Marjorie A. Ambos

Angiographie Patterns in Renal Oncocytomas1

Renal oncocytomas are benign tumors arising from proximal tubular epithelial cells. They appear radiographically as solid masses which are vascular on angiography. Angiograms of 13 cases of renal oncocytomas were reviewed, as well as those of 155 renal-cell carcinomas. The classic angiographic findings for the oncocytoma include a spoke-wheel pattern, a homogeneous nephrogram, and a sharp, smooth rim. The finding of a homogenous blush and/or a spoke-wheel pattern greatly increases the possibility of an oncocytoma, though a renal-cell carcinoma may have any or all of the classical findings described for an oncocytoma.

Polycystic kidney disease

P OLYCYSTIC kidney disease represents a group of conditions that are banded together because of certain pathologic similarities but are a collection of different entities that have diverse clinical and radiologic presentations. In this article we will follow the Elkin and Bernstein classification12 (Table 4 of Dr. Elkin’s article on page 101 of this Seminar) and discuss polycystic disease of the young (infantile polycystic kidney disease), including the newborn and childhood forms, and adult polycystic disease in sequence.

Involvement of the Inferior Vena Cava in Patients with Renal Cell Carcinoma

Inferior vena cavography plays an important role in the staging of renal cell carcinoma. The renal angiograms and inferior vena cavograms in a series of patients with renal cell carcinoma were reviewed to determine which patients require cavography. Our findings show that renal angiography is of great value in suggesting tumor involvement of the renal vein or vena cava, and that the decision to do cavography can be made from the angiographic findings. In the series of 172 patients with renal carcinoma, 15 or 9% had inferior vena cava involvement.

The Pear-Shaped Bladder

The tear-drop or pear-shaped bladder was originally described in cases of pelvic hematoma. It may also be seen, however, with a variety of other entities, including pelvic lipomatosis, inferior vena cava occlusion, lymphocysts, and enlarged pelvic lymph nodes. Pertinent radiographic findings of these conditions are reviewed.

Computed Tomographic Diagnosis of Ureteral Obstruction Secondary to Aneurysmal Disease

Three cases of ureteral obstruction associated with aortoiliac aneurysms were studied with computed tomography. CT was able to document the presence of aneurysm and display the perianeurysmal, fibrotic, contrast-enhancing mass accounting for ureteral obstruction. The value of computed tomography in the diagnosis and evaluation of these cases is described.

Ureteral involvement by metastatic disease.

Ureteral obstruction secondary to metastases from distant primary tumors may be studied by urography, pyelography, venography and lymphangiography. An added dimension to the study of this disease process is obtained by the use of sonography and computed tomography since these techniques are better able to demonstrate the extent of the disease in the retroperitoneum.

Blood flow to the kidney via the gonadal-renal capsular artery

The gonadal artery is an important collateral pathway of blood flow to the kidney. Collateral routes may be from the gonadal artery to the inferior capsular artery (gonadal-renal capsular artery) or to the periureteric arteries. These pathways develop in cases of renal artery stenosis, or when a vascular renal tumor increases the kidneys need for blood. We present five cases in which the gonadal artery served as a source of blood supply to the kidney.

Visualization of collateral venous circulation during intravenous urography secondary to superior vena cava syndrome.

Transient visualization of superficial collateral abdominal veins can occur in intravenous urography in some patients with the superior vena cava syndrome. The findings are characteristic enough to lead the radiologist to the correct diagnosis. A presentation and explanation of this finding is made.

An unusual vascular impression on the renal pelvis.

In a female patient who presented with the complaint of dysuria, angiography was required to distinguish a vascular impression on the renal pelvis from a possible tumor or calculus. Neither intravenous urography nor retrograde pyelogram clarified the smooth filling defect sufficiently to rule out the possibility of a urothelial tumor.