尿路結核知見補遺 第II篇:腎結核のX線的診断法に就て

Abstract

The roentgenogrms of 339 surgically treated cases wer e studied in this report. The plain roentgenography, retrograde pyelography and excretory pyelography were used as a routine examination to diagnose the renal tuberculosis in our clinic. If necessary, the intravenous nephrography, pneumoretroperitoneum, translumbar aortography, direct pyelography, seriography and enlargement radiography were performed. The roentgenological findings in renal tuberculosis were described in detail and the value of each method was discussed. The abnormal calcification in renal region was revealed by the plain roentgenography in 20 (5.9%) cases. The total and partial cement kidney were present in 9 and 4 cases respectively. This method should be used in all cases. Retrograde pyelography was tried in all case s , and pyelograms were obtained in 169 (49.9%) cases succesfully. Almost in all cases the pyelogram showed the lesions in renal pelvis and calices honestly. However, the closed tuberculous cativy in which the contrast medium could not enter was present in 43 (25.4%) of the 169 cases. Excretory pyelogsaphy was performed in 213 cases. It off e rs a fairly accurate picture of kidney function in accordance with the destruction of renal parenchym, so it has a great importance not only in the diagnosis but also in the determination of treatment. The cases, whose kidney function was impaired seriously and whose pyelogram could not show the pelvis and calices clearly and sufficiently, were 135 (66.4%), and the pathological changes in nephrectomized kidney of these were too extensive to treat by chemotherapy only. It is very interesting that the nearly closed tuberculous cavity could be visu a lised by excretory urography, on the other hand it was impossible to visualise it by retrograde pyelography in some cases. The incidence of the closed cavity is promoted by the chemotherapy, and such cases are resistant to the medical treatment. Diagnosis of such lesion is a very important metter, and many other assistant procedures are used to this purpose. Pneumoretroperitoneum is a useful method to outlining the kidney, but if the a d hesion of the perirenal tissue is firm, it is impossible to clarify the kidney outline. I have been unable to recognize the kidney outline in 11.5% of the cases. Direct pyelography is carried out by meens of translumbar direct puncture of the kidney. This is valuable in tuberculous hydronephrosis in which a pyelogram can not be obtained by usual urography. There is no serious complication, if the case is selected properly. Aortography was performed in 11 cases. The pictures of these cases and aortograms of the nephrectomized kidney were illustrated and the details of these cases were described. Translumbar injection of the aorta with a contrast medium permits a accurate visualisation of the arterial blood supply of the tuberculous kidney. I found in a number of cases, that the extent of the lesion could be visualised and assesed on the arteriogram and nephrogram, and that the diagnosis of closed cavity and the estimation of destruction in parenchym could be possible. Then this method may be valuable in tuberculous pyonephrosis, if its pyelogram can not be obtained by urography and the presence of kidney is doutful. Sometimes aortogam affords a great help in determinating the safe extent of the resection when partial nephrectomy is applicable. If pyelogram arouses suspision of the closed lesion, aortography should be carried out with no hesitation. The serial aortography is a very useful procedure to know each stadium of aortography. The arterial phase, nephrography phase and venous phase are different from each other. And it is important that man should try to obtain a clear and complete roentgenogram in any method, especially in arteriography.