NMR findings in patients after wrist trauma with a negative plain radiographs.

BACKGROUND: The purpose was to assess the prevalence and location of the injuries of the carpal bones and soft tissue of the wrist on NMR in patients with negative radiographs. MATERIAL/METHODS: A total of 89 patients (9-81years) were consecutively examined after wrist trauma. Radiograms were performed in four projections: AP, PA, oblique and lateral. In 63 cases of negative radiographs and persistent clinical problem, simplified NMR (T1,T2, STIR; in coronal plane) was conducted with a 1.5 Tesla magnet. Results were evaluated by two independent observers. A positive X-ray result was stated when at least one observer suggested bone fracture. The MR images were viewed for detection of possible bone fracture, bone edema and soft tissue injuries. Cohen's kappa coefficient was calculated to assess the quality of chosen criteria by means of agreement between both observers and both methods. RESULTS: As many as 26 X-ray studies were classified as positive. Substantial agreement between independent observers was found (kappa=0.63). In 17 cases out of 63 with two negative wrist radiogram, the NMR result was positive (19%). The most frequently fractured or injured bone was scaphoid (10 cases) and distal radius (5 cases). Fair agreement was found between X-ray and NMR studies (kappa=0.37) due to different diagnostic information received in both methods. CONCLUSIONS: Simplified NMR imaging of the wrist proved to be strongly efficient in the detection of pathological changes in injured wrists.

Supernumerary kidney presenting as urinary leakage after an ipsilateral laparoscopic radical nephrectomy.

We present a case of a patient with supranumerary kidney diagnosed after laparoscopic radical nephrectomy. Urinary leakage, an unusual complication that appeared postoperatively, led to complementary examination and making the right diagnosis. The reevaluation of the preoperative CT (computed tomography) in enhancement phase and the new CT scan confirmed the presence of a real accessory organ connected to the main unit with a small bridge of tissue. The latter right nephrectomy was performed. Despite the scarceness of this anomaly, a thorough interpretation of images obtained during investigative procedures can provide a clue about the presence of this rare entity.