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Severe calculus induced hydroureteronephrosis
Visual Journal of Emergency Medicine 10 (2018) 13–14
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Severe calculus induced hydroureteronephrosis a,⁎
b
Joseph Pileggi , Noah May , Spencer Fogelman a b
MARK
a
DeBusk College of Osteopathic Medicine, Harrogate, TN, United States Mercy Catholic Medical Center, Darby, PA, United States
A R T I C L E I N F O Keywords: Calculi Hydroureteronephrosis Urology
A 48 year old male presented to ED with right lower quadrant abdominal pain for the last 12 h. He states the pain radiates to his back. He has a history of hypertension and kidney stones. He denies drug or alcohol use. On examination, all vital signs are normal. Tenderness was noted upon palpation of the right lower quadrant. McBurney's point is tender, but there is no rebound or guarding. Urinalysis shows 3–5 RBC's. CBC
shows a WBC of 11.9, 13% lymphocytes, and 8.5% neutrophils. CT of abdomen shows a 17 × 11 × 10 mm obstructing calculus within the proximal to mid right ureter causing severe right-sided hydroureteronephrosis. There is moderate right sided perinephric fat stranding which may represent urine extravasation or superimposed infection (Figs. 1 and 2).
Fig. 1. Severe right-sided hydroureteronephrosis.
⁎
Corresponding author. E-mail address: [email protected] (J. Pileggi).
http://dx.doi.org/10.1016/j.visj.2017.08.021 Received 14 July 2017; Accepted 24 August 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 10 (2018) 13–14
J. Pileggi et al.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2017.08.021. Reference 1. Worcester EM, Coe FL. Nephrolithiasis. Prim Care. 2008;35(2):369–391 [vii].
Questions 1. What is the most prominent component of most stones? a. Calcium phosphate b. Calcium oxalate c. Uric acid d. Cystine e. Struvite 2. Struvite stones form when the urinary tract is infected with organisms that produce what enzyme? a. Urease b. Hyaluronidase c. Kinase d. Coagulase 3. Stones smaller than what size will generally pass? a. 2 mm b. 3 mm c. 4 mm d. 5 mm Answers 1. Calcium oxalate. Explanation: Calcium oxalate is the prominent component is most stones, either in the monohydrate or dihydrate form. It is often mixed with calcium phosphate.1 2. Urease. Explanation: Struvite stones are composed of magnesium ammonium phosphate and carbonate apatite. They are formed when microorganisms such as Proteus, Providencia, and occasionally Klebsiella, Pseudomonas and enterococci.1 3. 5 mm. Explanation: Stones smaller than 5 mm usually pass on their own. Larger stones may require surgical intervention. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518455/
Fig. 2. Obstructing calculus.
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Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Severe calculus induced hydroureteronephrosis a,⁎
b
Joseph Pileggi , Noah May , Spencer Fogelman a b
MARK
a
DeBusk College of Osteopathic Medicine, Harrogate, TN, United States Mercy Catholic Medical Center, Darby, PA, United States
A R T I C L E I N F O Keywords: Calculi Hydroureteronephrosis Urology
A 48 year old male presented to ED with right lower quadrant abdominal pain for the last 12 h. He states the pain radiates to his back. He has a history of hypertension and kidney stones. He denies drug or alcohol use. On examination, all vital signs are normal. Tenderness was noted upon palpation of the right lower quadrant. McBurney's point is tender, but there is no rebound or guarding. Urinalysis shows 3–5 RBC's. CBC
shows a WBC of 11.9, 13% lymphocytes, and 8.5% neutrophils. CT of abdomen shows a 17 × 11 × 10 mm obstructing calculus within the proximal to mid right ureter causing severe right-sided hydroureteronephrosis. There is moderate right sided perinephric fat stranding which may represent urine extravasation or superimposed infection (Figs. 1 and 2).
Fig. 1. Severe right-sided hydroureteronephrosis.
⁎
Corresponding author. E-mail address: [email protected] (J. Pileggi).
http://dx.doi.org/10.1016/j.visj.2017.08.021 Received 14 July 2017; Accepted 24 August 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 10 (2018) 13–14
J. Pileggi et al.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2017.08.021. Reference 1. Worcester EM, Coe FL. Nephrolithiasis. Prim Care. 2008;35(2):369–391 [vii].
Questions 1. What is the most prominent component of most stones? a. Calcium phosphate b. Calcium oxalate c. Uric acid d. Cystine e. Struvite 2. Struvite stones form when the urinary tract is infected with organisms that produce what enzyme? a. Urease b. Hyaluronidase c. Kinase d. Coagulase 3. Stones smaller than what size will generally pass? a. 2 mm b. 3 mm c. 4 mm d. 5 mm Answers 1. Calcium oxalate. Explanation: Calcium oxalate is the prominent component is most stones, either in the monohydrate or dihydrate form. It is often mixed with calcium phosphate.1 2. Urease. Explanation: Struvite stones are composed of magnesium ammonium phosphate and carbonate apatite. They are formed when microorganisms such as Proteus, Providencia, and occasionally Klebsiella, Pseudomonas and enterococci.1 3. 5 mm. Explanation: Stones smaller than 5 mm usually pass on their own. Larger stones may require surgical intervention. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518455/
Fig. 2. Obstructing calculus.
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