scholarly journals 1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Swamad ◽  
M K Quraishi ◽  
S Ahmed
Keyword(s):  
Renal Mass ◽  
Left Kidney ◽  
Interesting Case ◽  
Ct Scans ◽  
Renal Ultrasound ◽  
Ultrasound Scan ◽  
Surgical Team ◽  
Tunnel Vision ◽  
Impact Patient Care ◽  
The Right

Abstract We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.

scholarly journals Pediatric renal pseudotumour

2020 ◽  
pp. 20200088
Author(s):  
David Ola ◽  
Ravikumar Hanumaiah ◽  
Anand Majmudar
Keyword(s):  
Renal Mass ◽  
Surgical Intervention ◽  
Color Doppler ◽  
Hypertensive Crisis ◽  
Kidney Injury ◽  
Renal Ultrasound ◽  
Ultrasound Study ◽  
Normal Renal Parenchyma ◽  
History Of ◽  
The Right

We present a case of 6-year-old female with history of respiratory distress who went into respiratory failure requiring intubation. Patient was subsequently found to be in hypertensive crisis with hyponatremic hypochloremic metabolic acidosis and acute kidney injury. Renal ultrasound was performed to find the cause of hypertension. The ultrasound study demonstrated lobulated isoechoic to hyper echoic mass-like lesion in the middle and lower pole of the right kidney with increased vascularity on Color Doppler examination. The renal mass was finally diagnosed as a pseudotumour, representing hypertrophied portion of the spared normal renal parenchyma in otherwise atrophic right kidney. Diagnosis was made using a combination of US, MRI, DMSA and CT angiography thus avoiding unnecessary surgical intervention.

A rare case of a cystic renal mass with heterotopic ossification and a mini literature review

2021 ◽  
pp. 1-9
Author(s):  
Xisheng Wang ◽  
Zejian Zhang ◽  
Xia Zhu ◽  
Wende Cheng ◽  
Jiqing Fang ◽  
...  
Keyword(s):  
Literature Review ◽  
Heterotopic Ossification ◽  
Rare Case ◽  
Renal Mass ◽  
Renal Cyst ◽  
Left Kidney ◽  
Renal Tumors ◽  
Cystic Nephroma ◽  
Nephron Sparing ◽  
The Right

INTRODUCTION: It is a challenge to make accurate pre-surgical diagnosis for renal tumors. This study is to report the findings, management, and outcome of one rare case of ossification in a cystic renal mass. We present and discuss the pathological characteristics, radiologic features, and treatment alternatives of the patient. PATIENTS AND METHODS: A 38 years old female patient had intermittent epigastric pain and microscopic hematuria for two months. Computerized tomography (CT) scan and Magnetic Resonance imaging (MRI) showed a mass with rough edge and dense calcification in the upper pole of the right kidney and normal left kidney. Pre-operative diagnosis is cystic nephroma or cystic renal mass (Bosniak III type, Bosniak renal cyst classification). GFR was within normal limits for age and no other significant laboratory aberrations were noted. Patient underwent a right retroperitoneal laparoscopic partial nephrectomy (margin status was negative). A mini literature review was performed to highlight the principals of diagnosis and treatment of cystic renal mass with heterotopic ossification. RESULTS: The entire renal mass was successfully removed from upper pole of the right kidney by laparoscopic nephron sparing surgery. The size of renal mass is 38×35×30 mm3 with thick and hard capsular wall. The cystic cavity contains yellow lipid-like substances without stone. Histological examination revealed renal cyst in which the cyst wall reveals fibrosis and no obvious lining epithelium. The additional unique feature includes the presence of dense calcification and ossification in the renal mass. Localization tissue of yellow bone marrow was detected. No complications occurred in 9 months after surgery during follow-up. CONCLUSIONS: Cystic renal mass with heterotopic ossification is a rare case of non-malignant renal tumor. Whether surgery is needed depends to whether patients have symptoms. For symptom renal tumors, laparoscopic nephron sparing surgical procedure is recommended. Furthermore, complete surgical resection of the lesion is needed when the mass is suspected to be malignant. An accurate histologic diagnosis is key in its diagnosis.

scholarly journals Long Term Follow-up Results of Ablation Treatment for Patients with Small Renal Mass

2020 ◽  
Author(s):  
Bilal Gumus ◽  
Ali Albaz ◽  
Fatih Düzgün ◽  
Oktay Ucer ◽  
Gokhan Temeltas ◽  
...  
Keyword(s):  
Renal Mass ◽  
Demographic Data ◽  
Left Kidney ◽  
Treatment Success ◽  
Minor Bleeding ◽  
Small Renal Mass ◽  
The Mean ◽  
The Right

Objective: The aim of this study is to evaluate the outcome of ablation therapy in our clinic for the treatment of patients with small renal mass Materials and Methods: We retrospectively evaluated the technic and follow-up data of 30 patients with 36 tumors who underwent Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) in our clinic. Demographic data, ablation type, tumor characteristics, peroperative and postoperative complications and treatment success of the patients were evaluated. Results: A total of 36 tumors who underwent ablation treatments, 23 were treated with RFA, 13 with MWA. The mean tumor size was 28.9 ± 6.92 mm in RFA and 29.3 ± 7.70 mm in MWA. 12 (52.1%) of the RFA procedures were applied to the right kidney while 11 (47.8%) were applied to the left kidney. 6 (46.1%) of the MWA procedures were performed on the right kidney and 7 (53.8%) on the left kidney. Of the 36 tumors, 4 (11.1%) were located central and 32 (88.8%) were peripheral. Complications occurred in 2 patients. In one of these patients, acute renal failure and urea creatinine were found to be elevated. In the other patient, local pain was found in the ablation side and minor bleeding was detected at the ablation site in USG. The mean follow-up period was 49.6 ± 24.7 months in patients with RFA and mean follow-up was 16 ± 8,05 months in MWA treatments. The overall success in MWA administration was calculated as 76.9%, while the overall success in RFA was 80%. Conclusion: Long-term oncologic efficacy of RFA appears to be successful in the treatment of T1a renal carcinomas. Further studies can be conducted to elucidate the influence of MWA on long-term oncological outcomes.

STUDY OF RADIATION CHARACTERISTICS THE RENAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES

2014 ◽  
pp. 73-77
Author(s):  
Van Chuong Nguyen ◽  
Thi Kim Anh Nguyen
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Disease Duration ◽  
Left Kidney ◽  
Cross Sectional ◽  
The Right

Background: A Research glomerular filtration rate (GFR) of 61 patients with type 2 diabetes mellitus with renal scanning 99mTc-DTPA glomerular filtration rate at the hospital 175. Objective: (1) To study characteristics of imaging of renal function. (2) Understanding the relationship between GFR with blood sugar, HbA1c, blood pressure and albuminuria in patients with type 2 diabetes. Methods: Descriptive, prospective, cross-sectional study. Clinical examination, Clinical tests and 99mTc-DTPA GFR gamma - camera renography for patients. Result: GFR of the study group was 75,4 ± 22,3 ml/phut/1,73m2, the left kidney was 35,0 ± 13,0 is lower than the right kidney and 39,8 ± 11,9; p <0,01. There is no correlation between GFR with blood glucose and HbA1c, the risk of reduced GFR in hypertensive group associated is OR = 6,5 with p<0,01; albuminuria (+) is OR = 4,2 with p <0,01; and disease duration > 10 years is OR = 3,5 with p <0.01. Conclusion: GFR of the left kidneys is lower than the right kidney; correlation decreased GFR associated with hypertension, albuminuria and disease duration. Keywords: GFR, diabetes, albuminuria

Ex Vivo Repair of a Renal Artery Saccular Aneurysm in a Living-Nonrelated Donor and Subsequent Successful Kidney Transplantation

2018 ◽  
Vol 52 (6) ◽  
pp. 455-458
Author(s):  
Rogerio A. Muñoz-Vigna ◽  
Javier E. Anaya-Ayala ◽  
Juan N. Ramirez-Robles ◽  
Daniel Nuño-Diaz ◽  
Sandra Olivares-Cruz
Keyword(s):  
Kidney Transplantation ◽  
Renal Artery ◽  
Ex Vivo ◽  
Incidental Finding ◽  
Left Kidney ◽  
Renal Arteries ◽  
Saccular Aneurysm ◽  
Preoperative Imaging ◽  
The Right ◽  
Stage Renal Disease

The use of kidney grafts with aneurysmal disease involving the renal arteries for transplantation is very uncommon and relatively controversial. We herein present the case of a 52-year-old woman who volunteered to become a living-nonrelated donor; during the preoperative imaging workup, a computed tomography angiography revealed a 1.5-cm saccular aneurysm in the left kidney, while the contralateral renal artery was normal. We decided to utilize the left kidney for a 25-year-old male patient with end-stage renal disease, and following the ex vivo repair using the recipient epigastric vessels and saphenous veins, we completed the transplantation in the right pelvic fossa. The postoperative period was uneventful, and at 8 months from the surgery, the graft remains functional. The surgical repair of renal artery aneurysms followed by immediate kidney transplantation is a safe technique and an effective replacement therapy for recipients. The incidental finding of isolated aneurysmal disease in renal arteries should not exclude graft potential availability for transplantation following repair.

scholarly journals Laparoscopic transposition for crossing vessels (vascular hitch) in pure extrinsic pelvic-ureteric junction obstruction: a successful case report of a 2-year-old infant with horseshoe kidney

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Satoshi Ieiri ◽  
Kouji Nagata
Keyword(s):  
Laparoscopic Surgery ◽  
Left Kidney ◽  
Horseshoe Kidney ◽  
Renal Scintigraphy ◽  
Multicystic Dysplastic Kidney ◽  
Extrinsic Compression ◽  
Dysplastic Kidney ◽  
Renal Vessels ◽  
The Right ◽  
Crossing Vessels

Abstract Background Pediatric hydronephrosis induced by pelvic-ureteric junction obstruction (PUJO) is treated by dismembered pyeloplasty (DP) via open and laparoscopic surgery. The etiology of PUJO involves both intrinsic stenosis and extrinsic compression of crossing vessels (CVs). PUJO owing to CVs is also treated by DP, as there is no consensus concerning this vascular condition. We encountered a 2-year-old infant with pure extrinsic PUJO combined with horseshoe kidney who successfully underwent laparoscopic transposition for CVs (vascular hitch). Case presentation A 2-year-old boy was prenatally diagnosed with left multicystic dysplastic kidney (MDCK) and right hydronephrosis and received a definitive diagnosis after birth. At 6 months old, renal scintigraphy revealed a non-functioning pattern in the left kidney and an obstructive pattern in the right, showing no response to furosemide loading. The patient also had recurrent urinary tract infection, and his right hydronephrosis gradually worsened. We decided to perform surgery for the right PUJO. Preoperative enhanced computed tomography detected three right renal vessels independently branching from the abdominal aorta. The middle renal vessels were located at the ventral side of the pelvis and coincident with the site of PUJO. These vessels were suspected of being CVs. The patient underwent laparoscopic surgery electively. A 5-mm trocar was inserted at the umbilicus for a 5-mm, 30° rigid scope. Two additional ports were then inserted under laparoscope inspection. The dilated right pelvis and CVs were detected after ascending colon mobilization. To confirm the pathogenesis of PUJO, the CVs were dissected and taped. After taping the CVs, an intraoperative diuretic test was performed using furosemide loading. Peristalsis of the right ureter was recognized, and the extrinsic PUJO owing to the CVs was definitively confirmed. We therefore performed transposition for the CVs (vascular hitch procedure). The CVs were mobilized in the cranial direction and those were wrapped by dilated pelvis. The post-operative course was uneventful. The renal scintigraphy findings improved and showed a favorable response of furosemide loading. Conclusions The laparoscopic vascular hitch procedure is minimally invasive and effective for extrinsic PUJO due to CVs. Anastomotic stricture after Anderson and Hynes DP can be prevented by appropriate patient selection.

The Right to Be Right: Civil-Military Relations and the Iraq Surge Decision

2011 ◽  
Vol 35 (4) ◽  
pp. 87-125 ◽  
Author(s):  
Peter D. Feaver
Keyword(s):  
Hybrid Approach ◽  
Interesting Case ◽  
Civil Military Relations ◽  
Military Commanders ◽  
The Right ◽  
Military Relations ◽  
The Military ◽  
President Bush ◽  
Primary Problem ◽  
Better Than

President George W. Bush's Iraq surge decision in late 2006 is an interesting case for civil-military relations theory, in particular, the debate between professional supremacists and civilian supremacists over how much to defer to the military on decisions during war. The professional supremacists argue that the primary problem for civil-military relations during war is ensuring the military an adequate voice and keeping civilians from micromanaging and mismanaging matters. Civilian supremacists, in contrast, argue that the primary problem is ensuring that well-informed civilian strategic guidance is authoritatively directing key decisions, even when the military disagrees with that direction. A close reading of the available evidence—both in published accounts and in new, not-for-attribution interviews with the key players—shows that the surge decision vindicates neither camp. If President Bush had followed the professional supremacists, there would have been no surge because his key military commanders were recommending against that option. If Bush had followed the civilian supremacists to the letter, however, there might have been a revolt of the generals, causing the domestic political props under the surge to collapse. Instead, Bush's hybrid approach worked better than either ideal type would have.

Renal lobar dysmorphism: a potential mimic of renal malignancy

2021 ◽  
Vol 14 (2) ◽  
pp. e237096
Author(s):  
Derek Barry Hennessey ◽  
Adrian B Brady ◽  
Rhona Dempsey ◽  
Kenneth Patterson
Keyword(s):  
Normal Tissue ◽  
Renal Mass ◽  
Intravenous Urography ◽  
Renal Ultrasound ◽  
Apparent Mass ◽  
Radiological Imaging ◽  
Radiological Findings ◽  
Anatomical Variant ◽  
Scrotal Swelling

A renal pseudotumour is any apparent renal mass that simulates a tumour on radiological imaging but is composed of normal tissue. Renal pseudotumours may be inflammatory, vascular, postsurgical or congenital. We report a case of renal lobar dysmorphism (RLD) of the kidney, a congenital renal pseudotumour. A 45-year-old man presented with scrotal swelling. Testicular ultrasound showed an epididymal cyst. Renal ultrasound showed a right solid renal apparent mass of 2.4 cm in diameter. Triphasic renal CT showed this was consistent with RLD. Intravenous urography confirmed a central calyx within the dysmorphic lobe. RLD is a rare congenital normal anatomical variant, which can appear as a renal pseudotumour. No further investigation or intervention is necessary. We present the radiological findings of RLD and review the literature.

Morphoconstitutional analysis of a series of 166 urinary stones in Western Algeria for a period of two years (2015-2017)

2018 ◽  
Vol 7 (3) ◽  
pp. 107-112
Author(s):  
Bouzana Fatima ◽  
Sbahi Khayra ◽  
Kerroumi Slimane ◽  
Attar Abderahmane ◽  
Seghir Madjhouda Omar ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Sequential Analysis ◽  
Left Kidney ◽  
Urinary Stones ◽  
Female Ratio ◽  
Composition And Structure ◽  
Male Female Ratio ◽  
Anatomical Localization ◽  
Western Algeria ◽  
The Right

A stone is not only an obstacle, sometimes painful, on the urinary tract justifying an emergency urological gesture to restore their permeability. It is primarily a symptom of crystallogenic pathologies or urinary imbalances of nu-tritional origin whose recurrence is the rule if the cause has not been correctly identified. It is therefore recommended in the patient's interest; analyze the calcul or its fragments to determine its composition and structure, one and / or the other orienting towards the pathology in question. A series of 166 urinary stones were collected nearby the hospitals of western Algeria after urological intervention or spontaneous expulsion and sequential analysis of the nucleus at the surface by Fourier transform infrared spectrophotometry. The male / female ratio was 1.78. The study of the anatomical localization of the stones showed a predominance of the high urinary tract with a rate of 76.9%. 27.3% of the stones were located in the left kidney compared to 25.7% in the right kidney. Analysis of the crystalline composition showed that calcium oxalate was predominant in 65.8% of the calculs and in 58.5% of the nuclei. In all, whewellite was present in 46.9% of cases and weddellite in 18.9%. uric acid anhydrous was the major component of 12.2% of the calculations analyzed. It was present in 23.3% of cases with predominance in subjects over 60 years. Our results show that the lithiasis of the urinary tree in western Algeria tends to evolve in the same direction as that of the industri-alized countries.

Abstract TP291: Hematoma Retraction and Perihematoma Hypodensity in Neutral Brain Model of Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shahram Majidi ◽  
Basit Rahim ◽  
Sarwat I Gilani ◽  
Waqas I Gilani ◽  
Malik M Adil ◽  
...  
Keyword(s):  
Biological Activity ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Early Period ◽  
Ct Scans ◽  
Hematoma Expansion ◽  
Human Cadaver ◽  
Fresh Blood ◽  
The Right

Background: The temporal evolution of intracerebral hematomas and perihematoma edema in the ultra-early period on computed tomographic (CT) scans in patients with intracerebral hemorrhage (ICH) is not well understood. We aimed to investigate hematoma and perihematoma changes in “neutral brain” models of ICH. Methods: One human and 6 goat cadaveric heads were used as “neutral brains” to provide physical properties of the brain without any biological activity or new bleeding. ICH was induced by slow injection of 4 ml of fresh blood into the right basal ganglia of the goat brains. Similarly, 20 ml of fresh blood was injected deep into the white matter of the human cadaver head in each hemisphere. Serial CT scans of the heads were performed at 0, 1, 3, and 5 hours after inducing ICH. Analyze software (AnalyzeDirect, Overland Park, KS) was used to measure hematoma and perihematoma hypodensity volumes in the baseline and follow up CT scans. Results: The initial hematoma volumes of 11.6 ml and 10.5 ml in the right and the left hemispheres of the human cadaver brain gradually decreased to 6.6 ml and 5.4 ml at 5 hours, showing 43% and 48% retraction of hematoma, respectively. The volume of the perihematoma hypodensity in the right and left hemisphere increased from 2.6 ml and 2.2 ml in the 1 hour follow up CT scans to 4.9 ml and 4.4 ml in the 5 hour CT scan, respectively. Hematoma retraction was also observed in all six ICH models in the goat brains. The mean ICH volume in the goat heads was decreased from 1.49 ml in the baseline CT scan to 1.01 ml in the 5 hour follow up CT scan showing 29.6% hematoma retraction. Perihematoma hypodensity was visualized in 70% of ICH in goat brains, with an increasing mean hypodensity volume of 0.4 ml in the baseline CT scan to 0.8 ml in the 5 hour follow up CT scan. Conclusion: Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in intracerebral hematomas in the absence of any new bleeding or biological activity of the surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodesity needs to be reconsidered.

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