Metabolic Syndrome And Big Stomach

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Figure 4.25. The intravenous pyelogram in this infant shows a left-sided ureterovesical obstruction resulting in a left hydroureter and severe left hydronephrosis. The radiograph was taken 3 hours after injection of the dye. Note that the calyceal pattern on the right side is normal and the bladder is not very enlarged. Hydronephrosis in the newborn is most commonly due to obstruction at the bladder neck or at the ureterovesical junction. With the advent of ultrasonography, intravenous pyelograms now are rarely performed. (Singleton, E.)

Severe Gastric Distention

Figure 4.26. This infant with massive abdominal enlargement, especially on the right side, had congenital posterior urethral valves causing bilateral hydronephrosis and hydroureter, both more severe on the right side. Urethral atresia could give the same appearance of gross distention of the bladder, ureters, and kidneys.

Figure 4.26. This infant with massive abdominal enlargement, especially on the right side, had congenital posterior urethral valves causing bilateral hydronephrosis and hydroureter, both more severe on the right side. Urethral atresia could give the same appearance of gross distention of the bladder, ureters, and kidneys.

Congenital Posterior Urethral Valves

Figure 4.27. The intravenous pyelogram in this infant with congenital posterior urethral valves demonstrates bilateral hydronephrosis, bilateral hydroureters, and a large dilated bladder. Obstructions at the ureterovesical junction result in unilateral involvement of the ureter and kidney and a normal bladder, whereas obstruction in the urethra results in bilateral involvement of the ureters and kidneys and bladder enlargement. (Singleton, E.)

Figure 4.28. A cystogram in the same infant as in Figure 4.27 with posterior urethral valves shows extensive vesicoureteral reflux and bilateral hydroureter and hydronephrosis.

Figure 4.29. Lateral excretory contrast radiograph in an infant with posterior urethral valves. Note the markedly enlarged bladder and large dilated prostatic urethra proximal to the urethral valve. (Singleton, E.)

Congenital Posterior Urethral Valves

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Figure 4.30. This infant with urinary ascites had congenital posterior urethral valves. In the cystogram study note the traumatic rupture of the calyx with extravasation of dye from the renal pelvis. (Singleton, E.)

Congenital Posterior Urethral ValvesEnlarging Urethra

Figure 4.31. Autopsy specimen of the same infant as in Figure 4.30 with congenital posterior urethral valves. Note the urethral valves, enlarged bladder, bilateral hydroureter, and bilateral hydronephrosis.

Abdominal Wall Muscle Rupture

Figure 4.32. An infant with the prune belly syndrome (Eagle-Barrett syndrome; triad syndrome) shows the marked wrinkling of the skin and flaccid abdominal wall which bulges laterally as a result of lack of the underlying abdominal muscles. The triad of findings include absence of the abdominal muscles, urinary tract abnormalities, and cryptorchidism. The abdomen has a doughy consistency on palpation, and the abdominal viscera can be felt with unusual ease.

Figure 4.31. Autopsy specimen of the same infant as in Figure 4.30 with congenital posterior urethral valves. Note the urethral valves, enlarged bladder, bilateral hydroureter, and bilateral hydronephrosis.

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Prune Belly Syndrome

Figure 4.32. An infant with the prune belly syndrome (Eagle-Barrett syndrome; triad syndrome) shows the marked wrinkling of the skin and flaccid abdominal wall which bulges laterally as a result of lack of the underlying abdominal muscles. The triad of findings include absence of the abdominal muscles, urinary tract abnormalities, and cryptorchidism. The abdomen has a doughy consistency on palpation, and the abdominal viscera can be felt with unusual ease.

Figure 4.33. Another example of the prune belly syndrome showing the outlines of loops of bowel. The genitourinary tract findings are most frequently the result of obstruction of the distal urethra which causes marked dis-tention of the bladder, and the ureters are dilated and tortuous. Currently it is thought that the marked distention of the bladder and ureters and renal involvement result in the ablation of the abdominal muscles, especially the recti. The kidneys may be hypoplastic or severely hydronephrotic as a result of the obstruction.

Turner Syndrome Big Abdomen

Figure 4.34. Patent urachus in an infant with absence of the abdominal musculature. The urachus is a persistence of the embryologic tract between the fundus of the bladder and the allantoic sac. A patent urachus results from failure of the tract to close and should be suspected when there is urinary drainage through the umbilicus. This finding is not uncommon in the prune belly syndrome.

Figure 4.34. Patent urachus in an infant with absence of the abdominal musculature. The urachus is a persistence of the embryologic tract between the fundus of the bladder and the allantoic sac. A patent urachus results from failure of the tract to close and should be suspected when there is urinary drainage through the umbilicus. This finding is not uncommon in the prune belly syndrome.

Figure 4.35. Abdominal radiograph in an infant with the prune belly syndrome. Note the marked asymmetrical bulging of the flanks.

Figure 4.36. Autopsy specimen in an infant with the prune belly syndrome showing the marked bulging of the flanks, lack of abdominal muscles, and bilateral polycystic kidneys.

Figure 4.36. Autopsy specimen in an infant with the prune belly syndrome showing the marked bulging of the flanks, lack of abdominal muscles, and bilateral polycystic kidneys.

Caudal Regression Syndrome

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