. The American journal of roentgenology, radium therapy and nuclear medicine . onthat the stones are in the lower calyx. Theureter seemed to continue upward from the tip of the catheter without indicatingthe presence of a true pelvis, but uponresuming the injection we found that theureter bifurcated and that there werereally two pelves. Fig. 8 was made atthis point and demonstrates the furthervery important fact that, except for thepresence of the three stones, the pelvesand calyces are entirely normal. We nowhave, in addition to the positive diagnosis,the exact location, definite indication f
. The American journal of roentgenology, radium therapy and nuclear medicine . onthat the stones are in the lower calyx. Theureter seemed to continue upward from the tip of the catheter without indicatingthe presence of a true pelvis, but uponresuming the injection we found that theureter bifurcated and that there werereally two pelves. Fig. 8 was made atthis point and demonstrates the furthervery important fact that, except for thepresence of the three stones, the pelvesand calyces are entirely normal. We nowhave, in addition to the positive diagnosis,the exact location, definite indication forsurgical procedure, an explanation of theabnormal size, and a favorable 9 represents an unusual point indifferential diagnosis—a mass presented inthe right upper abdomen. It had aboutthe size, shape and firmness of a of the symptoms were related to thekidney, especially pain and tenderness inthe loin. With one hand on the abdomenand the other on the back the mass couldbe felt by both hands and it was ratherfreely movable. A definite shadow ap-. FiG. 8. Pyeloscopy 171 I eared on the roentgenogram, with a shapeSimilar to that of the lower pole of a kidney,but perhaps more dense. During the pye-loscopic examination the mass could bejfelt and its shadow could be seen on the(screen, so that with an opaque solution in he renal pelvis visualizing the kidney itwas possible to observe the mobility of themass in question and also that of the kid-ney pelvis. The kidney could not be dis- m ^ \ Fi. placed by palpation, whereas the masscould be moved more or less freely. It wasclearly on a plane anterior to that of thekidne^^; also it moved toward the medianline to such an extent that the outermostpoint of the kidney calyces appeared be-yond the mass. The last mentioned ob-servation is clearly demonstrated. Atoperation a pendulous and greatly dis-tended gall-bladder was found. This briefly is the course pursued inevery case that is suitable for pyelographicstud
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