Delayed nephrogram (IVP)

Case contributed by Matt A. Morgan


History of prostate cancer, post treatment (including external beam radiation). Recent history of bilateral urolithiasis. An attempt was made to retrieve a right-sided ureteral stone, but the urologists could not navigate past the distal ureter.

Patient Data

Age: 70 years
Gender: Male

In the initial scout image there is a normal gas pattern. A safety pin and a clip from prior prostate surgery overlie the pelvis. The patient has a history of urolithiasis, but no renal or ureteral calculi were detected on this radiograph.

On the IVP images (including obliques), intravenous contrast concentrates in the left kidney and then travels through the left collecting system normally. Contrast concentrates more slowly in the right kidney and there is no opacification of the right collecting system.

On the 20 min post-void image there is opacification of the right kidney (delayed nephrogram), still without any contrast in the collecting system, compatible with high-grade obstruction of the right collecting system.

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