DIFFERENTIAL DIAGNOSIS OF NEPHROLITHIASIS AND RENAL TUBERCULOSIS BY ROENTGENOGRAPHY
Journal of the American Medical Association
very considerable degree of efficiency. The fact that he lived and that his symptoms disappeared, would seem to do away with the possibility of neoplasm. The patient in Case 2 died. The only direct evidence we had that this was not neoplasm of the pons was the fact that the woman had very marked pallor in each disk; a retrobulbar condition which could not be explained by a pontine tumor. In Case 3 the man's symp¬ toms began as a retrobulbar neuritis with scotomas, pro¬ gressed to bilateral
... d to bilateral paresthesia in the hands and ended with a well-marked middorsal lesion in the spine. Dr. Bassoe asked concerning the frequency of optic neuritis in sclerosis. At some stage of the process, retrobulbar neurtis has been present in most cases to some degree ; but practically every case of advanced disseminated sclerosis shows a varying degree of pallor of the disks. That can only be brought about by degeneration of the macular bundle, and that degeneration is produced by an area of edema in the course of the optic nerve. This is true optic neuritis, and while Uhtoff says that 50 per cent, of the cases of disseminated sclerosis show optic neuritis, I wonder if he does not mean that in half of the cases of disseminated sclerosis is found temporal papillary pallor. Answering Dr. Graves' question as to the production of permanent blindness in disseminated sclerosis, owing to lack of time I was silent on that question. I state in the paper, however, that the first patient's visual progress, his complete blindness and the recovery of his sight afterward to a very considerable degree, is only a quantitative variation of the progress that I am accustomed to look for in severe cases of this disease. I think one may lay it down as a fact that permanent bilateral blindness does not occur as a result of disseminated sclerosis. The differential diagnosis of renal tuberculosis and lithiasis is, at present, in the great majority of cases easily accomplished by the trained urologist. The positive evidence obtained from a good roentgenogram establishes at once the diagnosis of calculus, and if in a cachectic individual with suspicious lung-symptoms a protracted and distressing pyuria exists, the diagnosis of renal tuberculosis can be ventured, though tubercle bacilli may not be traceable in the bladder\x=req-\ urine. Thus a correct recognition of both pathologic conditions is, in many instances, feasible by the general practitioner who has taken the pains to familiarize himself with the routine technic of modern urologic diagnostic methods. Roentgenography is at present justly recognized as the most important means of diagnosing renal calculus, and a satisfactory kidney-plate demonstrating one or more characteristic calculus shadows is now, especially since the more general use of the compression diaphragm, feasible even at the hands of the country practitioner. The risk, besides that, of overlooking or not recognizing concrement shadows can be considerably reduced by the repeated roentgenographic examination of patients with suspicious symp¬ toms of the upper urinary tract. It is, therefore not surprising that indications for operative procedures in alleged renal lithiasis are, in many quarters, based solely on positive plate-findings.