A 5 year old NM American Bobtail was presented to an Emergency Clinic for urinary blockage and was subsequently unblocked. Proteinuria and hematuria was present on urinalysis.
A 5 year old NM American Bobtail was presented to an Emergency Clinic for urinary blockage and was subsequently unblocked. Proteinuria and hematuria was present on urinalysis.
Case Study
06-00062 Beau W Medullary calculus, mild hydronephrosis —-NEEDS C—–NO IMAGES—-
DX
Renal infarctions and medullary calculi with minor hydronephrosis of the left kidney.
Sonographic Differential Diagnosis
Multiple renal infarctions and medullary calculi with minor hydronephrosis of the left kidney. Urinary bladder calculi. The patient is likely passing renal and bladder calculi with secondary infarctions and remodeling/dystrophy. IV fluid therapy would be recommended aggressively over the next 3-6 days in this patient in order to enhance functional renal parenchyma. Blood pressure measurements should also be taken. Eventual cystotomy can be performed with calculi analysis. However, more calculi are present in the kidneys and will likely pass in the future causing future episodes of similar clinical presentation. Ureteral stents can be considered and placed by an interventional radiologist. The left renal pelvis at this time is not wide enough for a stent to be placed. Left renal nephrotomy can be considered in order to remove the calculi. However, this is considered somewhat invasive procedure. Guarded long term prognosis.
Image Interpretation
The urinary bladder presented normal structure. However, some suspended debris and 3-5 small shadowing calculi were noted and measured between 0.3-0.4 cm each were noted in the bladder. These are likely passage from the kidneys and ureters. The left kidney presented multiple infarctions with pyelectasia and multiple medullary calculi. This was similar in echogenicity to that of the bladder. This is likely the sequellae from hydronephrosis and ureteral calculi passage into the bladder. Echogenic, ill-defined changes were noted in both of the renal pelvises. The right kidney presented multiple infarctions as well likely owing to multiple calculi passage into the bladder. The right kidney measured 2.7 cm. The left kidney measured 3.7 cm.
Outcome
The patient had a repeat chemistry and CBC was normal. Urinalysis revealed a urine specific gravity of 1.023, 3 + blood, pH 6.0, protein 1+, RBC 20-30.
Comments
Connection between calculi passage and infarctions?
Clinical Differential Diagnosis
Bladder – interstitial cystitis/uroliths/neoplasia/blood clots Urethra – neoplasia/blood clot/urethral spasm Ureter – urolith
Sampling
None
Patient Information
Type of Imaging : Ultrasound
Images
