. Roentgen interpretation; a manual for students and practitioners . lie close to the margin of the psoas and are crossed by the shadowsof the last two ribs. 192 GENITO-URINARY TRACT Changes in size of the kidneys are not diagnostic. The shadowmay have been distorted or enlarged by the size of patient or posi-tion of tube; or a kidney may be hypertrophied as a result of diseasein its fellow, while on the other hand, the shadow may be of normalsize but the kidney be badly damaged. Changes in shape are due to tumors, cysts, or infections andanatomical variations. They may be found in the pelvis,
. Roentgen interpretation; a manual for students and practitioners . lie close to the margin of the psoas and are crossed by the shadowsof the last two ribs. 192 GENITO-URINARY TRACT Changes in size of the kidneys are not diagnostic. The shadowmay have been distorted or enlarged by the size of patient or posi-tion of tube; or a kidney may be hypertrophied as a result of diseasein its fellow, while on the other hand, the shadow may be of normalsize but the kidney be badly damaged. Changes in shape are due to tumors, cysts, or infections andanatomical variations. They may be found in the pelvis, they mayfuse across the vertebrae, there may be only one kidney presentand an additional ureter may be attached to a Fig. 167.—Position and outline of normal kidneys, v/ith the patient standing. Changes in density will be found extremely luireliable in diag-nosis. While it is true that in rare eases tuberculosis of the kidneymay be suspected from the presence of a mottled shadow of increaseddensity, in general, mottling will be found to be due to intestinalcontents. The principal value of the roentgen examination liesin the detection of stone. In good hands, probably SO to 90 percent, of all kidney and ureteral (not bladder) stones will visibility depends upon the technic, preparation and size ofpatient and the composition and size of the stone. The first two THE KIDNEYS 193 factors may be controlled by repeated examinations and in regardto the last point, the order of visibility is as follows: phosphatesand cystine very dense, oxalates next and urates last, which havelittle if any greater density than that of the soft tissues. Stoneswhich lie in large inflamed kidneys may be so obscure
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