Radiolucent Indinavir ureteric calculus

Case contributed by Dr Craig Hacking

Presentation

Right flank pain and haematuria

Patient Data

Age: 50-60
Gender: Male

Streak artefact from left total hip replacement.

Moderate right hydronephrosis and hydroureter to the level of the VUJ. There is moderate perirenal fat stranding and fluid and trace fluid in the right anterior pararenal space. No hyperdense renal or ureteric calculi. No bladder calculi. 3.3 cm right lower pole simple cyst. The 11 mm exophytic lesion in the left upper pole is smaller than the previous study.

Tiny gallbladder calculus. The remainder of the intra-abdominal and pelvic organs are unremarkable on non-contrast imaging. No free intraperitoneal fluid or gas.

Clear lung bases. Lumbar scoliosis. Grade 1 anterolisthesis of L4 on L5. No suspicious bony lesion.

Conclusion

Right hydronephrosis and hydroureter to the level of the VUJ, likely due to a calculus which has passed. A distal non calcified calculus may also be responsible - I note the patient is HIV positive and indinavir (anti-retroviral drug) is known to cause non-calcified calculi.

Moderate fat stranding in the right perirenal space raises the possibility of pyelonephritis.

Case Discussion

The patient was HIV positive and on indinavir. He subsequently passed a stone, with analysis confirming a indinavir stone.

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Case information

rID: 42036
Case created: 2nd Jan 2016
Last edited: 11th Jun 2017
System: Urogenital
Inclusion in quiz mode: Included

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