小児側腹部腫瘤の血管造影診断

Abstract

Eight children with flank mass ranging from 9 months to 6 years of age were examined arteriographically by Seldinger's method. Six cases of Wilms' tumor showed indirect signs such as aortic deviation, compression and displacement of the renal arteries, splaying and stretching of the intrarenal branches and diminished nephrograms. Tumor circulation was not so prominent as that of adult renal cell carcinoma with pooling sign, tumor stain and A-V fistula. Paucity in tumor circulation and large avascular area gave appearance of hydronephrosis at a glance. However, on close inspection of the serial angiographic films, scattering foci of tumor vessels, namely, small weaving vessels, minute vessels of irregular caliber, and zigzag arteries were found. Three cases out of six showed abdominal masses without visualization of ipsilateral pyelograms on IVP films. From the angiographic findings above mentioned, hydronephrosis was able to be differentiated from Wilms' tumor. Retroperitoneal carcinoma originating from the pancreas in a 6-year-old boy, showed florid tumor vessels and tumor stain. No major complication was noted by these arteriographic examinations. Four cases showed transient arterial spasm only as a minor complication. Arteriography in the field of pediatric urology can provide us with useful informations regarding diagnosis, prognosis and the choice of treatment without much untoward effect if performed under meticulous care. Each of aortography, vena-cavography, and pyelography can afford us indispensable informations regarding abdominal masses in children. However, consecutive examinations .of aortography, vena-cavography and pyelography done in different days are too timeconsuming and too aggressive to these children. In order to visualize aortogram, vena-cavogram and pyelogram sequentially by single examination with single dose of dye, "AORTO-CAVO-PYELOGRAPHY" was devised. Animal experiments were conducted on 9 mongrel dogs. At the time of Seldinger's aortography, the inflatable Dotter-Lukas balloon cathter was inserted into vena cava so that its tip could locate at the height above the junction of renal vein and below the junction of hepatic vein. After injecting dye into the aorta, the balloon was inflated to block vena caval blood flow for 30 seconds. Serial films were exposed and at 5 minutes another single film was shot. By this" AORTO-CAVO-PYELOGRAPHY", single dose of dye could demonstrate aortogram, cavogram, pyelogram and even renal phlebogram well in dogs.