Thursday, August 26, 2010

Hutch diverticula of Bladder

A 73-year-old man presented to the emergency department after having intermittent fevers for 2 weeks. He had a history of recurrent urinary tract infections, parkinsonism, and a compression fracture at the L2 vertebra that was the result of a fall 2 years before presentation.
In addition, he had paraparesis and a neurogenic bladder, also subsequent to the fall. The results of physical and laboratory evaluation were notable for the identification of Pseudomonas aeruginosa in a blood culture and for a urinalysis showing more than 100 white cells per high-power field. He was treated with empirical antibiotics.

Intravenous urography showed no obstructive uropathy, but symmetric diverticula could be seen near both ureteral orifices (arrows). These lesions, known as Hutch diverticula, are usually congenital rather than occurring as a result of a neurogenic bladder or an infection or obstruction. They represented a new finding in this patient. Hutch diverticula are more commonly seen in men and boys and are usually unilateral and asymptomatic. After treatment with antibiotics, the patient's fever and pyuria subsided.
He declined any further evaluation or intervention. During the year after diagnosis, two more urinary tract infections developed.

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Pocket Atlas of Radiographic Anatomy

Despite the introduction of digital radiography, the process of obtaining and evaluating radiographic images has not changed significantly in recent years, nor has the importance of good knowlegde of the anatomic details of conventional radiographs. This book is a case in point. We were very pleased with the wide distribution of the first edition, which has been an additional incentive to improve a number of details, include even better images, replace some of the drawings, and include a few new radiographs. The structure of the second edition also srickly follows that of Normal Findings in Radiology and Pocket Atlas of Radiographic Positioning. Our intention in this is to present clearly and concisely each repective chapter of conventional diagnostic radiography and to avoid unnecessary repetition. At the same time, we give the reader the opportunity to examine different aspects of the same material with the same degree of clarity, which may prove important on another occasion. We have employed a consistent style and the same radiographys to structure the material and make it more readily accessible for reading, learning, or reference purposes.


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