elderly patient with abdominal lump and pain in the left lumbar region (chronic)
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Left kidney is grossly enlarged in size measuring 25X20cm. There is gross dilatation of left renal pelvis and calyceal system with a thinning of the renal cortex. The dilated left renal pelvis is even extending across the midline. Left ureter could not be visualised.Multiple thin incomplete parenchymal septae are seen in the left kidney. The renal cortex appears as hypoenhancing rim suggestive of rim sign.
The dilated left kidney is abutting, compressing and displacing the stomach and pancreas towards right side, transverse colon anteriorly and spleen more superiorly.
No obvious excretion of contrast seen.
Non-enhancing grossly hydronephrotic left kidney with dilated renal pelvis and severe thinning of renal cortex as described could be secondary to pelviureteric junction obstruction.
This patient came to the out patient department with moderate colicky abdominal pain since last 2 months with a history of gradually increasing in size abdominal lump.
Pateint had an x ray abdomen with him (very poor quality) that showed displaced fundic gas shadow displace towards right side.
An USG abdomen was advised to the patient which showed huge cystic structure with anechoic fluid and few internal septae and non visualization of left kidney, differential of hydronephrosis was made and patient was advised CT abdomen.
And finally we got this!! A mammoth non-functioning kidney ;)
Gross hydronephrosis is a rare urological entity in patients of all ages. The most common cause of gross hydronephrosis is ureteropelvic junction obstruction, but stone disease trauma, renal ectopy and ureteral tumor have also been reported.