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13/10/2008
Case 1
50 year old female
Fever and left flank pain
Case 1
KUB
Large calculus overlying the region of the
left renal pelvis
Gross enlargement of the renal silhouette
CT
Enlarged left kidney with multiple lowattenuation masses
Soft tissue mass extending into left
perinephric and posterior paranephric
spaces
Ureteropelvic junction calculus
Incidental finding: gallstone
Case 1
Xanthogranulomatous pyelonephritis
Differential diagnosis:
Other chronic granulomatous infection
Tuberculosis
Fungal infection
Case 1
Chronic inflammatory process
Lipid-laden macrophages invade and
replace normal renal parenchyma
Seen in context of chronic urinary infection,
usually with calculi (thought to provoke
mild impairment of drainage)
Usual organisms
E. coli or Proteus mirabilis
Case 2
48 year old male
Case 2
NECT scan of the abdomen
Enlargement of both kidneys with multiple cysts,
ranging from 1 to 8 cm and scattered areas of
calcification
Case 2
von Hippel-Lindau syndrome
Case 2
von Hippel-Lindau syndrome is an autosomal
dominant disorder with incomplete penetrance, linked
with defect in short arm of chromosome 3.
Characterized by cysts, angiomas, and neoplasms of
CNS and abdominal viscera.
Common location and incidence:
Case 3
Acute onset right flank pain and
hematuria
Case 3
Wedge-shaped, cortically based,
hypodense area
Triangular in shape with widest part
at the cortex
Case 3
Renal infarct
Case 4
Backache
Case 4
Rind of soft tissue around aorta
Aorta not significantly anteriorly
displaced
Heterogeneous enhancement
Case 4
Retroperitoneal fibrosis
Case 4
Mass of whitish, dense, fibrous tissue
covering the aorta, vena cava, ureters,
and psoas muscles
Center of disease is usually located at
the level of the 4th or 5th lumbar
vertebra just at the aortic bifurcation
Relatively uncommon, more common
in males than in females
Predominantly patients aged 40-60
years
In almost 70% of patients, no cause is
found
Case 4
Primary or Idiopathic Retroperitoneal Fibrosis (RPF)
May be an autoimmune response to ceroid, an insoluble
lipid that can leak through a thinned arterial wall from
atherosclerotic plaques
Leads to a vasculitis
Also found in association with other fibrosing diseases
suggesting auto-immune mechanism
Case 4
Secondary Retroperitoneal Fibrosis associated with
Drugs
Methysergide
Beta-adrenergic blockers
Lysergic acid diethylamide (LSD)
Methyldopa
Amphetamines
Phenacetin
Hydralazine
Cocaine
Case 5
64 year old male with hematuria
Case 5
Retrograde pyelography of the left
ureter
mild dilatation of the left ureter with
large, multiple, smooth filling defects in
distal ureter
Case 5
Transitional cell carcinoma of the left
ureter
Differential diagnosis
stone
blood clot
fungal ball
sloughed papilla
pyeloureteritis cystica
Case 5
TCC is second most common
malignancy of the kidney. It occurs
most commonly in 5th to 7th
decades, with slight male
predominance.
Risk factors include smoking,
exposure to aniline dyes, and
phenacitin abuse.
Most frequent site is bladder followed
by ureter and collecting system.
Thank you
Peptic ulcer
Hamptons line
Porcelain gb
Sc anemia
Jones fracture
avm
Hemangioblasto
ma
Diff jpa