Management of Unilateral Chronic Pyelonephritis

finding 97% agreement between ultrasound traces and proof puncture, and 86% between radiographic appearances and poof puncture (Jannert et al. 1981), and it was concluded that ultrasound was the prime screening procedure. In the only British study, which again compared all three, the correlation between ultrasound traces and radiographs was confirmed (Pfleiderer et al. 1985). However, fluid was present in only 30% of patients in whom both radiographs and ultrasound traces were abnormal. Ultrasound examination produced a significant number of false-positives, which had not been revealed in previous studies. At best, ultrasound was only reliable in detecting the normal antrum though not significantly better than radiography. Serious doubts have now been raised concerning ultrasound's diagnostic reliability. It has not yet been shown to be an acceptable alternative to radiography for diagnostic screening in patients with chronic sinus disease. X-rays are still the screening method of choice and when a fluid level is seen or the sinuses are completely opaque, lavage is indicated; however, the presence of mucosal thickening rarely yields fluid (Hinde 1950, Pfleiderer et al. 1985), and proof puncture is seldom required. A G Pfleiderer Surgical Registrar Royal National Throat, Nose & Ear Hospital, London WCJ