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Biomedical subjects

K A Feinstein

Publications and source records attributed to K A Feinstein.

23 records · Page 2Linked to original sources
PubMed1988

Nephroblastomatosis: comparison of CT with US and urography.

A review of the imaging studies of five children with Wilms tumor and nephroblastomatosis demonstrated that contrast-enhanced computed tomography (CT) can show the multifocal involvement of nephroblastomatosis more accurately than either excretory urography or real-time ultrasound (US). In all five children, CT demonstrated multiple areas of nephroblastomatosis along the renal cortex. US showed a single intrarenal mass in each child (one bilaterally) but did not show the cortical nephroblastomatosis. Excretory urography also demonstrated only the dominant mass of the Wilms tumor. The superiority of CT is attributed to better spatial resolution and soft-tissue contrast differentiation and clear demarcation between nonenhanced nephroblastomatosis and enhanced normal renal parenchyma. Contrast-enhanced CT is therefore recommended for the evaluation of clinically abnormal and contralateral kidneys in all children with suspected Wilms tumor.

Child, Preschool↗
PubMed1987

Septated urinomas in the neonate.

Perirenal urinomas may develop when obstruction to urinary flow creates sufficient back pressure to produce extravasation of urine. Such fluid collections have been described as mainly sonolucent. However, in the last 2 years, we have imaged five neonates with multiple, marked septations of the urinoma, four with posterior urethral valves and one with a ureteropelvic junction obstruction. Diagnostic confusion may arise when the kidney is not identified, when the septated nature of the urinoma is not recognized, and when urinary tract obstruction is not seen.

Female↗
PubMedDate not supplied

Ureteral duplication and its complications.

Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Duplication may be either complete or incomplete and is often accompanied by various complications. Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys. Vesicoureteral reflux affects the lower pole and can be outgrown, as in nonduplicated systems. Ectopic ureterocele and ectopic ureteral insertion affect the upper pole. The ectopic ureterocele produces a filling defect of variable size in the bladder; it can be identified with contrast material studies or ultrasound. Ectopic ureters may function poorly, be difficult to detect, and cause enuresis in girls. A fourth complication, ureteropelvic junction obstruction, occurs only in the lower pole and is seen in more boys than girls. Anatomic variants or anomalies as well as suboptimal imaging techniques can either simulate or obscure duplication, making diagnosis difficult. However, familiarity with the embryology of duplication and an awareness of the potential pitfalls of excretory urography and voiding cystourethrography will foster an understanding of the varied appearances and associated complications of both incomplete and complete duplication.

Diagnostic Imaging↗
PubMedDate not supplied

Pediatric voiding cystourethrography: a pictorial guide.

Voiding cystourethrography is commonly performed in children with prenatally diagnosed hydronephrosis, urinary tract infections, and voiding abnormalities. Voiding cystourethrography can be performed with many variations designed to optimize visualization of disease and minimize radiation exposure. The procedure should include assessment of the spine and pelvis; masses or opaque calculi; bladder capacity, contour, and emptying capability; presence and grade of reflux; and urethral appearance. Radiologists differ as to whether the patient should void prior to catheterization. Anteroposterior imaging of the bladder is performed during early filling; little or no imaging is necessary during intermediate filling. When bladder filling is complete, steep oblique images that are centered on the ureterovesical junction should be obtained. If reflux is observed, the ipsilateral renal fossa may be imaged prior to voiding. With a smaller than expected voiding volume, bladder refilling is recommended. Voiding around the catheter is also strongly recommended. In girls, one anteroposterior image of the urethra is usually sufficient; in boys, the entire urethra must be imaged. Steep oblique imaging is optimal. At the conclusion of voiding, each renal fossa should be imaged to detect reflux missed at fluoroscopy as well as other anomalies. Familiarity with these abnormalities and use of proper techniques will allow detection of most common pathologic conditions with very low radiation exposure.

Child↗