Presentation
Right flank pain and hematuria.
Patient Data
Streak artefact from left total hip replacement.
Moderate right hydronephrosis and hydroureter to the level of the VUJ. There is moderate perirenal fat stranding and fluid and trace fluid in the right anterior pararenal space. No hyperdense renal or ureteric calculi. No bladder calculi. 3.3 cm right lower pole simple cyst. The 11 mm exophytic lesion in the left upper pole is smaller than the previous study.
Tiny gallbladder calculus. The remainder of the intra-abdominal and pelvic organs are unremarkable on non-contrast imaging. No free intraperitoneal fluid or gas.
Clear lung bases. Lumbar scoliosis. Grade 1 anterolisthesis of L4 on L5. No suspicious bony lesion.
Conclusion
Right hydronephrosis and hydroureter to the level of the VUJ, likely due to a calculus which has passed. A distal non-calcified calculus may also be responsible - I note the patient is HIV positive and indinavir (an anti-retroviral drug) is known to cause non-calcified crystalline calculi.
Moderate fat stranding in the right perirenal space raises the possibility of pyelonephritis.
Case Discussion
The patient was HIV positive and on indinavir (anti-retroviral). He subsequently passed a stone, with analysis confirming an indinavir stone.
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