MedPix® Patient Chart - Case No: 2304 :: Imaging - Review Images

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History

Age: 56 :: Gender: woman

Patient History

The patient is a 56 year-old woman who has had 20+ episodes of pyelonephritis throughout her adulthood requiring both IV and oral antibiotics on varying occasions. She was most recently treated as an outpatient 1 week ago, but presents now with recurrent frequency and urgency.

Exam


Physical Exam and Laboratory

Right costo-vertebral angle tenderness.

UA at the time of exam:    pH - 6.5      
   Prot – negative   
   Glu – negative
   Ket – negative   
   Blood – high      
   Nitrite – negative   
   LE – 2+      
   WBC – TNTC      
   RBCs – 5

Urine culture:   Pending but culture 1 month prior demonstrated lactose fermenting Gram negative rods c/w Citrobacter freundi


Imaging

Imaging - Review Images for PT: 2304

Findings


Summary of Findings

• Simple right ureterocele
• Partial obstruction of the lower pole of the right kidney
• Bilateral duplex kidneys and double ureters


Imaging

Imaging - Review Images for PT: 2304

Diffferential


Differential Diagnosis

Duplicated Renal Collecting System


Imaging

Imaging - Review Images for PT: 2304

Diagnosis


Case Diagnosis

Dx: Ureter, Duplicated, Bilateral


Dx Confirmed by: Imaging

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History:
The patient is a 56 year-old woman who has had 20+ episodes of pyelonephritis throughout her adulthood requiring both IV and oral antibiotics on varying occasions. She was most recently treated as an outpatient 1 week ago, but presents now with recurrent frequency and urgency.

Exam:
Right costo-vertebral angle tenderness.

UA at the time of exam:    pH - 6.5      
   Prot – negative   
   Glu – negative
   Ket – negative   
   Blood – high      
   Nitrite – negative   
   LE – 2+      
   WBC – TNTC      
   RBCs – 5

Urine culture:   Pending but culture 1 month prior demonstrated lactose fermenting Gram negative rods c/w Citrobacter freundi

Findings:
• Simple right ureterocele
• Partial obstruction of the lower pole of the right kidney
• Bilateral duplex kidneys and double ureters


Differential:
Duplicated Renal Collecting System

Diagnosis:
Ureter, Duplicated, Bilateral
Confirmed by:Imaging

Treatment and Followup:


Discussion:

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Submitted by: MS-4 USU Teaching File - Author Info
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