Two radiologists individually studied 220 intravenous urograms done during pregnancy in patients with apparently normal urinary tracts, and an observer-agreement technique was used to obtain the results. The few cases seen in early pregnancy show that dilatation of the urinary tract is uncommon, or at least mild, before mid term. Shortly thereafter, however, dilatation appears abruptly and remains virtually unchanged both in incidence and degree until full term. After mid term, the right side is dilated in about three-quarters of cases and the left side in about one-third. In only 10 % was the left side fuller than the right; in 86%, the right side was the fuller. Severe dilatation is infrequent, especially on the left. The dilatation never extends into the pelvis. The abdominal ureters are displaced outwards in a minority of cases, more often on the left. Little or no association was found between the dilatation and fetal position, maternal gravidity or urinary infection. These statistically derived conclusions should provide a firmer basis for what constitutes the limits of normality in the intravenous urogram during pregnancy.
Biliary calculi of a non-Western pattern were detected in 15 patients on real-time sonography performed over a 3-year period in a center serving a predominantly "Cape colored" (mixed race) population in South Africa. In two patients definite calculi were detected only in the common bile duct or gallbladder, but there was strong imaging and clinical evidence that the calculi were secondary to ascariasis. Twelve patients had intrahepatic calculi, predominantly left-sided, and evidence of past or present ascariasis. In at least five of the 12, biliary ascariasis was found at sonography or surgery. These fourteen patients reported recurrent, acute attacks of pain and cholangitis over a period of years. The symptoms were often difficult to distinguish clinically from those of uncomplicated intestinal or biliary ascariasis. The 15th patient had no evidence of ascariasis. Intrahepatic calculi were evenly distributed throughout both lobes and were clinically silent. Only one of the 13 patients with definite intrahepatic calculi had evidence of gallbladder calculi.
Biliary ascariasis should be searched for inside and outside the liver. The appearances of bundles and boluses are different from those of single worms. Intra- and extrahepatic biliary stones may be present.
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