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Patient: 15 year old female![]() |
History: Previously healthy, 15 year old� girl who presented with a 2-day history of left abdominal pain, vomiting, headache, and fever. |
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Findings: Diuretic renal scintigraphy: The posterior abdominal radionuclide angiogram demonstrates decreased perfusion of the left kidney and normal� right renal perfusion(Fig 1). Sequential renal images:� The left kidney and its extrarenal pelvis are massively enlarged and and the�parenchyma is thin with prompt uptake and excretion of the radiopharmaceutical by both kidneys (Fig 2). The estimated contribution of the right kidney to total renal function is 65% and that of the left kidney is 35% (Fig 3, 4). There is no appreciable clearance of pelvicalyceal activity on the left after diuretic administration. On the right, there is�normal, rapid�clearance of activity from the pelvicalyceal system. �After diuretic administration, the half-time of tracer clearance from the right kidney is 5 minutes and from the left kidney is unmeasurable due to lack of clearance (Fig� 5). �The renal sonogram as well as the computed tomography demonstrate left ureteropelvic junction obstruction with marked dilation of the left renal pelvis and calyces (Figure 6, 7) |
DDx: Differential diagnosis: 1.� Left ureteropelvic junction obstruction and massive dilatation of the renal collecting system 2.� �Hydronephrosis without obstruction |
Diagnosis: � 1.� Left ureteropelvic junction obstruction and massive dilatation of the renal collecting system |
References: Rossleigh MA et al: Determination of the normal range of furosemide half-clearance times when using Tc-99m MAG3. Clin Nucl Med. 19(10):880-2, 1994. �Karam M et al: Diuretic renogram clearance half-times in the diagnosis of obstructive uropathy: effect of age and previous surgery. Nucl Med Commun. 24(7):797-807, 2003 �"Pediatric Nuclear Medicine/PET"�: Salvador T. Treves; Springer�(2007) third edition � |
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Case Number: 373641 The reader is fully responsible for confirming the accuracy of this content. |