[Tomodensitometry in so-called radiotransparent urinary lithiasis].
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Biomedical subjects
Publications and source records attributed to G Lemaitre.
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The authors describe nine cases of pseudo-ureterocele secondary to various obstructive lesions: bladder tumors, stones in the ureteral meatus, tuberculosis of the bladder. Certain radiological signs, such as asymmetrical swelling of the terminal ureter and the thick halo which surrounds the dilatation, can sometimes distinguish pseudo-ureteroceles from idiopathic ureteroceles, and associated radiological anomalies in the bladder are also of greater value for differentiation.
Pancreatic pseudocysts were observed to simulate a mass in the upper pole of the left kidney in 4 patients. Urographic investigation of these pseudocysts revealed deformities similar in all respects to those produced by a cyst, though in two cases the mass was surrounded by a thick wall. A better definition of the parenchymatous deformity was obtained by the use of true trunk profile nephrotomograms. The value of ultrasonography, using the grey scale, and of transparietal puncture with measurement of amylase levels, is stressed. The authors discuss the problem of establishing the precise location--anterior to, surrounding, or within the kidney--of these pseudocysts.
The extension of infiltrating stomach cancer through the gastrocolic ligament into the transverse colon appears to be relatively common. The radiological appearance is characteristic, with more or less widespread, but shallow, extrinsic prints with irregular contours typical of malignant tumours. Its gastric origin is strongly suggested by its position of the superior border of the transverse colon. The authors report 6 observations in which the value of this very characteristic radiological abnormality of the colon to diagnose primary stomach cancer was confirmed. Radiological appearances are not very specific in primary stomach cancer and interpretation is often difficult; endoscopy or even biopsies are often inconclusive.
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Secondary tumours of the kidney are relatively common. Found at autopsy in approximately 4 per cent of patients dying of malignant disease, they are clinically latent in most instances. Thus in a total series of 295 malignant tumours of the kidney, only 8 were metastases. The primary tumour is most often a bronchial carcinoma, this being confirmed in our series (5 cases). This is followed, in order of decreasing frequency, the breast, stomach, pancreas and stomach. Two of the 8 cases were rarities: a renal metastasis from a meningoblastoma and a metastasis from one tumour to another, a carcinoma of the ovary metastasising to a hypernephroma. The pathogenesis of these secondary tumours leads to the consideration of 2 modes of spread: haematogenous and lymphatic. They present no special clinical features. Intravenous pyelogram reveals the appearances of a malignant tumour mass. Angiography is more informative, the results reflecting the histological nature of the primary tumour. The latter being most frequently a carcinoma, the arteriographic image is one of hypovascularisation, thus differing from a hypernephroma with its rich vascularisation and resembling an infiltrating pelvi-calyceal carcinoma. Histopathological examination is not always conclusive itself. Nephrectomy is effectively only justified if the primary tumour has been or can be successfully treated in the absence of other metastases.
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In severe obstructive disease of the kidney, with major distension of the intrarenal collecting ducts and marked thinning of the parenchyma, intravenous urography with high doses of contrast medium may reveal, almost pathognomic nephrographic abnormalities, such as, the dense capsule appearance, or septal appearances. The diagnostic value of these radiological appearances is all the greater in these very advanced cases of hydronephrosis, opacification of the excretory ducts can often not be obtained.
About four cases, the authors exhibit roentgenographic features of subcapsular hematomas. They particularly emphasize the interest of nephrotomography and angiography two provide the typical signs; i.e.: flattening of the lacteral border of the renal parenchyma, absence of acute edges between normal renal outline and flattened portion, and at last, displaced capsular artery and/or renal capsule itself. Between flattening of kidney and capsular artery or capsule, one may individualize a mass of soft tissue density, convex or biconvex, corresponding to the hematomas. Particular attention is required concerning differential diagnosis with renal cyst, and possibility of a small neoplasm, sometimes indetectable at angiography, as a cause of "spontaneous" subcapsular hematoma.
The authors report 84 cases of post-operative intestinal obstruction and demonstrate the value of straight XRays and barium meal in the diagnosis of the variety of early post-operative obstruction and the indications for operation. In 74 cases out of 82, a precise diagnosis of the mechanical or paralytic nature of the obstruction was made and the operation always carried out under best possible conditions.
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