Bilateral renal pelvic stones with grade IV hydronephrosis

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Abdominal swelling and pain

Patient Data

Age: 25 years
Gender: Male

Marked enlargement of both kidneys with diffuse hypodensity, the right kidney measures 24 cm and the left kidney reaches 29 cm in length. Impacted stone at the pelvis of each kidney measuring 1.5 cm on right one and 4 cm on the left one. The tinned-out parenchyma between calyces are seen delineating shaped of markedly dilated calyces, confirming the presence of bilateral grade IV hydronephrosis.

Multiple small stones are seen at the middle and lower calyces of the left kidney.

Case Discussion

The patient didn't seek medical service for abdominal pain and bilateral loin pain and was on analgesics. On admission, abdominal distension raised the concern for bowel obstruction. On x-ray (not available), there was diffuse abdominal opacity and on ultrasound (not available), there were dilated water-filled structures along the abdomen that is connected to each other.

CT shows that the dilated water-filled structures are the markedly enlarged kidneys with thinned-out parenchyma due to bilateral renal pelvis obstruction by stones. The patient is expected to have high renal functions and was hospitalized.

Differential diagnosis is autosomal dominant polycystic kidney disease (ADPKD).

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