Picture quiz: renal impairment
BMJ 2003; 327 doi: https://doi.org/10.1136/sbmj.0307235 (Published 01 July 2003) Cite this as: BMJ 2003;327:0307235
- Menelaos Philippou, final year medical student1,
- Richard Napier-Hemy, consultant urologist2
- 1University of Manchester
- 2Manchester Royal Infirmary, Manchester
A 68 year old man with renal impairment was referred to a urology department. He had traces of blood and protein in his urine. He was clinically well and the examination was unremarkable.
The radiographs in figs 1, 2, and 3 were taken.
Questions
What are the investigations shown in figs 1 and 2?
What abnormality is seen in figs 1 and 2?
Fig 3 is an oblique view of the above investigation. What can you see?
Answers
Fig 1 shows kidneys, ureters, and bladder film (KUB); fig 2 shows an intravenous urogram (IVU).
Fig 1 shows a radio-opaque mass at the level of the left proximal ureter. Whether the mass is in the ureter or overlying it is not clear. Fig 2 shows the same radio-opaque mass in addition to the outline of the renal tract. The left renal tract proximal to the mass appears to be dilated.
The oblique view shows an mass 8 mm across in the left ureter causing partial obstruction. The calcified mass seen above is a mesenteric lymph node overlying the ureter.
From left to right: Fig1, Fig2 & Fig3.
Discussion
Renal stone disease has been affecting human beings for as long as records exist, and, in fact, much of the early history of surgery deals with stone disease and its disastrous consequences. The Hippocratic …
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