Calcified Areas in the Abdominal Cavity

Abstract

Calcification of an Intracapsular Renal Hematoma Case 1 (A126067). A man, aged 59 years, had sustained a severe accident while coasting, thirty years before. Several ribs were fractured, and it was believed that there were abdominal and spinal injuries. There was motor and sensory paralysis for the first three weeks, and loss of sphincteric control of the bladder and rectum for four or five days. He was in bed for three months, and had been able to work only about ten of the thirty years since the accident. Examination disclosed a large, hard mass in the left upper quadrant, apparently in the kidney. The X-ray (Fig. 1) revealed two stones in the right kidney and a large pear-shaped mass on the left side, from the eleventh rib to the crest of the ilium. Urologic investigation demonstrated that the left kidney was functionless; only a remnant of the pelvis remained, the kidney substance being almost entirely destroyed. A diagnosis was made of an intracapsular renal hematoma with calcification. Myocarditis was causing the patient considerable distress, and this, with the condition of the kidney, contra-indicated surgery. He returned home, and died seven months later; necropsy was not performed. Post-Typhoid Enlargement of the Spleen Case 2 (A198574). A man, aged 50 years, came to the Clinic with Bright's disease and marked edema of the legs. He had had typhoid fever four years before. Enlargement of the spleen had been noted during the attack of typhoid fever; there had been no noticeable change in its size since. At examination a large mass was palpated in the left abdomen, reaching from the level of the sixth rib anteriorly to the crest of the ilium. The Wassermann blood reaction was negative, and there was nothing in the history to suggest syphilitic infection. X-ray revealed a large calcified area on the left side (Fig. 2), and the urologic investigation proved this to be extrarenal. A clinical diagnosis was made of post-typhoid enlargement of the spleen; surgery was not advised. Post-Typhoid Lumbar Abscess Case 3 (A221665). A man, aged 32 years, had had typhoid fever six months before coming to the Clinic. In the sixth week he had had a severe nasal hemor-rhage, and two days later pain in the left side, with infection that necessitated rib resection and pleural drainage at the end of three weeks. The wound had continued to drain. X-ray examination disclosed slight fixation of the diaphragm at the costophrenic angle, probably due to adherent pleura. At operation an old encysted empyema with a small cavity, about 7 cm. in diameter, as found, but no extension could be felt or probed. Nine months later the patient returned and the X-ray (Fig. 3) revealed a large circumscribed calcified area on the left side, extending down to the upper level of the fourth lumbar vertebra. A pyelogram revealed an evident reduplication of the pelvis of the kidney; the area apparently was extrarenal.