case write-up radiology 4

Identification Data

Name : Noor Badrul Hisham Bin Noor Shah

Age     : 50 years old

Race   : Malay

X-Ray  No : 2305

Type of Imaging : Intravenous Urography

Positioning : Supine

Clinical History

Patient is a known case of dyslipidemia diagnosed  15 years ago. He complaints of having left loin to groin pain. The pain was dull in nature and he described it as very severe because he had to roll around the bed to relieve it. There were no hematuria, or passing out stone during micturition. Intravenous urography was done to rule stone and other urinary tract pathology.

 Patient Preparation

        i.            No food for 5 hour prior to the examination.

      ii.            Patient should, preferably be ambulant for 2 hour prior to examination to reduce bowel gas.

    iii.            If patient has allergy to contrast medium, consideration  should be given to administer methyl prednisolone orally 12 and 2 hour prior to injection of contrast medium.

Procedure

        i.            Preliminary film taken in supine,full length AP position of the abdomen,in inspiration to make sure adequate bowel preparation and to rule out any urinary calculi.

      ii.            Patient is given Intravenous bolus infusion of contrast media which is Iopamiro 300.

    iii.            5 minute film taken to determine if excretion is symmetrical and is invaluable for assessing the need to modify technique.

   iv.            15-minute film to demonstrate pelvicalyceal system.

     v.            Release film is taken to show whole urinary tract.

   vi.            Post micturition film to assess bladder emptying and to demonstrate return to normal of dilated upper tracts with relief of bladder pressure.

Findings

        i.            Preliminary film: There is faceted radiopacity seen on the left L1 and L2 vertebral level measuring 3 cm and 1 cm.

      ii.            Post Contrast :

·        Both kidneys are normal in shape, size and position.

·        Bipolar length  of Right kidney measures 12.0 cm while left kidney measures 15.5 cm.

·        No hydronephrosis  or hydroureter  seen

·        Normal configuration of urinary bladder.

·        Persistent clubbing seen within the left lower calyx is consistent with the opacity seen in preliminary film.

    iii.            Post micturition : No contrast hold up and no significant residual volume seen in urinary bladder.

Impression

Left renal calculus with no evidence of obstructive uropathy