value, can be used to guide the aspiration needle and therapeutic procedures, and permits effective follow-up of the course of the disease. Chronic abscesses develop thick borders which give an ultrasonographic appearance similar to that of a necrotic cancer. In the perinephric phlegmon the cavity compresses the capsule. The pyonephrotic kidney is large and heterogenous in appearance. The clinical picture and the results of guided needle puncture are the essential features for diagnosis.
Subject(s)
Abscess/diagnosis , Kidney Diseases/diagnosis , Ultrasonography , Abscess/therapy , Adult , Aged , Child, Preschool , Chronic Disease , Diagnosis, Differential , Female , Humans , Kidney Diseases/therapy , Male , Middle Aged , Nephritis/diagnosis , Perinephritis/diagnosis , PuncturesABSTRACT
One hundred tumours were detected by IV urography and studied by echotomography. In 37 cases, a nephrotomography was performed and in 65 cases a renal arteriogram. The reliability of these three examinations was analysed. Three calcified masses were impossible to analyse by echography and required arteriography from the outset. There were two false negatives related to an error of interpretation and not to any defect in the echography. With regard to the 3 calcified masses, no better information was obtained by nephrotomography. Four necrosed carcinomas were erroneously identified as cysts. Four carcinomas were missed at arteriography. The reliability of echotomography was good apart from in cases of small carcinomas (less than 2 cm) and calcified masses. It proved to be more reliable than nephrotomography and arteriography. By contrast, it was less selective since there were false positive results in 13% of cases.
