Diagnostic mistakes of radiology visualization of urolithiasis
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Diagnostic mistakes of radiology visualization of
urolithiasis
M. Pasichnyk , S.Pasichnyk, A. Shulyak
Lviv National Medical University
Lviv, Ukraine
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Clinical presentation
• Age: 40 years • Gender: male• Complaints: Acute renal colic. • History of disease: acutely admitted by ambulance
to the Rivne Regional Diagnostic Center• History of life: before hospitalization this patient
had no complaints.• Occupation: worker of the porcine farm
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Results of clinical examination
• Pain in right flank, positive Merphy’s sign on the right
• Blood cell count: Hb 122 g/L, er 3x1012/L, L 6.8x109/L, ESR 9 mm/h
• Differentional blood cell count: eosiniphilia (9%).• Urinalysis: normal• Blood biochemistry: normal• Blood coagulation test: normal
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Ultrasonography
Right kidney: parenchima normal, hydroureteronephrosis to the upper third of ureter (its diameter 9 mm) without any stone
Left kidney, liver, spleen, regional lymphatic nodes are normal.
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KUB (lumbar region)
Please note two shadows suspicious of calculus located at LI and LIII-IV on the right side
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KUB (pelvic region)
Please note two shadows located in the soft tissues above the coxofemoral joint
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Topogram of the trunk
Note the multiple system ossifications in the soft tissues
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CT of trunk
There are a lot of calcificates in the muscles of back
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CT with contrasting
Note the hydroureteronephrosis on the right
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CT of the brain
Note foci of calcification in the brain
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Conclusions of CT
Multiple calcifications of the soft tissues
Hydroureteronephrosis to the upper third of the ureter on the right caused by the periureteral calcification (diameter about 7 mm)
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Management
• This particular patient refused from any treatment
• Follow-up of this case was impossible
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What is your diagnosis?
What additional tests would you prescribe?
What management would you suggest?
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Our diagnosis
• Cystocercosis?
• Treatment: specific drugs against cystocercosis according to the consultation of infectionist and ureteral stenting
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Similar cases from the literature
Typical oval calcified cysticercus in muscles of a hip (Nigeria)
CT – calcified cysticercus located in a brain near the
ventriculus, but in that patient not causing other changes (CT with
contrasting) (Egypt)
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What is cysticercosis ? - Similarly to other parasitic diseases, cysticercosis
is caused by the use of contaminated food or water. Sometimes autoinfection of the patient already infected with a tape worm is noted. Unlike in the brain (or eyes), in the visceral organs cysticercus are surrounded by the fibrous capsule, but remain alive for several years.
Holger Pettersson, MD
Professor of Radiology University Hospital Lund, Sweden, 1995
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