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South Med J. 1977 Mar;70(3):277-85.

Asymptomatic space-occupying lesions of the kidney: a programmed sequential approach and its impact on quality and cost of health care.


Sequential roentgenographic investigation of asymptomatic space-occupying lesions of the kidney is credited with establishing the diagnosis in 84.6% of 940 patients using only two examinations. Two thirds of all patients were diagnosed by relatively noninvasive technics such as infusion nephrotomogram, renal scintiscan, and the cyst puncture and aspiration test complex. Only for 2.3% was surgical exploration required to establish a diagnosis. The accuracy and confidence level of the diagnosis obtained by roentgenographic examinations (97%) compared well to that of surgical exploration (98%). Mortality and morbidity, however, were considerably reduced among patients examined according to the sequential roentgenographic protocol, as was the cost for diagnosis both in money and hospitalization time. The predominance of older patients in the group harboring asymptomatic space-occupying lesions of the kidney calls for an approach capable of establishing the diagnosis with acceptable confidence, but at a minimum cost in time, money, and complications. Our program of a systematized roentgenographic investigation of such lesions appears to provide a protocol capable of meeting these demands.

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