Man With Renal Cell Carcinoma

Thursday, July 29, 2010 1 comments

This is a single cut from  CT series after intravenous contrast,of a 68 year old man who admitted to the surgery ward complaining of  Haematuria and Loin pain.He was hypertensive and pale.Renal cell carcinoma was confirmed in this patient.


What is the abnormality seen in this Contrast CT image?

ANSWER

The Correct Answer is Invasion of the IVC by Renal Cell Carcinoma
This single cut from a CT series after intravenous contrast (given into a lower limb vein) shows opacification of spinal and pre-vertebral veins (immediately behind the aorta). The density of a renogram shows the site of the left kidney. The inferior vena cava opacification is incomplete, outlining a soft tissue mass in the vein and decreasing the effective lumen by at least 75%.

Male with Diabetes Mellitus

Monday, July 19, 2010 0 comments

This is the Pelvic Xray of a 56 year old patent who has been having poorly controlled Diabetes Mellitus about for 8 years.


Identify this X- ray?


ANSWER

The Correct Answer is CALCIFIED VAS DEFERENS in the left side

Diabetes and TB are the two common causes of calcification of the vas deferens. Diabetes tends to cause bilateral, symmetrical, non-obstructing calcifications in the muscle part of the vas, while TB tends to cause unilateral, irregular calcifications.

Other causes include infections like gonorrhea and syphilis as well as chronic urinary tract infections.

This is an intravenous urogram of a 27 years old white male with a 3 month history of dysuria and bilateral loin pain.He did not have either haematuria or obstructive lowerurinary tract symptoms.On examination of this patient he had bilateral renal angle tenderness and tenderness over the suprapubic area. 

Identify the abnormality in this IVU?

ANSWER

Correct Answer is Bilateral Ureterocoeles
Clinical history is suggestive of pyelonephritis.
The kidneys pelvicalyceal systems and proximal ureters appear grossly normal, renal pelvis and calyces are dialted indicating bilateral mild hydronephrosis, implying the possibility of obstruction.(mild left sided hydronephrosis).Both ureters are normal calibre.The lower ends of the ureters cross the bladder wall towards the trigone, but are dilated at their lower end.(cobra head sign) The contrast in the lower end of the ureter is surrounded by a zone of contrast free space within the density of the bladder.

This is a micturating cystogram of a 8 months old male infant who was brought to the paediatric ward by the mother complaining of high fever which was lasting about 1week associated with excessive crying when micturates,freaquency,vomiting and decreased oral intake.On physical examination, tenderness in the costovertebral angle and suprapubic tenderness was elicited.Full blood count and Urine full report revealed UTI.


What would be the possible diagnosis in this infant?

ANSWER

The Correct Answer - This 8 months old male infant is having urinary tract infection secondary to posterior urethral valve

Micturating cystogram shows that visible bladder base tapers towards the prostatic urethra which abruptly dilates. The dilatation is non-uniform and shows the dual crescentic shadows from the contrast held back by the folds of the valves. These overlap the membranous urethra. Beyond the external sphincter, the calibre is normal.

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