Vasanth Kumar Right PUJOwjsjsjsnsjj.pptx

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1. VASANTH KUMAR

2. CHIEF COMPLAINTS : 31 yrs male , IT professional, came with chief complaints of Right loin pain x 2 weeks History of presenting illness : Patient came with complaints of Right loin pain x 2 weeks No H/O fever/burning micturition /vomiting   PAST HISTORY: Patient is not a known case of DM/SHTN/BA/TB. PERSONAL HISTORY : NIL SIGNIFICANT

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 – 15.5, TC – 944 0, PLT – 3.92 , UREA – 19 CREATININE- 1.0 SERUM ELECTROLYTES: Na-131 ; K-4.2 ; Cl-92 ; HCO3-21   LFT- NORMAL URINE ROUTINE- pH 6.5, 1.010,WB C 0-1 URINE CULTURE- No growth

5. XRAY KUB RADIOLOGY:

6. USG KUB RIGHT KIDNEY LEFT KIDNEY BLADDER

7. USG KUB: RK- 11.5X5.5CM SIZE WITH MODERATE HYDRONEPHROSIS LK -10.6X4.1CM SIZE BLADDER NORMAL PROSTATE NORMAL IN SIZE FEATURES S/O MODERATE RIGHT HYDRONEPHROSIS

8. CECT UROGRAM WITH ANGIOGRAM

9. CT UROGRAM WITH ANGIOGRAM RIGHT KIDNEY : 12 X 6.5CM,NORMAL IN SIZE WITH DIFFUSE CORTICAL THINNING REDUCED PARENCHYMAL ENHANCEMENT COMPARED TO LEFT KIDNEY MINIMAL CONTRAST EXCRETION NOTED IN DILATED PCS, HOWEVER THERE IS NO OPACIFICATION OF RIGHT URETER THROUGHOUT ITS COURSE EVEN IN 2 HR DELAYED PHASES. THREE RENAL ARTERIES SEEN SUPPLYING THE KIDNEY(ONE MAIN AND TWO ABERRANT ARTERIES) THE ABERRANT RIGHT RENAL ARTERY SUPPLYING THE LOWER POLE IS SEEN TRAVERSING CLOSELY TO THE PELVIURETERIC JUNCTION. RIGHT URETER IS NOT DILATED THERE IS MILD PERINEPHRC FAT STRANDING WITH PROMINENCE OF ANTERIOR, POSTERIOR RENAL FASCIA AND LATERAL CONAL FASCIA. IMPRESSION RIGHT GROSS HYDRONEPHROSIS WITH DIFFUSE CORTICAL THINNING, ABRUPT TRANSITON NOTED AT PELVI-URETERIC JUNCTION WITH REDUCED EXCRETORY FUNCTION. ABERRANT RIGHT RENAL ARTERY SUPPLYING THE LOWER POLE IS SEEN TRAVERSING CLOSELY TO THE PELVI-URETERIC JUNCTION. LIKELY PUJ OBSTRUCTION?(MECHANICAL)- SECONDARY TO ABERRANT VESSEL

10. DTPA

11. DTPA GFR-59.68ML/MIN SCALED GFR- 45.36ML/MIN LEFT KIDNEY: NORMAL SIZED WITH NORMAL PARENCHYMAL FUNCTION AND NON-OBSTRUCTED DRAINAGE. RIGHT KIDNEY: POOR PARENCHYMAL FUNCTION. DRAINAGE CANNOT BE COMMENTED UPON.

12. PROGRESS PATIENT UNDERWENT USG GUIDED RIGHT PCN INSERTION ON 30/11/23