Presentation
Left loin pain and heaviness for a long time. Ultrasound revealed left renal hilar cystic dilatation and CT was prompted.
Patient Data
Markedly dilated left renal pelvicalyceal system down to the PUJ where abrupt transition has been seen and hence no dilated caliber seen.
The left kidney shows relatively enlarged size (nephromegaly) with lobular contour and markedly reduced parenchyma (thinned out) as well as relatively attenuated left renal artery suggesting chronicity.
Poor/No contrast excretion of the left kidney suggesting a poor renal function.
Few tiny left renal calcifications/ gravels.
Other incidental findings; mild fatty liver, left small inguinal hernia, and colonic gaseous distension.
The arrow highlights the point of abrupt transition at the left renal pelvi-ureteric junction.
Case Discussion
Here is a case of a late presentation of PUJ obstruction. Abrupt caliber change at the PUJ, with significant obstruction and cortical thinning as well as the reduced caliber of the left renal artery, all denote chronicity.
The poor/no excretion from the left kidney with still preserved renal contrast concentration suggesting minimal residual function. A MAG-3 scan would clarify this.