Interstate medical journal (1917) (14597123488)

Identifier: interstatemedica2419unse (find matches)

Title: Interstate medical journal

Year: 1917 (1910s)

Authors:

Subjects: Medicine

Publisher: St. Louis, : Interstate Medical Journal

Contributing Library: The College of Physicians of Philadelphia Historical Medical Library

Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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5. Multiple renal calculi usually vary in size and shape. Multiplebiliary calculi usually have relatively the same size and shape (Fig.10, 11). 6. In renal calculi the surfaces are usually rounded. In biliarycalculi the surfaces are usually faceted (Fig. 12, 13). 7. Renal calculi frequently are branching with irregularities con-forming to the pelvis and calices. Biliary calculi are never branch-ing, but do occasionally have flat surfaces (Fig. 10, 14). 8. Renal calculi seldom change their position between examina-tions. Biliary calculi frequently change their position between ex-aminations (Fig. 15, 16). I shall now present some of that small group of troublesome situa-tions where the differentiation of the two conditions is most diffi-cult, and where the differentiation cannot be made from the physicalcharacteristics. Subsequently I shall show how these can be differ-entiated. Occasionally when an examination of the right kidney is made Cole: Right Renal Lithiasis and Gall-Stone 949

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950 INTERSTATE MEDICAL JOURNAL and the kidney outline is distinctly shown, there will appear withinthe kidney shadow a sharply defined, rounded calculus, casting auniformly dense shadow of relatively small size (Fig. 17). Natu-rally one would be prone to make a diagnosis of renal calculuswithout much hesitation when confronted with such a strikingpicture, but this is where careful differentiation many times savesan embarrassing situation. I have only recently seen such a casewhere a diagnosis of renal calculus was made by another roentgen-ologist, and the diagnosis was subsequently established as gall-stone. Fortunately this patient was not operated before the correctdiagnosis was established. The reverse of the foregoing example might just as readily hap-pen. One may get good, crisp plates showing a sharply definedgall-bladder, and lying within this shadow the same type of dense,rounded calculus may be observed. Again, one must be carefulto assure himself that this is not a renal sto

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1917

The College of Physicians of Philadelphia and the National Endowment for the Humanities

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