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Diagnostic Imaging of the Kidney and Urinary Tract in Children A. R. Chrispin

Diagnostic Imaging of the Kidney and Urinary Tract in Children By A. R. Chrispin

Diagnostic Imaging of the Kidney and Urinary Tract in Children by A. R. Chrispin

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All unsuccessful revolutions are the same, but each successful one is different in its own distinctive way. The reason why revolutions occur is that new forces attain increasing significance and classic institutions are incapable of accomodating these forces. These successful revolutions produced a new dynamic and new perspectives.

Diagnostic Imaging of the Kidney and Urinary Tract in Children Summary

Diagnostic Imaging of the Kidney and Urinary Tract in Children by A. R. Chrispin

All unsuccessful revolutions are the same, but each successful one is different in its own distinctive way. The reason why revolutions occur is that new forces attain increasing significance and classic institutions are incapable of accomodating these forces. Such has been the pattern of events in the English, American and French revolutions. These successful revolutions produced a new dynamic and new perspectives. One English revolutionary put this succinctly: "Let us be doing, but let us be united in doing". This book sets out what is a revolution in. the perspectives of diagnostic imaging of the kidney and urinary tract. Forces which have brought about this revolution are the advent of reliable techniques in radioisotope studies, ultrasonics and computerized tomographic (CT) scanning. This last modality carries with it specific problems for routine paediatric work and its role in the study of kidney and urinary tract problems is discrete and circumscribed. However, in conjunction with classic radiology, each of these techniques yields information of a different type and so a synthesis of data accrues.

Table of Contents

1 The Clinical Context.- 1.1 Introduction.- 1.2 Renal Failure.- 1.2.1 Renal Failure in the Very Young.- 1.2.2 Protracted Renal Failure.- 1.3 Enuresis - Retention - Incontinence.- 1.4 Oliguria.- 1.5 Polyuria.- 1.6 Haematuria.- 1.7 Urinary Infection.- 1.8 Pain.- 1.9 Complexes, Syndromes and Conditions of a Generalised Nature.- 1.10 Conclusion.- 2 Investigatory Techniques.- 2.1 Introduction.- 2.2 Intravenous Urography (IVU).- 2.2.1 Preparatory Details.- 2.2.2 Injection of Contrast Medium and Radiographic Techniques.- 2.2.2.1 Preliminary Film.- 2.2.2.2 Injection of Contrast Medium.- 2.2.3 Cavography.- 2.2.4 Timing of Radiographs.- 2.2.5 Radiographs of the Kidney.- 2.2.6 Imaging of the Ureters.- 2.2.7 Lower Urinary Tract.- 2.2.8 Reactions to Contrast Medium.- 2.3 Micturition Cystourethrography (MCU).- 2.3.1 Radiological Techniques at MCU.- 2.3.2 Equipment.- 2.3.3 Sedation and Anaesthesia.- 2.4 Injection Urethrography.- 2.5 Retrograde and Descending Contrast Medium Studies by Injection.- 2.6 Ultrasonography.- 2.6.1 Preparation.- 2.6.2 Sedation.- 2.6.3 The Room.- 2.6.4 Equipment.- 2.6.5 Real Time Ultrasound Systems.- 2.7 Radioisotope Studies.- 2.7.1 Kidney Scans Using DTPA.- 2.7.2 Kidney Scans Using DMSA.- 2.7.3 Technique.- 2.7.4 Dose of Radiopharmaceutical.- 2.7.5 Pictorial Data.- 2.7.6 DTPA Scan.- 2.7.7 DMSA Scan.- 2.7.8 Analysis of Function by Isotope Study.- 2.7.9 The Problem of the Dilated Upper Tract.- 2.7.10 Radioisotope Cystography.- 2.7.11 Imaging of the Adrenal Glands.- 2.8 Angiography.- 2.8.1 Arterial Studies.- 2.8.1.1 Injection Technique.- 2.8.1.2 Control of the Examination.- 2.8.1.3 Complications.- 2.8.1.4 Local Complications at Catherization and Immediate Sequelae.- 2.8.2 Venous Angiography.- 2.9 Urodynamics.- 2.9.1 Indications.- 2.9.2 Method.- 2.10 Computed Tomography.- 2.11 Strategy and Tactics in Investigation.- 2.11.1 General Comment.- 2.11.2 Investigation of the Very Young Infant.- 2.11.3 Renal Failure in Infancy and Childhood.- 2.11.3.1 Acute Renal Failure in Infancy.- 2.11.3.2 Renal Failure in the Child.- 2.11.4 Haematuria.- 2.11.5 Objectives in Investigation.- 3 Obstruction in the Urinary Tract.- 3.1 Introduction.- 3.2 Acute Obstruction of the Kidney.- 3.2.1 The Role of IVU, Ultrasonics and Radioisotope Studies.- 3.2.2 Causes and Sites of Obstruction: Evaluation and Management.- 3.2.3 Late Consequences of Acute Kidney Obstruction.- 3.3 Protracted Obstruction.- 3.3.1 Summary: The Potential of IVU, Radioisotope Studies, MCU and Ultrasonics in Evaluating Protracted Obstruction.- 3.3.1.1 Sites and Causes of Obstruction Shown by IVU.- 3.3.1.2 Radioisotope Studies.- 3.3.1.3 Sites and Causes of Obstruction Shown by MCU.- 3.3.1.4 Sites and Causes of Obstruction Shown by Ultrasound.- 3.3.2 Defining the Site of Obstruction.- 3.3.2.1 Renal Changes Shown by IVU.- 3.3.2.2 Ultrasonics.- 3.3.3 Obstruction Proximal to the Bladder.- 3.3.3.1 Characteristic Findings.- 3.3.4 Causes of Obstruction to Bladder Emptying.- 3.3.4.1 Vesical Diverticulum.- 3.3.4.2 Bladder Neck Obstruction.- 3.3.4.3 Posterior Urethral Valves.- 3.3.4.4 Anterior Urethral Diverticulum.- 3.3.4.5 Distal Urethral Obstruction.- 3.3.4.6 Calculus Obstruction.- 3.3.4.7 Urethral Duplication.- 3.3.4.8 Urethral Stricture.- 3.3.5 Effect of Obstruction on the Bladder.- 3.3.6 Urinary Ascites and Perinephric Urinoma.- 3.3.7 "Non-Functioning Kidney".- 3.4 Tactics in Investigation of Patients with Suspected Obstruction.- 3.4.1 Investigation to Establish Diagnosis of Obstruction.- 3.4.2 Evaluating the Upper Tract Problem in Lower Ureteric Obstruction.- 3.4.3 Role of Cystography.- 3.5 Monitoring Progress.- 4 Urinary Infection and Vesico-ureteral Reflux.- 4.1 Introduction.- 4.2 Infection and the Bladder.- 4.3 Ureterovesical Junction: Functional Characteristics.- 4.4 Significant Factors in Vesico-Ureteral Reflux.- 4.5 Acute Kidney Infection and the Advent of the Pyelonephritic Scar.- 4.6 Sequels to Renal Scarring and Reflux.- 4.6.1 Differential Diagnosis of the Small Kidney.- 4.7 Investigations and Implications for Management in Urinary Infection.- 4.7.1 Indications for Surgical Treatment.- 4.7.2 Indications for Medical Management.- 4.7.3 Timing of Investigation.- 4.8 Collateral Considerations.- 4.8.1 Covert Urinary Tract Infection.- 4.8.2 Reflux in Families.- 4.9 Miscellaneous Urinary Infections.- 5 Nephrocalcinosis-Nephrolithiasis-Urolithiasis.- 5.1 Introduction.- 5.2 Causes of Nephrocalcinosis, Nephrolithiasis, and Urolithiasis.- 5.2.1 Nephrocalcinosis.- 5.2.2 Nephrolithiasis.- 5.2.3 Urolithiasis.- 5.3 Investigation.- 5.3.1 Techniques.- 5.4 Consequences of Calculi in the Urinary Tract.- 5.4.1 Acute Renal Obstruction.- 5.4.2 Obstruction and Atrophy of the Kidney.- 5.4.3 Recurrence of Urinary Infection and Continuing Surveillance.- 5.4.4 Pyonephrosis.- 5.4.5 Xanthogranulomatous Pyelonephritis.- 5.4.6 Perinephric Abscess.- 5.5 Miscellaneous Considerations Concerning the Lower Urinary Tract.- 5.6 Conclusion.- 6 Innate Abnormalities of Renal Development.- 6.1 Introduction.- 6.2 Abnormalities of Renal Parenchymal Development.- 6.2.1 Renal Agenesis.- 6.2.2 Renal Hypoplasia.- 6.2.3 Variants of Renal Rotation and Position.- 6.2.3.1 Malrotation.- 6.2.3.2 Ectopic Kidney.- 6.2.3.3 Fused Crossed Ectopia.- 6.2.3.4 Horseshoe Kidney.- 6.2.4 Dysmorphic Kidney.- 6.2.4.1 Dysplastic Kidney.- 6.2.4.2 Segmental Renal Hypoplasia.- 6.2.4.3 Cleft Kidney.- 6.2.5 Renal Cystic Disease.- 6.2.5.1 Congenital Renal Dysplasia with Cystic Changes.- 6.2.5.2 Polycystic Disease.- 6.2.5.3 Medullary Sponge Kidney.- 6.2.5.4 Medullary Cystic Disease: Juvenile Nephronophthisis.- 6.2.5.5 Syndromes Associated with Cystic Kidneys.- 6.2.5.6 Simple Cyst.- 6.2.5.7 Calyx Cyst.- 6.3 Absent Abdominal Muscles (Prune Belly) Syndrome and Variants.- 6.4 Duplication in the Kidney and Ureters.- 6.4.1 Simple Duplication.- 6.4.2 Simple Duplication with Complications.- 6.4.3 Complete Duplication with Small or Poorly Functioning Upper Component.- 6.4.3.1 Ectopic Ureterocoele.- 6.4.3.2 Urethral Ectopic Ureter.- 6.4.4 Duplex Kidney with Atrophic Features in the Lower Renal Component.- 7 Vesical and Urethral Problems.- 7.1 Introduction.- 7.2 Developmental Variants.- 7.2.1 Absence of Ureteric Orifice in the Normal Location.- 7.2.2 Exstrophy and Epispadias.- 7.2.3 Hypospadias.- 7.2.4 Persistent Cloaca.- 7.2.5 Persistent Urachus and Urachal Cyst.- 7.2.6 Duplication in the Bladder and Urethra.- 7.2.7 Anorectal Anomaly and the Lower Urinary Tract.- 7.2.8 Vesical Diverticulum.- 7.3 Neoplastic Disease.- 7.3.1 Rhabdomyosarcoma.- 7.3.2 Other Malignant Lesions.- 7.3.3 Non-Malignant Mass Lesions.- 7.3.3.1 Simple Polyps.- 7.3.3.2 Angioma.- 7.3.3.3 Myomas.- 7.4 Cystitis.- 7.4.1 Simple Cystitis.- 7.4.2 Cystitis Cystica.- 7.4.3 Tuberculous Cystitis.- 7.4.4 Bilharzia.- 7.5 Neuropathic Bladder.- 7.5.1 Causes.- 7.5.2 Characteristics.- 7.5.3 Cryptogenic Neuropathic Bladder.- 8 Acute Kidney Lesions.- 8.1 Introduction.- 8.2 Shock States and Kidney Damage.- 8.2.1 Antecedent Factors.- 8.2.2 Vulnerability of the Kidney to the Shock State.- 8.2.3 Tubular Necrosis.- 8.2.4 Medullary Necrosis.- 8.2.5 Renal Venous Thrombosis.- 8.2.6 Haemolytic Uraemic Syndrome.- 8.2.7 Cortical Necrosis.- 8.3 Nephritis.- 8.3.1 Acute Nephritis and its Evolution.- 8.3.2 Nephrotic Syndrome.- 8.3.3 Renal Damage as Part of Generalised Disease.- 8.3.4 Haematogenous Pyelonephritis and Acute Pyelonephritis.- 8.4 Miscellaneous Types of Kidney Damage.- 9 Renal Abdominal and Pelvic Masses.- 9.1 Introduction.- 9.2 Renal Neoplasms.- 9.2.1 Wilms' Tumour - Nephroblastoma.- 9.2.1.1 Clinical Presentation.- 9.2.1.2 The Renal Lesion.- 9.2.1.3 Extension and Dissemination.- 9.2.1.4 Staging of Wilms' Tumour.- 9.2.1.5 Follow-up Examination in Wilms' Tumour.- 9.2.2 Mesoblastic Nephroma.- 9.2.3 Renal Carcinoma.- 9.2.4 Other Tumours Affecting the Kidney.- 9.2.5 Conclusion.- 9.3 Non-Neoplastic Renal Masses and Lesions Simulating Masses.- 9.3.1 General Disease with Renal Masses.- 9.3.1.1 Tuberous Sclerosis.- 9.3.1.2 Hydatid Disease.- 9.3.2 Obstruction in the Urinary Tract.- 9.3.3 Cystic Disease in the Kidney.- 9.3.3.1 Multicystic Disease.- 9.3.3.2 Adult-Type Polycystic Disease.- 9.3.4 Ectopic Kidneys.- 9.3.5 Pseudotumour: Cleft Kidney.- 9.3.6 Disappearing Calyces.- 9.3.7 Renal Venous Thrombosis.- 9.3.8 Renal Abscess Formation.- 9.3.9 Perinephric Infection and Abscess.- 9.3.10 Xanthogranulomatous Pyelonephritis.- 9.3.11 Trauma.- 9.4 Extrinsic Malignant Masses Affecting the Kidney and Urinary Tract.- 9.4.1 Neuroblastoma.- 9.4.2 Hodgkin's Disease.- 9.4.3 Non-Hodgkin's Lymphoma.- 9.4.4 Hepatoblastoma.- 9.4.5 Teratomas.- 9.5 Extrinsic Benign Masses Affecting the Kidney and Urinary Tract.- 9.5.1 Enlargement of Liver and Spleen.- 9.5.2 Neurofibromatosis.- 9.5.3 Ganglioneuroma.- 9.5.4 Parapelvic Cyst.- 9.5.5 Hydrometrocolpos.- 9.5.6 Large Ovarian Cysts and Dermoids.- 9.5.7 Pelvic Abscess.- 9.6 Strategy in Investigation.- 10 Adrenal and Gonadal Lesions.- 10.1 Introduction.- 10.2 Tactics in Investigation of the Adrenal.- 10.2.1 Clinical Information.- 10.2.2 Plain Radiographs.- 10.2.3 Ultrasonography.- 10.2.4 Scintigraphy.- 10.2.5 Angiography.- 10.2.6 Retroperitoneal Gas Insufflation.- 10.2.7 Computerized Tomography.- 10.3 Adrenal Haemorrhage and Abscess.- 10.3.1 Adrenal Haemorrhage.- 10.3.2 Adrenal Abscess.- 10.4 Congenital Adrenal Hyperplasia (Adrenogenital Syndrome).- 10.5 Cushing's Syndrome.- 10.6 Virilizing and Feminizing Tumours of the Adrenal Gland or Gonad.- 10.6.1 The Clinical Problem.- 10.6.2 Virilization.- 10.6.3 Feminization.- 10.6.4 Precocious Puberty.- 10.6.5 Role of Investigation.- 10.7 Other Gonadal Lesions.- 10.8 Conclusion.- 11 Systemic Hypertension.- 11.1 Introduction.- 11.2 Clinical Presentation.- 11.3 Causes of Hypertension.- 11.3.1 Non-Congenital Coarctation.- 11.3.1.1 Coarctation Due to Non-Specific Arteritis.- 11.3.1.2 Neurofibromatosis.- 11.3.1.3 Chronic Granulomatous Disease.- 11.3.2 Renal Parenchymal Lesions.- 11.3.2.1 Chronic Nephritis.- 11.3.2.2 Obstructive Atrophy.- 11.3.2.3 Renal Venous Thrombosis.- 11.3.2.4 Atrophic Chronic Pyelonephritic Scarring.- 11.3.2.5 Segmental Renal Hypoplasia.- 11.3.2.6 Dysmorphic Kidney.- 11.3.2.7 Haemolytic Uraemic Syndrome.- 11.3.2.8 Haemangiopericytoma.- 11.3.3 Renal Arterial Disease.- 11.3.3.1 Group A. Arterial Lesions Outside the Kidney.- 11.3.3.2 Group B. Arterial Lesions Within Renal Parenchyma.- 11.3.4 Phaechromocytoma.- 11.4 Conclusion: Tactics in Investigation.- 12 Bone Changes in Chronic Renal Failure.- 12.1 Introduction.- 12.2 Cortical Bone.- 12.2.1 General Radiological Changes.- 12.2.2 Sites of Bone Resorption.- 12.3 Cancellous Bone.- 12.3.1 General Radiological Changes.- 12.3.2 Sites of Cancellous Bone Lesions.- 12.4 Diaphyseal Lesion.- 12.5 Epiphyseal Lesion.- 12.6 General Considerations.- 12.7 Clinical Presentation.- 12.8 Conclusion.- 13 Full Circle: An Epilogue.- 13.1 Large Kidneys.- 13.2 Englargement of one Kidney.- 13.3 Small Kidneys.- 13.4 Renal Malposition.- 13.5 Renal Calcification.- 13.6 Dilated Ureters.- 13.7 Ureteric Displacement.- 13.8 Large Bladder.- 13.9 Small Bladder.- 13.10 Bladder Displacement.- 13.11 Space-occupying Lesions in Bladder.- 13.12 Syndromes with Associated Renal Malformations.- 13.13 Syndromes Associated with Renal Cysts.- 13.14 Syndromes Associated with Nephropathy.- 13.15 Congenital Renal Anomalies Associated with Other System Involvement.- 13.16 Hemihypertrophy.- 13.17 Conclusion.- 14 Subject Index.

Additional information

NGR9781447130994
9781447130994
1447130995
Diagnostic Imaging of the Kidney and Urinary Tract in Children by A. R. Chrispin
A. R. Chrispin
Current Diagnostic Pediatrics
New
Paperback
Springer London Ltd
2012-01-04
208
N/A
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