The Röntgenographic diagnosis of gall-stones and cholecystitis / by Lewis Gregory Cole.

  • Cole, Lewis Gregory, 1874-1954.
Date:
1914
Catalogue details

Licence: In copyright

Credit: The Röntgenographic diagnosis of gall-stones and cholecystitis / by Lewis Gregory Cole. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    gas, or air artificially injected into the colon, will accentuate the stone in a remarkable manner. The organs surrounding it are rela- tively dense to the X-rays. There are stones which are no more opacjue to the rays than the tissue which surrounds them, and there are others which are as opaque as the densest renal calculus. Between these two extremes are stones of all degrees of density. The techniciue above described will enable one to detect a relatively large jiercentage of biliary calculi. Dijferentiation between biliary and renal calculi. The differential diagnosis of biliary calcuh from right renal calculi is of great im- portance, and should be carefully made in every case presenting a stone in this region. The following points will aid in identification: First. Biliary calculi show more distinctly and appear smaller when the plate is placed on the abdomen than when the plate is placed on the back. The opposite is true of renal calculi. When the biliary calculi is well back in the cystic duct, this variation of size is not so great as when it is in the gall-bladder. In such cases it is wise to place a small triangular marker on the abdominal wall and make two exposures, either on the same plate or on different plates, shifting the tube five inches between the exposures. Where two plates are used, match the shadows of the lead marker and measure the distance between the two shadows of the gall-stone. In order to deter- mine with accuracy whether the shadow is nearer the anterior or posterior wall of the abdomen, repeat the above process with the plate posterior, and compare the distance between the shadows. 7Y determine distance of calculus from abdominal wall. By measuring the distances of the tube from the plate, and how far the tube is shifted between the exposures, the old principle of localizing foreign bodies described may be apifiied to find the distance of the calculus from the anterior abdominal wall. Let A^^O = plane of the two positions of the tube. C and Z) = two positions of the tube. CD =s, distance between the positions of the tube. LM = plate, parallel to plane NO. X = shadow of marker on plate. .4 = shadow of stone when tube is at D. B = shadow of stone when tube is at C. EX = 20. To find .YT;— By measurement AB is found to be i. .-. .iX =K. CD =5. .-. DE zyi. Lay off FX equal to EC. A BFC and A BXY are right-angled A’s. and have a common acute < BCF. The sides of right-angled triangles having a common acute angle have the same ratio. •. FB ; FC XB : XY, or 3 : 20 YF' : AT' YF = 3>^. O. K. D. Second. The second differential point is the ring-hke shadow cast by a biliary calculus when there is a calcareous coating to a cholesterin nucleus. Renal calculi seldom if ever have this appearance. Third. When three or more biliary calculi are present they are likely to have faceted surfaces, which are readily recognized rontgen- ographically. If more than one renal calculus is present one is usually larger than the others, and the group frequently has the appearance of a large, branching phosphatic calculus. Fourth. INIoving the tube from side to side alters the relation of a biliary calculus to the kidney, but it does not alter the relation of a renal calculus to the kidney.