Pyonephrosis, stones and intervention

Case contributed by Dr Ian Bickle

Presentation

Renal stone disease, with recent right ureteric calculus and pyonephrosis

Patient Data

Age: 45
Gender: Male
Modality: Ultrasound

Right kidney showing a moderate-severe hydronephrosis. 

Left kidney with staghorn calculus with intense posterior acoustic shadowing.

 

Modality: CT

Left sided staghorn calculus. Right sided multiple small renal stones and a stone in the proximal urter, causing mild upstream obstructive changes. 

Modality: Fluoroscopy
Lower pole puncture - thick frank pus within the collecting system
Modality: X-ray

Severe right hydrophrosis on prior ultrasound.

Case Discussion

Patient with known nephrolithiasis.  Presented with right sided renal colic and fever.

Initial plain film shows bilateral renal calculi.  CT-KUB bilateral renal stone disease and hydronephrosis.  On ultrasound the right sided hydronephrosis is illustrated and left staghorn calculus. 

Percutaneous nephrostomy performed, which identified a pyonephrosis.

Subsequent to this ureteroscopy and stone removal performed and placement of a retrograde ureteric stent.

The final plain abdominal radiograph shows a feft staghorn calculus, right sided percutaneous nephrostomy and ureteric stent.

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Case Information

rID: 21111
Case created: 5th Jan 2013
Last edited: 20th Mar 2017
Inclusion in quiz mode: Included

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