Joshua A. Becker

Wandering spleen--the radiological and clinical spectrum.

Eight cases of wandering spleen demonstrate that this rare entity has a characteristic constellation of findings which, though nonspecific, are highly suggestive of the diagnosis. Angiography or isotopic imaging specific for the spleen confirms the diagnosis. Asymptomatic patients may be carefully observed, with the institution of splenectomy should signs of torsion develop.

Urologic Complications of Renal Transplantation

ROLOGIC complications occur in approximately 12% of patients undergoing renal allograft transplantation.L~6~7~z3~26~z7~43~46 These complications seldom bear an immunologic relationship to the source of the kidney; rather, they depend on the surgical technique of donor nephrectomy and implantation, on the uremia and anemia found in the transplant recipient, and on the use of postoperative immunosuppressive therapy. At the Downstate Medical Center during the 5-year period from 1972 to 1976,43 1 patients underwent renal allograft transplantation. Of these, 40 developed urologic complications, a 9.2% complication rate. Within the last 1M years, however, the experience at this medical center has been similar to that at other transplantation centers, with a complication rate less than 3%.37 Since most urologic complications are associated with a decrease in graft function, they usually are discovered during evaluation of a possible episode of rejection or of acute tubular necrosis. It is extremely important that urologic complications be differentiated from rejection and acute tubular necrosis, since many of the complications are surgical emergencies, and it is imperative that an early diagnosis be made. The mortality from urinary tract fistula may approach 50% if the condition is untreated, but generally it has remained less than 1% when the condition has been identified and appropriate surgical correction has been made. If a urologic complication is not identified and the patient is presumed on the basis of decreased renal function to be experiencing a rejection episode, then increased doses of steroids will increase the morbidity. Therefore the transplantation physician must be as aware of the potential for a mechanical problem associated with graft function as he is for rejection and acute tubular necrosis. Urologic complications are usually due to extravasation, obstruction, and extraurinary collections. These complications may occur in the immediate posttransplantation period or years after transplantation. The more common complications, which usually occur early, are urinary extravasation, urinary obstruction, and vascular occlusion. The less common complications, which usually occur late in the course of

Renal pelvic carcinoma. An angiographic re-evaluation.

A series of 22 cases of renal pelvic carcinoma were reviewed in an attempt to find characteristics which would distinguish this entity from hypernephroma which it closely resembles. Distinctive angiographic characteristics are enlarged pelviureteric artery, fine neovascularity, vascular encasement, and absence of arteriovenous shunting. Since ureteronephrectomy is the preferred treatment for renal pelvic carcinoma, the importance of differentiating this tumor from other renal lesions is strongly stressed.

Sonography of tuberculous kidney.

Sonography of 8 patients with renal tuberculosis is reported and collated with 3 additional cases reported in the literature. The patterns of hydronephrosis versus granuloma formation are presented and the differential diagnoses at sonography reviewed.

Giant aneurysm of the splenic artery

Abstract Two giant aneurysms (15 and 18 cm) of the splenic artery are reported. One patient demonstrated radiographic findings of a chronic process and an underlying cause of medial hyperplasia.* The second patient demonstrated the clinical and radiographic findings of an acute aneurysm with rupture.

Renal and Suprarenal Pseudotumors Caused by Variations of the Spleen

Abstract Variations in the contour and position of the spleen simulated renal or suprarenal masses on routine radiographic studies in 5 patients. Angiography was able to determine the true etiology of the apparent masses in 4 (assisted by isotopes in one case). Localized flattening of the upper pole of the kidney, usually thought to indicate adrenal disease, was seen in 3. Splenic variations included a lumpy spleen, a transverse spleen with a prominent superior pole, a rotated and ptotic spleen, a depressed spleen, and an accessory spleen.

Radiologic diagnosis of renal trauma

Computed tomography is the diagnostic procedure of choice for the evaluation of significant blunt abdominal trauma. It not only assesses the extent and character of renal injury, but also identifies the presence of intraperitoneal hemorrhage and parenchymal injury. It allows the best opportunity to diagnose and salvage the injured renal pedicle, and to discover the pathologic renal injury. Urography should be reserved for use in patients with penetrating abdominal trauma and isolated renal trauma.

Radiologic diagnosis of extrarenal genitourinary trauma.

The radiologic management of lower genitourinary trauma requires that practitioners be familiar with a wide variety of imaging modalities including retrograde urethrography and cystography, scrotal ultrasonography, and corpus cavernosography. These conventional examinations will provide accurate and clinically relevant data if they are performed using techniques appropriate for the patient.

Hemangiomas of the liver in patients with renal cell carcinoma.

Five patients with renal cell carcinoma were noted at angiography to have vascular hepatic lesions which resembled metastatic renal cell carcinoma but which proved to be benign hepatic hemangiomas. The angiographic differentiation between small hemangiomas and metastatic vascular neoplasms of the liver can be difficult; angiographic characteristics may not be definitive. Surgery to remove the renal tumor should not be deferred solely on the basis of vascular hepatic lesions found at angiography.

Unusual pelvic complications of a pancreatic pseudocyst.

Pancreatic pseudocysts are notorious for their extension beyond the normal confines of the pancreatic bed. Their inferior extension has been known to involve kidney and ureter. However, involvement of the bladder and rectum is unique although understandable on anatomic grounds. We report an enormous pseudocyst with extension deep into the pelvis to displace both rectum and bladder.