Imaging

Abstract

Editorial CommentEncrusted retained ureteral stents are a frustrating and difficult surgical challenge. Shock wave lithotripsy of the stent to loosen fragments, combined percutaneous and cystoscopic lithotripsy of the renal and bladder ends of the stent (which are usually the most encrusted), and open surgery have all been reported. The authors of this article demonstrate nicely that small caliber ureteroscopes can be used with great effectiveness to provide a less morbid, outpatient solution. The silk-loop retraction of the bladder end of the stent appears to be a great trick, as friction of the ureteroscope on the stent can sometimes be problematic as the ureteroscope is advanced up the ureter, and allowed use of a semi-rigid instrument with a pneumatic lithotrite. The next time you are faced with an encrusted ureteral stent, consider the ureteroscopic approach. Am J Roentgenol. 2004; 182: 1033-7 Objective: Prior series of percutaneous imaging-guided biopsies of adrenal masses before the advent of dedicated CT and MRI of the adrenal glands have shown that 40-57% of adrenal masses biopsied were adenomasbenign lesions requiring no further evaluation or treatment. This study was performed to assess the effect of dedicated adrenal imaging with CT and MRI on the rate of percutaneous imaging-guided biopsies of adrenal masses. Dr. J. Stuart Wolf Jr.Materials and Methods: We reviewed 50 consecutive adrenal mass biopsies performed during a 48-month period. The patient demographics, technique of biopsy, pathology results, and results of any prior dedicated adrenal imaging with MRI or CT protocols were noted.Results: Only six (12%) of 50 biopsies were adenomas. Five of these six cases were preceded by dedicated adrenal CT or MRI. Thirty-five cases were metastatic disease, four were adrenal cortical carcinoma, three were pheochromocytoma, and two biopsies were nondiagnostic. Overall, 20 of 50 cases were preceded by a dedicated adrenal CT or MRI examination to exclude an adenoma; in 21 of the remaining 30 cases, the imaging characteristics before biopsy were inconsistent with the potential diagnosis of an adenoma and dedicated adrenal CT or MRI was not recommended.Conclusion: The number of adrenal adenomas biopsied has declined markedly with the introduction of dedicated adrenal CT and MRI for adrenal adenomas. Percutaneous imaging-guided biopsy is useful in confirming the presence and nature of suspected metastatic deposits to the adrenal gland and in diagnosing or excluding adrenal adenomas in patients with equivocal imaging characteristics. Editorial CommentMost incidentally found adrenal masses are adenomas even in patients with known primary tumors.For this reason a well stablished radiologic work-up is currently used in this clinical setting. By using a dedicated