Obstructive uropathy with delayed nephrogram

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Left renal colic.

Patient Data

Age: 45 years
Gender: Male
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Axial renal
excretory phase
This study is a stack
Coronal renal
excretory phase
This study is a stack
Sagittal renal
excretory phase
This study is a stack
CTU
3D-VR
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Info

Leftt kidney is moderately enlarged and shows:

  • mild to moderate hydronephrosis with ureteral dilatation up to the pelvic region where there is an ureteral stone obstructing the ureteral lumen
  • delayed cortical nephrogram well-demonstrated on excretory phase

Right kidney shows normal appearance with no renal or ureteral stone. Absent cortical nephrogram on excretory phase.

Diffuse hepatic steatosis is noted.

Annotated image
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Info

Annotated images showing the ureteral stone (red arrow) measuring 12 x 6 mm, mean density = 850 HU).

Case Discussion

CT Urogram features of left obstructive uropathy due to ureteral stone with delayed nephrogram.

The delayed nephrogram is characterized by nephrographic enhancement in the delayed or urographic phase which persists for a prolonged period of time.

Obstructive uropathy is the most common cause. Other causes include renal vein thrombosis, renal artery thrombosis and extrinsic compression (Page kidney).

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