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Extrarenal Calices
EXTRARENAL CALICES L. L.
VESEEN
From the Genito-urinary Department, St. Luke's Hospital, Chicago, Illinois
The following case presents a close resemblance to one reported by Dr. Eisendrath in 1925. It is a rarity. Dr. Eisendrath
FIG. 1. EXTRARENAL CALICES.
DORSAL ASPECT
collected 3 other cases (Fiirstner, Herz and Apert) besides his, this making the fifth. 487
488
L. L. VESEEN
In May, 1930, Mrs. L. B., aged fifty, entered St. Luke's service complaining of left lumbar pain, irregular fever, pyuria and dysuria over a period of several months. There was a slight loss of weight. The physical examination was essentially negative except for palpable left kidney which was slightly movable.
Fm. 2.
ExTRARENAL CALICES.
VENTRAL AsPECT
Cystoscopic examination was negative. There was no obstruction to the passage of a No. 6 x-ray catheter except that the left would not pass all the way to the renal pelvis. Phenolsulphonephthalein test was normal on the right. There was a trace of the dye from the left side in twenty minutes. Urine from the left side was hazy, from the right was clear. Pus and B. coli were found from the left side, specimen from the right side was negative. Twenty-five cubic centimeters of 15 per cent
EXTRAREN AL CALICES
489
sodium iodide instilled on the left side and pyelograms made. There was a moderate reaction but unsatisfactory picture. Nephrectomy was advised. At operation there was found an anomalous vessel crossing the middle of the dorsal aspect. A kinked ureter was adherent to the pelvis by small bands of adhesions. A normal
Fm. 3.
ExTRARENAL CALICES.
DORSAL ASPECT
pedicle was found and there was an incomplete rotation present (see figs. 2 and 3). The patient made an uneventful recovery. The pathological report showed a left infected hydronephrosis with stricture of the left ureter at the ureteropelvic juncture (inner diameter at this point 0.1 cm. caliber of ureter); kink at ureteropelvic juncture measuring 5 cm.; capacity 200 cc. of purulent urine. The hydronephrotic sac was made up of a large sacculated caudal portion and three smaller calices, the
490
L. L. VESEEN
tips of which entered the renal parenchyma. The hilus of the kidney was markedly deficient on the ventral aspect. The dorsal border showed a more marked development. The parenchyma was atrophic with but little renal tissue. The ureter in the embryo divides into a number of calices inside of the renal blastema but may do so equally well outside of it.
122 S. Michigan Avenue, Chicago, Illinois REFERENCES ErsENDRATH, DANIEL N.: Hydronephrosis in kidney with extrarenal ralyces. Jour. Urol., January, 1925, xiii, 51-58.
VESEEN
From the Genito-urinary Department, St. Luke's Hospital, Chicago, Illinois
The following case presents a close resemblance to one reported by Dr. Eisendrath in 1925. It is a rarity. Dr. Eisendrath
FIG. 1. EXTRARENAL CALICES.
DORSAL ASPECT
collected 3 other cases (Fiirstner, Herz and Apert) besides his, this making the fifth. 487
488
L. L. VESEEN
In May, 1930, Mrs. L. B., aged fifty, entered St. Luke's service complaining of left lumbar pain, irregular fever, pyuria and dysuria over a period of several months. There was a slight loss of weight. The physical examination was essentially negative except for palpable left kidney which was slightly movable.
Fm. 2.
ExTRARENAL CALICES.
VENTRAL AsPECT
Cystoscopic examination was negative. There was no obstruction to the passage of a No. 6 x-ray catheter except that the left would not pass all the way to the renal pelvis. Phenolsulphonephthalein test was normal on the right. There was a trace of the dye from the left side in twenty minutes. Urine from the left side was hazy, from the right was clear. Pus and B. coli were found from the left side, specimen from the right side was negative. Twenty-five cubic centimeters of 15 per cent
EXTRAREN AL CALICES
489
sodium iodide instilled on the left side and pyelograms made. There was a moderate reaction but unsatisfactory picture. Nephrectomy was advised. At operation there was found an anomalous vessel crossing the middle of the dorsal aspect. A kinked ureter was adherent to the pelvis by small bands of adhesions. A normal
Fm. 3.
ExTRARENAL CALICES.
DORSAL ASPECT
pedicle was found and there was an incomplete rotation present (see figs. 2 and 3). The patient made an uneventful recovery. The pathological report showed a left infected hydronephrosis with stricture of the left ureter at the ureteropelvic juncture (inner diameter at this point 0.1 cm. caliber of ureter); kink at ureteropelvic juncture measuring 5 cm.; capacity 200 cc. of purulent urine. The hydronephrotic sac was made up of a large sacculated caudal portion and three smaller calices, the
490
L. L. VESEEN
tips of which entered the renal parenchyma. The hilus of the kidney was markedly deficient on the ventral aspect. The dorsal border showed a more marked development. The parenchyma was atrophic with but little renal tissue. The ureter in the embryo divides into a number of calices inside of the renal blastema but may do so equally well outside of it.
122 S. Michigan Avenue, Chicago, Illinois REFERENCES ErsENDRATH, DANIEL N.: Hydronephrosis in kidney with extrarenal ralyces. Jour. Urol., January, 1925, xiii, 51-58.