ECR 2013 Rec: Can a contrast-enhanced ultrasound nephrostogram be used instead of a fluoroscopic nephrostogram: preliminary findings #SS1807 #B0976


B-0976 Can a contrast-enhanced ultrasound nephrostogram be used instead of a fluoroscopic nephrostogram: preliminary findings

 M. Daneshi, K. Patel, D. Huang, M. Sellars, P. Sidhu | Monday, March 11, 14:00 – 15:30 / Room G/H

Purpose: The use of contrast-enhanced ultrasound (CEUS) has extended beyond traditional uses, and the possibility to delineate percutaneous tubes and drains is achievable. We have compared the traditional fluoroscopic nephrostogram using iodinated contrast agents with CEUS nephrostogram to ascertain the accuracy, utility and convenience of the CEUS nephrostogram.
Methods and Materials: The standard conventional nephrostogram was performed immediately prior to the CEUS nephrostogram. The CEUS nephrostogram technique involved diluting 0.2ml of SonoVue with 40 ml of normal saline and introduced into the renal collecting system via the nephrostomy tube. Digital cine-clips and still images were recorded to allow accurate retrospective comparison by two independent reviewers to the reference standard.
Results: Twelve nephrostomies in 10 patients (median age 64 yrs, range 29-91 yrs, 6 females and 4 males) were performed and reviewed. The renal pelvicalyceal system was visualised in both CEUS and fluoroscopic nephrostograms in 11/12 (92%) with one nephrostomy tube identified as being misplaced. The entire ureter was visualised in 6/12 (50%) with a CEUS nephrostogram compared with 8/12 (75%) using traditional nephrostogram. Fluoroscopic nephrostogram showed drainage of contrast into the bladder in 10/12 (83%) cases compared with 9/12 (75%) using CEUS.
Conclusion: Preliminary results suggest that CEUS nephrostogram is a feasible method to confirm the correct positioning of the nephrostomy tube, image the ureters and determine if there is satisfactory drainage into the bladder. CEUS nephrostogram is a suitable alternative for the traditional nephrostogram in patients with contraindications to iodinated contrast agents or if the procedure needs to be performed at the bedside.

ECR 2013 Rec: Scrotal tumours #A425 #CC1421


A-425 Scrotal tumours

P.S. Sidhu | Sunday, March 10, 14:00 – 15:30 / Room C

Ultrasound remains the imaging modality of choice for the assessment of any form of scrotal pathology. The resolution capabilities of the technique and the superficial nature of the scrotal contents allow ultrasound examination to deliver optimal imaging. Testicular tumours maybe imaged and characterised with ease, without need for further imaging techniques. The addition of colour Doppler ultrasound allows for the interrogation of the vascularity of any lesion seen, and the addition of newer techniques such as contrast-enhanced ultrasound and tissue elastography has beneficial effects to aid interpretation and diagnosis. Nearly all focal abnormalities of the testis in the adult patient are malignant lesions, with primary germ cell tumours a frequent abnormality in the younger patient, and lymphoma or a secondary malignancy common in the older patient. However, benign abnormalities such as a focal infarction, haematoma or an epidermoid cyst may mimic malignancy. It is important to be able differentiate benign from malignant causes, with testis sparing the ultimate goal. Non-germ cell tumours present a specific conundrum, with the newer imaging techniques likely to be of benefit in distinguishing these tumours from germ cell tumours. Extra-testicular tumours are nearly always benign and include lipoma and adenomatoid lesions. Inflammatory disease may also simulate a tumour and presents an unexpected pitfall. A carful scrotal ultrasound examination, using all the available ultrasound techniques should allow the examiner to make a confident assessment of any scrotal tumour, and allow for the correct management without need for further imaging.

ECR 2013 Rec: Imaging of renal trauma #A534 #CC1621


A-534 Imaging of renal trauma

V. Logager | Monday, March 11, 08:30 – 10:00 / Room C

Approximately, 10 % of all trauma admissions have kidney injuries. According to the American Association of Surgeons in Trauma (AAST), blunt traumas can be graded in a 5-point Renal Injury Scale. (Moore EE, Shackford SR, Pacher HL Organ Injury Scaling: Spleen, Liver and Kidney. J. Trauma 1989;29:1664-1666). On the basis of the patient’s clinical findings an imaging algorithm is set. In general, patients that are normotensive with microscopic haematuria have less than 0.2% risk of serious kidney damage and imaging is unnecessary, whereas patients with either: A) gross haematuria or B) microscopic haematuria and blood pressure less than 90mmHg or occasionally C) microscopic haematuria and positive result of diagnostic peritoneal lavage will require imaging. Contrast-enhanced CT is the way to go. Imaging should be in 3 phases (cortico medullary, delayed 3-5 min and late phase (more than 10 min). Image reading should be a multiplanar approach. Most of the findings do not require surgical intervention, the rest does. On the basis of case presentations, findings will be analysed, discussed and correlated to the patient’s clinical status and treatment possibilities, including where and which signs to look for. Which modality could be used to solve the diagnostic problem when the clinical picture does not fit with the radiological picture. Always expect the unexpected.