A rare but important case of mine.
Without any further explanation: what do you think?
this is a KUB and not a contrast IVP so i do not think this is TB. bilateral full staghorn stone.
I would definitely want to see a CT scan, and probably a nuclear medicine scan as well, to determine function. Is the patient's renal function normal? TB is still a possibility, but this may be just be bad infection related stone. I would also consider anatrophic nephrolithotomy, which would permit infundibulopelvoplasties to improve drainage from the calices. PCNL still the treatment of choice, depending upon CT scan.
Its bilateral stag-horn calculi, infected with gas forming organism. There is gas in the calyxes. Patient may be diabetic. Need to know general condition of the patient.
Thank to all colleagues trying to find the Dx.
Stone is clearly visible, but as one of the colleagues( Dinanath) mentioned, It has gas in the Upper tract.
Can you find more?
Nice! There is clearly gas in the calices. I confess I am spoiled by CT. Xanthogranulomatous pyelonephritis? Is the patient still alive?
There is bilateral stag horn stones -mud- and emphysematous pyelonephritis .
What do you find more than Bilateral Staghorn and Bilateral Emphysematus Pyelonephritis ?
An opacity in the line of right ureter at S1. The lie is not exactly that of ureteral stone. Yet in all probability it is.
I suppose that this could be a case of a bilateral colo-renal fistula probably secondary to the nephrolithiasis. Isn't it dr Sina?
Dear Luca,
Bilateral fistula without any surgery(stones are intact) seems very rare. َindeed you can find gas in the bladder( in a circumferential shape). What do you think now?
Dear Sina, the case is fascinating and exiciting. With a lot of creativity I can also suppose a fistula between bladder and bowel with a urofecal mixture and proliferation of gas producers bacteria.... but probably the best way to solve this case is to examine the patient and receive more clinical details....
Dear Luca, this is a new case without any surgery and any prominent medical problem, except DM and his presenting disease. Think about it as a whole.
Dear colleagues
The diagnosis is Bilateral Emphysematus pyelonephritis+Emphysematus Cystitis+Bilateral Staghorn
This is a very rare case(less than 10cases reported).
I think it is bilateral staghorn stone with gas producing organism (empesematous pyelonephritis),otherwise debeletating patient.
Interesting case! Bravo Sina! Thank you for the challenging case. Something about the approach used from you?
Dear Luca and Sini,
Diabetes + staghorn stones is the ideal environment for Xanthogranulomatous pyelonephritis as well. So in any case my question is similar to Lucas', what was the intervention and if the patient is still alive?
Dear Luca and Petros
After a few days of medical treatment under close observation, he underwent Bilateral DJ insertion,then after 2 weeks of medical treatment, Bilateral Anatrophic Nephrolithotomy one by one.
He is now alive.
Honourable Colleague
On Your excellent Xray picture could it be possible that this poor boy has a spina bifida from L1/L5? Otherwise seldom but possible an extravesical ureter at the vesiculae seminalis or simple below the typical location.. On both sides a percutaneus urune derivation from ectatic pelvis gives You enough time to rfuther
diagnosis
All teh Best
Your Hainz
Dear colleague
would you check for the possibility of Renal Tubular Acidosis in this this patient, the multiple bilateral renal stones strongly suggest an underlying metabolic disorder ( a hallmark of rapid recurrence if not corrected).
being densely opaque makes RTA highly posssible.
all the best
D.hawary
it is bilateral staghorn stone with empesematous pyelonephritis!
2 open nephrolithotomy were performed after stenting? Why did not fulfill PNL?
What urine culture?
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases