Abdominal Ultrasound

This investigation is essential in all patients. Relevant renal and hepatic pathology can be assessed as can splenic size. Simple renal cysts are common and increase with patient age, but unlike polycystic kidneys, are uncommon causes of erythrocy-tosis. Hydronephrosis and benign and malignant renal and hepatic tumors can also be ruled out on ultrasound. Further computed tomography (CT) scanning or arteriography may be necessary to define any abnormality found. Palpable splenomegaly in the absence of hepatic pathology is a reliable major criterion of PV, but splenic enlargement occurs before it is clinically palpable. Scanning techniques have shown that two-thirds of all patients with PV have splenic enlargement at diag-nosis,17,95 and radiological evidence of splenomegaly is therefore a minor diagnostic criterion for PV.

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