Case 10 :
A 56-year-old male, known hypertensive and diabetic (known case of chronic renal failure, with previous ultrasound showing features suggestive of chronic medical renal disease, and bilateral small renal calculi) presents with anuria since 2 days. CT scan is performed. What is the diagnosis?
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Imaging Findings

Study shows bilaterally hydronephrotic kidneys with dilated pelvis, and peri-renal fat stranding. Both ureters are dilated, and show upper ureteric calculi.


Since the patient was a known diabetic/ hypertensive, with previous ultrasound showing bilateral medical renal disease, a high BUN/ Creat and anuria was thought to be due to the latter itself. US scan was postponed and performed only after a day, which showed no renal stones, and dilated ureters.


Spiral CT is now the examination of choice for the patient with typical renal colic. Five mm thick cuts are obtained from top of the kidneys to the bladder base. Definitive findings are hydronephrosis and hydroureter, to the point of the obstructing stone readily visible on CT. Supportive but non-diagnostic finding is perinephric stranding. Diagnostic accuracy is well above 95%. In addition, in 10% of the patients another cause for acute pain is discovered, unrelated to the urinary tract, such as appendicitis, diverticulitis, ruptured aortic aneurysm, dissecting aortic aneurysm, etc. The examination is quick and painless.

Ultrasound and X-ray KUB combination has a high detection rate, but a calculus may be missed on a radiograph in 34%. An ultrasound may also not always detect a calculus, and the diagnosis may be made only on the presence of hydronephrosis and hydroureter. A spiral CT thus obviates the need for an IVP.

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Dr. Rahul Sachdev, BR Diagnostics, New Delhi