Dr. Pepe’s Diploma Casebook: Case 12 – SOLVED!

Dear Friends,

This week’s case is a 51 year-old woman with a history of chronic urinary tract infection. She consulted for left lumbar pain and intermittent mild fever of several weeks’ duration.

Fig. 1

Possible diagnoses:

1. Staghorn calculus with pyonephrosis
2. Staghorn calculus with hydronephrosis
3. Staghorn calculus and renal tumour
4. None of the above

Click here for the answer

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    20 Responses to : Dr. Pepe’s Diploma Casebook: Case 12 – SOLVED!

    1. Isobel says:

      Staghorn calculus with pyonephrosis

    2. Albert says:

      Staghorn calculus and mass effect in the left renal fosa with enlargement of renal silouette which obscurate the psoas line and seems to cause displacement of the descendent colon to the left side. In this case I think the entity we have to think of and confirm it with a CT is a Xantogranulomatous Pyelonephritis.

    3. Dr Hesham says:

      is there a stone at the LT distal ureter there is a shadow at the pelvis is seen.
      other wis im in the answer 1

    4. Lavinia says:

      I think its answer 3. There is a mass efect and the fever was never high, just mild intermitent. I beleive its a renal tumor stage 3 or 4

    5. irshad says:

      most probably staghorn stone with tumor

    6. Genchi Bari Italia says:

      Il rene sx è aumentato di volume:il DL che normalnente non sorpassa il corpo di 4 vertebre lombari, corrisponde nel caso in esame ad oltre 5 vertebre.L’aumento di volume è diffuso a tutto il rene: si esclude il tumore renale che è “localizzato”( eccezione per l’infiltrazione linfomatosa).Non si può differenziare all’Rx-standard la idronefrosi, dalla pionefrosi( DD con US) il calcolo a stampo é caliceale e non si localizza anche nella pelvi( si esclude la idronefrosi e la pionefrosi).Vi è la storia di IVU cronica, in soggetto femminile, con flogosi.Il tutto è compatibile allora con una pielonefrite cronica, xantogranulomatosi, in cui la calcolosi, predispone all’infezione cronica, con un particolare tipo di infiltratto, grassoso. La TC, confermerà tutti questi dati!

    7. Genchi Bari Italia says:

      Volevo meglio specificare che il calcolo a stampo è “sopratutto” caliceale, con lieve propaggine naella pelvi.

    8. Buki Ajiboye says:

      Staghorn calculus in left kidney which is enlarged- xanthogranulomatous pyelonephritis

    9. Xose says:

      None of the above. Xanthogranulomatous pielonephritis.
      Dr. Pepe, is true that you will retire?

    10. Staghorn calculus with pyonephrosis

    11. Ieva says:

      None of above.

      I believe it is xantogranolomatous pyelonephritis with staghorn calculus.

    12. Vijay kumar ichpujani says:

      Its staghorn calculus with renal tumour

    13. Lonci says:

      Staghorn calculus and pyonephrosis

    14. Carlos Brizuela says:

      Staghorn calculus with pyonephrosis

    15. Tomasete says:

      Xantogranulomatous pyelonefritis.. Any reward for me??

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