Presentation
Hematuria and flank pain.
Patient Data
There is a 6 mm calculus in the proximal right ureter. The right kidney is enlarged with diffuse widespread areas of low attenuation/non-enhancement. A focal area of parenchyma hypoattenuation seems to represent a fluid collection with minimal peripheral enhancement. There is adjacent fat stranding. The right renal vein is hypodense, enlarged and has adjacent fat stranding. There is no hydronephrosis.
The left kidney, adrenals, spleen, pancreas and imaged liver are normal. Cholecystectomy with surgical clips noted. IDC and IUD are in situ. There is a trace of free fluid in the pelvis. There is no free intraperitoneal gas.
Conclusion: Findings are in keeping with an obstructed and infected right kidney with widespread poor perfusion, probable renal abscess and renal vein thrombosis. The lack of hydronephrosis suggests that the kidney has a minimal function.
Case Discussion
The calculus in the proximal right ureter has resulted in obstruction and secondary renal infection involving all of the organ.
E. coli was isolated from urine specimens.
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