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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. |
Image Size:[small][as-submitted]
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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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Comments: No comments posted. |
Additional Details:
Case Number: 373641Owner(s): Keith Fischer and Rosana PonisioLast Updated: 02-07-2013 The reader is fully responsible for confirming the accuracy of this content. |