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Fluoroscopic Examination of the Injected Kidneys, And Report of a Case1
FLUOROSCOPIC EXAMINATION OF THE INJECTED KIDNEYS, AND REPORT OF A CASE 1 F.R.HAGNER
Fluoroscopic examination of the kidneys, both with and without injection of the pelvis of the kidneys, is, I believe, a valuable adjunct to the accurate diagnosis of certain kidney conditionso It can often be definitely settled whether a shadow in the kidney region is caused by a calculus in the kidney or is due to some calcareous deposit in the gland or some other organ. The X-ray catheter or injection of the pelvis may be necessary to make an accurate diagnosis, the fact of being able to see the catheter in place and observing the simultaneous movement of the catheter and the shadow of the calculus caused by the respiration will often help materially in clearing up the diagnosis. Our ability to see the kidney injected and to watch the fluid escaping into the pelvis often gives us information more valuable than roentgenography. I will quote Dr. Merritt, the roentgenologist of Garfield Hospital, who summarizes his views and gives his technique as follows: The method assists materially in locating the kidney and estimating its size. Stereoscopic plates are always made afterwards as a matter of record but they seldom if ever give additional information and many times the lesions show more plainly in the fluoroscopic than in the X-ray plates. The essential points are as follows: 1. A low gap, not more than four inches and as low as two. 2o Five milliamperes of current. 3. Absolutely darkened room, with operator protected from daylight at least twenty-five minutes prior to the examination. 4. The patient having been previously catheterized, is brought in on an ordinary hospital cart and transferred to the X-ray 1 Read at the meeting of the American Association of Genito Urinary Surgeons, Rochester, Minn., May, 1920.
389 THE JOURNAL OF UROLOGY, VOL, V, NO,
4
390
F. R. HAGNER
table when the injection of the ureters may be performed at the pleasure of the urologist. I have an interesting observation to report but will not go into the history of the case except briefly. This was a case of pyelitis in which we made a diagnosis of a suppurative perinephritis. Both Dr. Fuller and I thought there was possibly some connection between the pelvis of the kidney and the suppurative process outside the kidney. Patient's kidney was injected and fluoroscopic examination was made during injection of the kidney. As soon as 10 cc. of thorium was injected into the pelvis, the injected fluid began to escape into a cavity outside of the nephritic tissue. Another 10 cc. was injected and the fluid could be seen escaping out into this cavity in a streamno force being used- patient complaining of no pain. This showed much more distinctly while watching it than it does in the plate I have here. At operation the next day, when the kidney was exposed and the abscess cavity explored it was found to connect with the kidney pelvis. The kidney was drained as was the suppurative area around it. The convalescence of this patient was very interesting but that is another story. He is now well, having clear normal urine from both ureters.
Fluoroscopic examination of the kidneys, both with and without injection of the pelvis of the kidneys, is, I believe, a valuable adjunct to the accurate diagnosis of certain kidney conditionso It can often be definitely settled whether a shadow in the kidney region is caused by a calculus in the kidney or is due to some calcareous deposit in the gland or some other organ. The X-ray catheter or injection of the pelvis may be necessary to make an accurate diagnosis, the fact of being able to see the catheter in place and observing the simultaneous movement of the catheter and the shadow of the calculus caused by the respiration will often help materially in clearing up the diagnosis. Our ability to see the kidney injected and to watch the fluid escaping into the pelvis often gives us information more valuable than roentgenography. I will quote Dr. Merritt, the roentgenologist of Garfield Hospital, who summarizes his views and gives his technique as follows: The method assists materially in locating the kidney and estimating its size. Stereoscopic plates are always made afterwards as a matter of record but they seldom if ever give additional information and many times the lesions show more plainly in the fluoroscopic than in the X-ray plates. The essential points are as follows: 1. A low gap, not more than four inches and as low as two. 2o Five milliamperes of current. 3. Absolutely darkened room, with operator protected from daylight at least twenty-five minutes prior to the examination. 4. The patient having been previously catheterized, is brought in on an ordinary hospital cart and transferred to the X-ray 1 Read at the meeting of the American Association of Genito Urinary Surgeons, Rochester, Minn., May, 1920.
389 THE JOURNAL OF UROLOGY, VOL, V, NO,
4
390
F. R. HAGNER
table when the injection of the ureters may be performed at the pleasure of the urologist. I have an interesting observation to report but will not go into the history of the case except briefly. This was a case of pyelitis in which we made a diagnosis of a suppurative perinephritis. Both Dr. Fuller and I thought there was possibly some connection between the pelvis of the kidney and the suppurative process outside the kidney. Patient's kidney was injected and fluoroscopic examination was made during injection of the kidney. As soon as 10 cc. of thorium was injected into the pelvis, the injected fluid began to escape into a cavity outside of the nephritic tissue. Another 10 cc. was injected and the fluid could be seen escaping out into this cavity in a streamno force being used- patient complaining of no pain. This showed much more distinctly while watching it than it does in the plate I have here. At operation the next day, when the kidney was exposed and the abscess cavity explored it was found to connect with the kidney pelvis. The kidney was drained as was the suppurative area around it. The convalescence of this patient was very interesting but that is another story. He is now well, having clear normal urine from both ureters.