Scintiscan evaluation of prominent renal columns

Sonographic evaluation of hypertrophy of septum of Bertin

Sonography was utilized to evaluate 12 patients with hypertrophy of the septum of Bertin. To confirm the diagnosis, angiography was used in 7 patients and radionuclide imaging in 2. Three sonographic characteristics were found: (1) an isoechogenic, ellipsoid mass with an echogenic linear rim of renal sinus fat; (2) contiguity of the mass with a normal-placed septum of Bertin; and (3) the occurrence of the mass effect always at the level of the emergence of the renal vein. The sonographic findings could be divided into two definite types. Type I showed moderate hypertrophy with a mass effect ranging from 1.1 by 2.3 cm to 2.0 by 3.2 cm in diameter, usually presenting with a smooth contour and discrete mass effect on the intravenous pyelogram (IVP). Type II showed severe hypertrophy with a mass effect ranging from 3.2 by 4.0 cm to 3.5 by 4.5 cm in diameter, usually presenting with a lobulated contour and irregular stretching of the calyceal system on IVP. The differential diagnosis is discussed. In conclusion, we found that sonography associated with excretory urography is an accurate method for the diagnosis of hypertrophy of the septum of Bertin.

Radionuclide scanning--new applications in urology

The current status of nuclear renal scanning and function evaluation is summarized. The indications for renal imaging are discussed. Techniques for measurement of split and total renal function are reviewed. Special attention is given to the role of renography (conventional and diuretic) in the evaluation of the obstructed kidney.

An evaluation of the use of 99Tcm-dimercaptosuccinic acid (DMSA) as a static renal imaging agent

The clinical value of 99Tcm-dimercaptosuccinic acid, utilized as a static renal imaging agent, has been analysed in 366 patients. It proved to be diagnostically most useful in space occupying lesions of the kidney when equivocal on IVU and provided useful additional information when used in the determination of divided renal function or the distribution of intrarenal function. Its use is contraindicated in the determination of divided renal function in obstructed kidneys because of accumulation of significant amounts of DMSA that are excreted by glomerular filtration. When DMSA uptake at three hours after injection is compared with 99Tcm-DPTA uptake from 90 to 150 seconds after bolus injection, there is a good correlation between the two methods of determination of divided renal function.

Displaced renal lobe simulating tumour

Three cases of renal pseudotumour are presented, with the radiographic appearances. At urography, a mass is demonstrated. Angiography reveals slight displacement of the interlobar arteries, a normal venous phase, but no tumor vessels. The nephrographic effect is similar in the mass and in the renal parenchyma. The nephroscintigraphy is likely to be normal. The main differential diagnoses are mentioned.

Magnification renal scintigraphy in the differential diagnosis of septa of Bertin

Eight consecutive patients, referred because intravenous urography (IVP) raised the question of hypertrophied septum of Bertin versus a pathologic mass, were examined using 99mTc labeled radiopharmaceuticals with magnification renal scintigraphy. The areas of concern showed a spectrum of activity, from normal to markedly increased, as compared to surrounding tissue. The activity correlated with the size of the mass effect on IVP. Increased resolution provided by pinhole magnification was important in evaluating these patients. We feel that magnification renal scintigraphy is valuable in the evaluation of intrarenal masses.

The "central lucency" sign of lobar dysmorphism (pseudotumour of the kidney)

A proved case of pseudotumour of the kidney due to lobar dysmorphism showed a "central lucency" sign, differentiating this developmental variant from an enlarged column of Bertin. This sign is described in a further case.

The diagnosis of renal pseudotumours

The radiological features of 13 cases of renal pseudotumour due to infolding of the columns of Bertin are presented. 5 of these patients (38%) had partial duplication of the renal pelvis. Pseudotumours show as space-occupying lesions at urography. At angiography they show a clearly defined nephrogram but no abnormal vessels, no pooling of contrast medium and no early venous filling. Radio-isotope scans on 4 cases of pseudotumour showed uptake at the site of the pseudotumour in contrast to cysts and carcinomas which are known to show diminished uptake.

The evaluation of abdominal masses in children with emphasis on noninvasive methods. A roentgenographic approach

Intravenous urography with total body opacification, and tomography as required, often give the most information toward evaluating abdominal masses in children. Ultrasonography is a noninvasive procedure which defines normal structures and differentiates cystic and solid tumors. The combination of these studies gives sufficient information about renal tumors to plan for possible surgery. Arteriography is not necessary for the diagnosis of Wilms' tumor, nor its surgical or medical management. Pseudotumor of the kidney is due to focal cortical hyperplasia. It can be diagnosed by nephrotomography, renal arteriography or renal scanning. The latter method is most accurate and has the lowest morbidity. Aortography is advisable in the evaluation of a patient with pheochromocytoma in an attempt to locate multiple tumors. Determining the extent of abdominal neuroblastoma by angiography and lymphangiography does not appear to influence the mode of therapy, not the survival rate; therefore, invasive diagnostic procedures do not appear to be indicated in neuroblastoma. Angiography is necessary in the evaluation of liver cancer. If one lobe is determined to be free of disease, lobectomy is a possible cure. Splenic cysts and choledochal cysts can be diagnosed by noninvasive methods such as ultrasonography or radioisotope scanning. Arteriography and percutaneous opacification are not necessary to make these diagnoses.