Clinical characteristics and diagnostic considerations in acquired renal cystic disease.

Acquired multiple bilateral cystic transformation of kidneys has been increasingly noted in patients with long-standing renal failure treated by chronic dialysis. To study the clinical characteristics of this newly described disease and assess the utility of available diagnostic methods, 130 patients with chronic renal failure (100 on dialysis, 30 nondialyzed) were studied with ultrasonography and/or computerized tomography (CT). Among patients on dialysis, 22% had acquired renal cystic disease (ARCD), an additional 30% had one to three solitary cysts, and 48% had no cysts. In nondialyzed patients, 7% had ARCD, 53% had one to three solitary cysts, and 40% had no cysts. Among these 130 chronic renal failure patients (nondialyzed and dialyzed), 21 of 86 males compared to 1 of 44 females had ARCD (P less than 0.001). Duration of dialysis therapy and age were greater in patients with ARCD (49.8 +/- 8 months, 55 +/- 4 years, respectively) compared to those with solitary cysts (28 +/- 6 months, 45 +/- 2 years) or no cysts (15 +/- 3 months, 42 +/- 2 years). The diagnostic accuracy of ultrasound (US) was compared to CT. CT is purportedly 100% accurate in the characterization of renal cysts. We are disappointed at the low level of diagnostic accuracy for both CT and US in the detection of renal cysts in chronic uremia. It appears both a negative CT and ultrasound are necessary to absolutely exclude either ARCD or solitary cyst.

A pictorial essay of pelvic and abdominal masses seen during pregnancy.

Since the advent of ultrasound, pelvic and abdominal masses occurring with pregnancy are being recognized more frequently and at earlier stages of gestation. The precise sonographic definition of the size and location of a mass is important for determining route of delivery or surgical approach during laparotomy and cesarean sections. We hope to illustrate that a variety of etiologies need to be considered, and although it is not often possible to make a histologic diagnosis on the basis of ultrasound finding alone, the integration of imaging information with other clinical data can be helpful in narrowing the differential diagnostic possibilities.

Benzyl alcohol toxicity: impact on mortality and intraventricular hemorrhage among very low birth weight infants.

Benzyl alcohol preservative in intravascular flush solutions has been reported to cause neurologic deterioration and death in very low birth weight infants. Following the widespread discontinuation of the use of such solutions in newborns, scattered reports of decreased mortality and decreased incidence of intraventricular hemorrhage among small premature infants appeared in the pediatric literature. To better assess the true impact of benzyl alcohol toxicity in this group of infants, we undertook a detailed review of the medical records of all babies less than 1,250 g birth weight admitted to our neonatal intensive care unit for 13 months before and 13 months after the use of solutions containing benzyl alcohol was stopped. Significant decreases were found in both mortality rate (from 80.7% to 45.7%) and incidence of grade III/IV intraventricular hemorrhage (from 46% to 19%) among infants less than 1,000 g birth weight who did not receive the preservative compared with those who did. No significant changes were found in several other prenatal factors that could have contributed to this improvement in survival. We conclude that benzyl alcohol toxicity contributed significantly to both mortality and the occurrence of major intraventricular hemorrhage among infants weighing less than 1,000 g at birth and that solutions containing benzyl alcohol should never again be used in the care of such infants.

CT evaluation of glucagonomas.

Seven patients with clinical features of the glucagonoma syndrome, including the characteristic rash, diabetes mellitus, and weight loss, were examined by CT. Computed tomography demonstrated a primary pancreatic tumor in all patients, and, in four, hepatic metastases were identified. The primary tumors, relatively large and solid in nature, varied in size from 2.5 to 6 cm in maximum diameter. The tumor was found in the tail of the pancreas in three patients and in the head of the pancreas in four. No obliteration of adjacent perivascular or peripancreatic fat planes was observed in any patient. Calcification was present in the primary tumor in three patients and in the hepatic metastases in one. All tumors that were studied angiographically were found to be hypervascular. In contrast to insulinomas, which are frequently quite small when clinically diagnosed, glucagonomas appear to attain considerable size prior to being clinically apparent. Thus, we conclude that CT ought to become the mainstay in the identification, localization, and staging of these tumors.

Computed tomography and ultrasound of retained placenta from abdominal pregnancy.

The computed tomographic (CT) and ultrasound findings in a case of retained placenta from an abdominal pregnancy are presented. To our knowledge, this is the first published report of CT findings in retained placenta of abdominal pregnancy. The complementary role of CT and ultrasound in managing this disorder are discussed.

Unsuspected adnexal masses in renal transplant recipients.

Post-transplant sonograms in 74 female recipients less than 40 years old revealed unsuspected adnexal masses in 5 (7 per cent). Sonographically, these masses were difficult to distinguish from other post-transplant fluid collections, such as lymphoceles, urinomas or abscesses and, consequently, led to further diagnostic evaluations in 4 patients. Of the adnexal masses 4 were excised surgically: 2 were hemorrhagic ovarian cysts, 1 was a follicular ovarian cyst and 1 was a paraovarian cyst. A coexisting gynecologic mass should be included in the differential diagnosis of a perinephric mass in female transplant recipients. Pre-transplant sonograms to identify or exclude occult pelvic masses in women may be of benefit in simplifying the postoperative management and minimizing unnecessary diagnostic evaluation.