Duplicated collecting system

Duplex collecting systems can be unilateral or bilateral and can be associated with a variety of congenital genitourinary tract abnormalities. Most patients are asymptomatic, with genitourinary tract abnormalities being detected incidentally on imaging studies performed for other reasons. Symptomatic patients usually have complete ureteric duplication in which the ureters are prone to developing obstruction, reflux, and infection.

The Committee on Terminology, Nomenclature, and Classification of the Section on Urology of the American Academy of Pediatrics suggests the use of the following terms in reference to duplex collecting systems3 :

•Duplex kidney - The duplex kidney has a single renal parenchyma that is drained by 2 pyelocaliceal systems.
•Upper or lower pole - The poles represent one component of a duplex kidney.
•Duplex system - The kidney has 2 pyelocaliceal systems and is associated with a single ureter or with a bifid ureter (a partial duplication) or, in the case of a complete duplication, with 2 ureters (double ureters) that drain separately into the urinary bladder.
•Bifid system - Two pyelocaliceal systems join at the ureteropelvic junction (bifid pelvis), or 2 ureters join before draining into the urinary bladder (bifid ureters).
•Double ureters - Two ureters open separately into the renal pelvis superiorly and drain separately into the bladder or genital tract.
•Upper and lower pole ureters - Upper and lower pole ureters drain a duplex kidney's upper and lower poles, respectively.

For further reading:

http://emedicine.medscape.com/article/378075-imaging
http://www.sonoworld.com/fetus/page.aspx?id=2660

Azygos fissure

Sometimes the azygos vein can be seen clearly on chest x-ray. And sometimes you can even see an "azygos fissure". This fissure delineates a accessory "azygos lobe".

It's actually a congenital failure of normal migration of the azygos vein from the chest wall to its place above the tracheo-bronchial angle. The invaginated visceral and parietal pleural layers persist to form a fissure.

Normally it's just a variant of the normal. But it can cause trouble during thoracotomy(bleeding) and one case of torsion of the azygos lobe has been described.

For further reading:

http://www.ispub.com/journal/the_internet_journal_of_anesthesiology/volume_11_number_1_1/article_printable/the_azygos_lobe_anesthetic_considerations.html

Iatrogenic pseudoaneurysm of the femoral artery

It is one of the most troublesome complications after various invasive cardiovascular procedures related to the femoral arterial access site. Iatrogenic pseudoaneurysms (IPA) form when an arterial puncture site fails to seal, allowing arterial blood to ooze into the surrounding tissues and form a pulsatile hematoma.

Diagnostic criteria include: swirling color flow in a mass separate from the affected artery, and a typical “to-and-fro” Doppler waveform in the pseudoaneurysm neck.

Ultrasound-guided compression repair has replaced the need for surgical repair of FAP. Recently, percutaneous thrombin injection in the FAP has gained popularity.

For further reading:

LENARTOVA, M. Iatrogenic Pseudoaneurysm of Femoral Artery: Case Report and Literature Review. Clin Med Res. 2003 July; 1(3): 243–247.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069051/

Intestinal amyloidosis

Radiological signs are the symmetric thickening of the valvulae conniventes and decreased intestinal motility.

The CT image of amyloidosis resembles that of an inflammatory or ischemic enterocolitis. The wall is thickened, its lumen is narrowed and intussusception may be present. Irregular plicae thickening can be seen as well. The diagnosis of amyloidosis is made by biopsy.

For further reading:

http://www.radiologycases.com/casereports/?mod=case_ihtmlf&id=165

Avulsion fracture of the anterior inferior iliac spine

A 15 year old boy complains of pain in the right groin after kicking against a hard ball. The physician requests an ultrasound of the groin region for excluding muscle or tendon rupture.



The ultrasound didn't show any abnormalities of the muscle or tendon structures. What we do see is a loose bone fragment at the proximal end of the m. rectus femoris.



X ray of the right hip shows an avulsion fracture of the anterior inferior iliac spine. This is where the m. rectus femoris inserts. An avulsion is caused by a hyperextension movement of the leg.

Supracondylar fracture

Lateral view of the left elbow.



Lateral view of the right elbow.

















This child had a trauma of the left elbow. As you can see there is an elevated posterior fatpad. But the question is, where is the fracture?

The normal humerus has a hockey stick shape on lateral view. If you draw a line along the anterior surface of the humerus, this line has to go through the middle one thirth of the epicondyle(see drawing).






If the line goes through the first one thirth, this is suspicious of a supracondylar fracture. See case and example.













Link: http://www.wikiradiography.com/page/Imaging+Supracondylar+Fractures+of+the+Humerus