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UROLOGY

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

Marked female preponderance


10% of patients are diabetic

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

CECT scan of the head


Cystic area in left cerebellum with enhancing
nodule and small cystic area in right cerebellum
Extensive calcification is seen in the right orbit

Axial post contrast T1W images of the posterior


fossa
Multiple enhancing nodules in cystic areas in right
and left cerebellum
Enhancing lesions in the right orbit.

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:

Retinal angiomas (40-50%)


Hemangioblastomas (40-80%)
Cerebellum (75% of hemangioblastomas in VHL)
Spinal cord (25% of hemangioblastomas in VHL)
Visceral cysts and neoplasms (50-70%)

Renal involvement shows multiple cortical cysts (most


common abdominal manifestation), renal cell
carcinoma and angioma (up to 40 %).

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

Primary biliary cirrhosis


Fibrosing mediastinitis
Glomerulonephritis
Panhypopituitarism
Rheumatoid arthritis
Ankylosing spondylitis
Polyarteritis nodosa
Systemic lupus erythematosus (SLE)
Hashimoto thyroiditis

Case 4
Secondary Retroperitoneal Fibrosis associated with
Drugs

Methysergide
Beta-adrenergic blockers
Lysergic acid diethylamide (LSD)
Methyldopa
Amphetamines
Phenacetin
Hydralazine
Cocaine

Desmoplastic response to malignancy


Lymphoma
Carcinoid
Retroperitoneal metastases (breast, lung, thyroid, GI tract, GU organs)

Retroperitoneal fluid collection as in trauma, surgery or


infection
Aneurysm of the aorta or iliac arteries (desmoplastic response)
Radiation therapy

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

CECT scan images of the pelvis


mild dilatation of the left distal ureter
with intraluminal filling defect

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