Search

The value of spinal computed tomography in the diagnosis and management of spinal dysraphism is described. Eight patients with diverse etiological agents were evaluated by clinical examination and subsequent computed tomography, without contrast enhancement. The diagnosis and location of the pathology thus ascertained allowed for appropriate surgery without invasive diagnostic studies. The value of this approach in children and in those patients in whom a low conus medullaris is suspected is obvious.

Two cases are presented in which the preoperative diagnosis of abdominal cerebrospinal fluid pseudocyst was made by computed tomography (CT). The collection can be well outlined by this method, and measurement of density values characterizes the contents as a water density; the relationship of portions of the shunt catheter to the pseudocyst can be demonstrated as well. It is suggested that, in a patient with a ventriculoperitoneal shunt who develops abdominal signs or symptoms, CT can provide the definitive diagnosis of this entity.

Twelve patients with the clinical findings of spinal dysraphism form the basis for this report. In eight patients, physical findings, plain x-rays, and unenhanced spinal computed tomography allowed for precise diagnosis and subsequent therapy, without contrast myelography. All patients in the study had intravenous pyelography, and this revealed evidence of renal deterioration in two. The other 10 patients had radiographically normal upper urinary tracts. Urodynamic assessment was performed in seven; three were abnorma. The pattern of the abnormal studies (three “flaccid type” with an adequate urethral pressure profile and one with detrusor-sphincter dyssynergia) allowed for appropriate therapy to be employed for bladder emptying and continence. Both spinal computed tomography and urodynamic testing serve as noninvasive studies that can be employed in the follow-up and management of patients with spinal dysraphism.

Five cases of retroperitoneal iliac fossa abscess are presented. Abnormal excretory urogram and plain films, coupled with a history of either hip pain, limp, or pelvic mass should suggest the diagnosis. The excretory urogram is the most sensitive means of detecting iliopsoas abscess; all patients had medial displacement of the distal ureter. The upper urinary tract was normal in all cases. Study of the gastrointestinal tract may be of additional help in localizing the abscess and ruling out other pathology. A retroperitoneal muscle splitting approach is the preferred surgical procedure. Drainage of the abscess cavity and systemic antibiotic coverage are curative.

A case of massive hydronephrosis secondary to a ureteral valve was discovered upon evaluation of mild trauma. The orderly diagnostic studies, including ultrasonography and antegrade pyelography, led to the correct diagnosis and appropriate therapy. Ultrasonography as a diagnostic tool in urology is discussed and characteristics of the 18 cases of ureteral valves reported to date are reviewed.