| BACKGROUND: The clinical manifestations of pulmonary thromboembolism are non-specific, which makes this condition difficult to diagnose. A case of helical computerized tomography angiographically documented pulmonary thromboembolism, which initially presented as upper abdominal and flank pain, is described. CASE REPORT: A 46-year-old woman was referred to the emergency department for left flank and upper abdominal pain with diaphoresis and nausea. Her history included rheumatoid arthritis 3 years previously. During her examination the only abnormal finding was abdominal tenderness at the right upper quadrant and a positive Murphy sign without other systemic signs. A chest radiograph demonstrated an atelectatic line at the left lung base. The alveolar-arterial gradient was increased, and a ventilation-perfusion scan revealed a mismatch at the left upper and lower lobes, indicative of pulmonary thromboembolism. Helical computerized tomography angiography revealed filling defects on that side. The patient received anticoagulant therapy and gradually improved. CONCLUSION: The pathogenesis of the pain in the flank and upper abdomen is not known in this case. Unexplained upper abdomen and flank pain in a patient with risk factors for pulmonary thromboembolism, such as rheumatoid arthritis, should be investigated to rule out this treatable but potentially fatal condition. ( info) |
12/34. adult Wilms' tumor mimicking hemorrhagic renal cyst. A 36-year-old man presented with macroscopic hematuria associated with right flank pain. Examination of the patient revealed a cystic mass in the right kidney. Because the mass had increased in size, enucleation of the mass was performed. Histopathological findings revealed nephroblastoma, therefore, radical nephrectomy was performed. We believe the pathogenesis of the cystic formation to be a process in which a tumor that had developed in the pericalyceal region spontaneously ruptured, exuding urine into the perinephric space, forming a cystic mass. The patient is alive with no evidence of disease 24 months after the operation. ( info) |
13/34. Nephron-sparing surgery for multilocular cyst of the kidney in a child. Multilocular cyst of the kidney is an uncommon benign renal neoplasm. Because of its benign nature, this lesion is best managed by nephron-sparing surgery. This report describes a child who underwent a partial nephrectomy for a multilocular cyst of the kidney. After reviewing other cases, we discuss the clinical characteristics of multilocular cyst of the kidney and emphasize the cystic partially differentiated nephroblastoma as a differential diagnosis. ( info) |
14/34. A young man with a renal colic. We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension. ( info) |
15/34. Loin pain hematuria syndrome: case series. Loin pain hematuria syndrome (LPHS) is a rare condition manifested by flank pain, hematuria, and occasional low-grade fevers. Usually there are no physical findings other than hematuria. Although numerous etiological theories exist, the pathophysiology of LPHS is unknown and diagnosis remains one of exclusion. Renal autotransplantation has been suggested as an effective procedure to control the severe and debilitating pain. However, pain often recurs in the long term. This paper reviews our experiences with the diagnosis and management of this condition. ( info) |
16/34. Laparoscopic ureterolysis and reconstruction of a retrocaval ureter. A 32-year-old man was investigated for repeated episodes of right-sided flank pain. ultrasonography showed a dilated right pelvicalyceal system and upper ureter as well as multiple gallstones; subsequent intravenous urogram demonstrated a retrocaval ureter. At surgery, a right-sided double-J ureteric stent was placed under fluoroscopic guidance. Initially, three laparoscopic ports were used. The dilated pelvis and upper ureter were mobilized, followed by the lower ureter. The pelvis was transected and transposed anterior to the inferior vena cava. Reconstruction was carried out with an intracorporeally sutured anastomosis over the double-J stent. A fourth port was added for completion of cholecystectomy. The patient had an uneventful recovery and was discharged on the third day. Fourteen months later he remains well, with a recent intravenous urogram showing regression of hydronephrosis. We review the previously reported cases of laparoscopic and retroperitoneoscopic reconstruction of retrocaval ureter to compare and contrast these minimal access approaches. ( info) |
17/34. Correlation of radiological and clinical features of metanephric neoplasms in adults. The main objective was to determine the clinical and radiological features of metanephric neoplasms. The tumors were diagnosed on histopathological examination. The clinical data and imaging features were retrospectively analyzed. Between 1998 and 2003, 3 patients underwent radical nephrectomy for renal masses turning out as metanephric neoplasms on histopathology. Two of these tumors were metanephric adenoma (MA) and one was metanephric adenofibroma (MAF). Clinical and radiological features were reviewed. All patients were adult females who presented with flank pain. Tumor was detected on screening ultrasound as a hyperechoic lesion. In all cases CT showed a hyper-attenuating exophytic lesion with cystic areas that enhanced with IV contrast. Based on combination of clinical and imaging features it may be possible to prospectively identify metanephric neoplasms and thus avoid unnecessary radical nephrectomy in favor of conservative surgery. ( info) |
18/34. Laparoscopic pyeloplasty with simultaneous pyelolithotomy using a flexible ureteroscope. Laparoscopic pyeloplasty is rapidly becoming the gold standard in the repair of adults with uretero-pelvic junction obstruction. Renal calculi are a recognized complication of uretero-pelvic junction obstruction and their presence has often been used to justify percutaneous nephrolithotomy and endopyelotomy as primary treatment. Stones developing secondary to uretero-pelvic junction obstruction have been removed through simultaneous laparoscopic pyeloplasty and pyelolithotomy, but with rigid laparoscopic instruments access is limited to the renal pelvis. As exemplified within this report, endourologic techniques such as flexible ureteroscopy can be combined with laparoscopic pyeloplasty to deal with complex stone disease and to provide optimal treatment of the patient with a uretero-pelvic junction obstruction. ( info) |
19/34. Sporadic angiomyolipomas of the kidneys silent and symptomatic: a report of three CT-scan diagnosed cases. Three cases of sporadic angiomyolipomas (AML) of the kidneys presented to the department of radiology faculty of medicine. Two of them presented with sudden onset of flank pain and gross hematuria and the other was asymptomatic. They had Ultrasound (US), Computerised tomography (CT) scans with and with out intravenous urography (IVU). CT findings were diagnostic and correlated with the final histological diagnoses. The epidemiological and clinical features. US and CT findings, and the histology of this unusual case are briefly discussed. ( info) |
20/34. Recurrent flank pain caused by eosinophilic ureteritis mimicking urinary stone disease: a case report. flank pain is caused by a variety of pathologies of which urinary stone disease is the most frequent. Eosinophilic ureteritis is a rare stenosing condition of the ureter. Eosinophilic ureteritis can cause flank pain and/or unilateral hydronephrosis. On pathological examination it is characterised by a marked infiltration of the submucosal layers by eosinophils. A relationship of this condition with atopy, hypereosinophilic syndrome and prior ureteral trauma has been described. Surgical resection of the stenosing segment with end-to-end anastomosis is usually a successful treatment. In some cases of proximal disease total nephro-ureterectomy has been performed. One author describes remission of disease after a prolonged oral corticosteroid regimen. In this article we report another case of eosinophilic ureteritis and discuss different treatment strategies. ( info) |