Luis B. Morettin

Needle biopsy of the lung in diffuse parenchymal disease: An analysis of 151 cases

Summary Of 220 percutaneous cutting needle biopsies of pulmonary disease, 151 patients were biopsied for purposes of diagnosis of diffuse parenchymal disease. Diffuse disease was divided into generalized and lobar disease because of differences in technical management, complications, and productivity. A postbiopsy chest tube was inserted in all cases of generalized lung disease. Tissue diagnosis was established in 90 per cent of the patients with diffuse disease with a serious complication rate of 1.3 per cent and a mortality of 0.66 per cent. The present experience suggests that needle biopsy is the procedure of choice in patients with more advanced generalized lung disease and in patients with lobar diffuse disease. Open biopsy is recommended as the procedure of choice for good risk patients with generalized bilateral parenchymal disease.

Follicular Carcinoma of the Thyroid Metastatic to the Kidney 37 Years After Resection of the Primary Tumor

A case is described of thyroid carcinoma presenting as renal metastases 37 years after initial resection of the primary. Thyroid carcinoma metastatic to the kidney detected during life is rare, only 2 cases having been reported to date. An additional feature of this case is that the patient had donated the contralateral kidney for transplantation before discovery of the metastases. Metastatic thyroid carcinoma is reviewed and the implication of organ donation in patients with thyroid carcinoma is discussed.

Adult Wilms’ tumor: Clinical and radiographic features

The clinical and radiographic features of Wilms’ tumor in 4 adult patients are described. Wilms’ tumors in adults are usually bulky and contain numerous areas of necrosis and hemorrhage, imparting a complex appearance to the lesion on sonography and computed tomography. Angiography reveals the tumor to be hypovascular with some neovascularity. No specific features of the lesion differentiate it from hypernephroma. In contrast to the childhood variety, Wilms’ tumors in adults have ill-defined margins and frequently extend into the retroperitoneum. Their treatment is the subject of debate and prognosis is poor.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY

Percutaneous transhepatic cholangiography is a very useful procedure in the diagnosis of jaundice, particularly obstructive jaundice, and other hepatobiliary and pancreatic diseases. It is complementary to endoscopic cholangiography, but is superior to the latter in the diagnosis of proximal lesions in and near the liver. The procedure is very safe, if not absolutely, when performed by experienced personnel with certain precautions. The use of an ultrasound guidance system not only reduces the number of punctures to enter an intrahepatic bile duct, but also prevents puncturing the lung, gallbladder, and portal vein branches, reducing the frequency of complications.

Small renal carcinoma with large retroperitoneal hemorrhage: Diagnostic considerations

Two cases of small peripheral papillary renal carcinoma causing large spontaneous perirenal hemorrhages are presented. The value and limitations of computerized tomography, ultrasonography, arteriography, and percutaneous aspiration biopsy in these cases are discussed. The need for careful explorative surgery and dissection of the specimen is emphasized. Excretory urography should be the first examination in all patients with renal pain and signs of internal bleeding. Arteriography should be done when the diagnosis is not evident.

ANGIOGRAPHIC FINDINGS IN ARTERIOVENOUS FISTULAS FOLLOWING LUMBAR DISK SURGERY

The development of an arteriovenous fistula between the aorta and its iliac branches and the vena cava and its iliac tributaries is an uncommon complication of surgery for herniated intervertebral disk. The diagnosis is usually obvious by physical examination. Retrograde femoral abdominal aortography accurately displays the anatomic character and the location of the communication.Three cases are reported.

Nephrobronchial fistula: an uncommon manifestation of inflammatory renal disease.

It is well known that inflammatory diseases of the kidney may involve the perirenal space and spread contiguously to other organs, such as the stomach, colon, gallbladder and duodenum. It is less well known that fistulas may develop between the kidney and the lung. Presenting symptoms may suggest either renal or pulmonary disease. Two cases are reported. Familiarity with this entity should help to avoid misdiagnosis, especially when presenting symptoms are related to the respiratory system.

Pancreatic carcinoma masquerading as renal cell carcinoma

Three cases of pancreatic carcinoma that arose in the tail and extended into the adjacent left kidney are presented. Because of misleading symptoms and radiographic features, the tumors were misdiagnosed as primary renal tumor. In most cases, computed tomography (CT) provides the correct diagnosis and prevents unnecessary surgery.

A DEVICE FOR SIMPLIFIED FEMORAL ARTERIOGRAPHY

A simple, inexpensive, easily constructed film holding device for femoral arteriography is described. The technique for its use and its advantages are discussed.