A Further Study in Normal Pyelograms and the Value of Bilateral Simultaneous Pyelography

Abstract

AT the 1925 meeting of this Society we directed attention to the many variations in normal pyelograms. We divided those which we had observed into three groups: (a) ampullary; (b) bifid, and (c) a third to which we proposed applying the name “pseudospider,” because they resembled closely the “spider” deformity so often seen in pyelograms from cases of renal neoplasm. Since reading this paper we have had the opportunity to verify the convenience of retaining the above three groups. In to-day's contribution we add some unusual examples of the ampullary and bifid types. We referred briefly in our first paper to the value of bilateral ureteropyelography and described our technic. Since that time we have had abundant opportunity to see the many advantages and test the freedom from danger of such a method. We will refer to these matters later. As a third instructive experience during the past year we wish to call attention to the role which is played by contractions of the musculature of the renal pelvis and its calyces and of insufficient distention in the production of apparent deformities even in normal pyelograms. Let us now take these up in the order named. Additional Observations on the Three Previously Cited Groups of Normal Pyelograms 1. Ampullary type.—This is by far the most common of the three groups or types. One can find all degrees of variation, both in the size of the pelvis proper and in the size, mode of origin, etc., of the major calyces. There may be an almost rudimentary condition of the major calyces, as shown in Figure 1. There may be a difference between the pelves of the two sides, as shown in Figure 2, where one fails to see an inferior major calyx on the right side but can observe a relatively large pelvis proper and a very well developed wide-necked superior major calyx. On the opposite (left) side the pelvis proper and all of the calyces are extremely narrow. In Figure 3 we note the same type of pelvis on both sides, i.e., ampullary with very long major calyces, especially the superior. On the right side the pelvis proper is vertical while on the left side it is almost horizontal. 2. Bifid type.—We have encountered an unusual example of this group, as can be observed in Figure 4. The two chief divisions unite, close to the point of origin of the ureter. The upper pelvis has a well defined superior and a rudimentary inferior major calyx. The lower pelvis has both superior and inferior major calyces and also a rudimentary middle one arising from the superior. One can readily understand such a case by comparison with Figure 6 of our previous paper, in which the evolution of the bifid pelvis from the one with a long superior calyx can be seen.