Hydronephrosis - investigation and treatment

Case contributed by Dr Ian Bickle

Presentation

Vague abdominal pain and generally under the weather.

Patient Data

Age: 70 years
Gender: Female

Moderate right hydronephrosis.

The renal cortex is well maintained.

Moderate right sided hydronephrosis secondary to a cystic para-aortic lesion with surrounding inflammatory change.

CT guided aspiration/biopsy requested by the clinicians.

CT

CT guided aspiration of para-aortic cystic lesion.  Lesion approached with the patient in the prone position.

CT guided aspiration peformed for cytological and microbiological analysis.

The smears and cell block contain abudant neurophils. No histocytes, giant cell cells or malignant cells.

Ziel Nielsen negative.

Conclusion: Inflammatory/Infective

Due to renal impairments and concerns over an infected renal tract a nephrostomy was requested.

Fluoroscopy

Lower pole puncture with subsequent percutaneous nephrostomy tube insertion.

Moderate nephrohydroureter with absolute obstruction in the proximal third of the ureter.

Case Discussion

A beautiful example of the multi-factorial role played by a modern clinical imaging department, in performing both non-invasive and invasive diagnostic procedures and assisting in treatment.

This patients hydronephrosis and so renal impairment was secondary to an abscess in the right para-aortic space, diagnosed with a CT guided aspiration and temporized with a percutaneous nephrostomy tube insertion.

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