MANJUNATHAN BL ggvvhhbhbbbbSTAGHORN2.pptx

H

1. MANJUNATHAN

2. CHIEF COMPLAINTS :3 5 yrs male, , came with chief complaints of left loin pain since 4 days associated with fever and vomiting History of presenting illness : Patient left loin pain since 4 days associated with fever and vomiting No complains of hematuria,burning micturition. PAST HISTORY: Patient is not a known case of SHTN/BA/TB. Recently diagnosed DM H/o urolithi asis 5 years ago managed conservatively H/O Left above knee amputation and right shoulder disarticulation in RTA in 2016  

3. FAMILY HISTORY: Nil significant   O/E: Conscious, oriented, Afebrile VITALS: BP – 120/80 mmHG , PR – 80 /min   S/E: CVS – S1S2+ RS- BAE+ P/A – Soft, non-tender CNS – NFND GENITALS – Meatus Normal No Phimosis B/L Testis normal

4. INVESTIGATIONS: HB – 14.3, TC –11860, PLT –4.85, UREA – 23, CREATININE- 1.5 SERUM ELECTROLYTES: NORMAL   LFT- NORMAL URINE ROUTINE- pH 7.0 , 1.010,protein +, glucose+++ 6-8 WBCs URINE CULTURE- Klebsiel la pneumoniae . s/t Nil I/ t Colistin

5. X-RAY KUB

6. USG KUB

7. USG ABDOMEN RIGHT KIDNEY: NORMAL IN SIZE 11.3 X 6.47 CM . MODERATE HYDROURETERONEPHROSIS NOTED. MULTIPLE CALCULI NOTED UPTO 10 IN NO SIZE RANGING BETWEEN 1-2CM LARGEST 17.6MM IN UPPER POLE. LEFT KIDNEY : NORMAL IN SIZE 12.7 X 7.1 CM . MODERATE HYDROURETERONEPHROSIS NOTED. MULTIPLE CALCULI NOTED UPTO 10 IN NO SIZE RANGING BETWEEN 1-2CM LARGEST 19.4MM IN LOWER POLE. BLADDER : CHANGES OF CYSTITIS

8. CT KUB

9. CT KUB

10. CT KUB PLAIN RIGHT KIDNEY CONGLOMERATE CALCULUS OF SIZE ~2.6 X 2.1 X 2.7 CM OF MAXIMUM HU~ 1951 NOTED IN UPPER, INTER AND LOWER CALYX EXTENDING INTO RENAL PELVIS CAUSING DILATATION OF PELVICALYCEAL SYSTEM- LIKELY COMPLETE STAGHORN CALCULUS. PCS APPEARS DILATED LEFT KIDNEY MULTIPLE CALCULI NOTED IN UPPER, INTER AND LOWER CALYX AND RENAL PELVIS LARGEST OF SIZE ~1.6 X 2.5 X 1.6 CM OF MAXIMUM HU~ 1707 NOTED IN RENAL PELVIS PCS APPEARS DILATED

11. RIGHT KIDNEY Large stag-horn calculus of maximum HU ~+1951 noted in upper, inter and lower calyx extending into renal pelvis causing severe dilatation of pelvicalyceal system. Few discrete and conglomerate calculi noted in inter & lower pole calyx, largest of size 12 x II x 7mm (CC x TR x AP) with maximum HU of&+ 2160 noted in the lower pole calyx. LEFT KIDNEY Multiple ( atleast 10) calculi (few discrete and few conglomerate) noted in upper,inter & lower pole calyx and renal pelvis largest of size 18 x 25 x 18 mm (CC x TR x AP) with maximum HU of-€+ 1707 noted in the renal pelvis. Pelvicalyceal system appears grossly dilated. Percutaneous nephrostomy (PCN) catheter tip noted in the left inter-pole calyx ( insitu ) with mild reduction in dilation of Pelvicalyceal system compared to previous CT dated 05/09/23. Moderate perinephric fat stranding seen with significant thickening of anterior and posterior para-renal fascia and lateral conal fascia with minimal fluid — Likely Post procedural changes. Renal parenchyma shows relative hypo-enhancement as compared to the right kidney. Delayed excretion/emptying of contrast seen (4 hours delayed phase). IMPRESSION: S/P left PCN insertion Obstructive right complete staghorn calculus causing severe hydronephrosis. Obstructive left renal calculi causing grade IV hydronephrosis With delayed excretion Of contrast. Bilateral renal calculi. Left PCN catheter in-situ with post procedural changes as described.