Category: Case Diagnosis
Quizzes
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 38-year-old man, without adenoma sebaceum of the face, presents for sudden right flank pain without fever or hematuria. At the time of the initial examination, his pulse is 88/min and his blood pressure is 110/70 mm Hg.
Palpation reveals dull tenderness in the right lumbar region. Hematocrit and creatinine are within normal levels. He undergoes a CT scan (Figure 1).
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis-Tunisia
A 17-year-old man with no prior urologic history was referred for right lumbar pain. He denied any lower urinary tract symptoms or fever. His physical examination was normal but revealed right lumbar pain at palpation. The creatinine level was normal and so was the urine analysis. Ultrasonography concluded to bilateral hydroureters and hydronephrosis. An intravenous urography was performed (Figure). What is the diagnosis?
Submitted by Mr. Nikhil Vasdev, Specialist Registrar, Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
A male patient underwent a laparoscopic cystoprostatectomy, ureterectomy, extracorporeal ileal conduit formation, and pelvic lymph node dissection for T2G3M0 TCC bladder. Presently, on day 61, we treated 2 painless lesions on the scrotum and 2 lesions on the penile shaft. Acute radiological imaging was performed (ultrasound of the testis, Figure 1; CT scan of the pelvis, Figure 2).
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 45-year-old man presented with large left scrotal masses. He had the masses since his adolescence and their size gradually increased in the past 5 years.
A physical examination revealed a painless swollen scrotum due to moderate hydrocele. The testis was normal in size and feeling. A scrotal ultrasonographic examination was performed (Figure).
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 45-year-old woman was admitted because of sudden onset of right flank pain without preceding trauma. On arrival, she was conscious and her vital signs were normal.
A physical examination revealed only tenderness of the right flank. An ultrasonography showed a right perirenal collection. An emergent computed tomography (CT) scanning of the suspected right retroperitoneal lesion was performed.
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 37-year-old man was referred to the urology service with chronic and isolated right flank pain. A physical examination was unremarkable.
Ultrasonography showed a hydronephrotic right kidney with very thin parenchyma. A CT scan of the abdomen and pelvis was performed (Figure).
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 31-year-old man presented for right lumbar pain. He denied any haematuria, fever, or lower urinary tract symptoms. His medical history was unremarkable.
A physical examination revealed tenderness in the right flank area. The KUB film was normal.
He underwent an intravenous urography (IVU) and CT scan (Figure). What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 17-year-old man with no prior urologic history, especially upper urinary infection, presented for right renal lumbar pain. He denied any history hematuria, fever or lower urinary tract symptoms. Physical examination revealed pain on right flank palpation.
Blood laboratory tests and urinalysis were normal.
KUB film was normal but ultrasonography showed right hydronephrosis.
He underwent an intravenous urography (Figure). What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 55-year-old man presented with a 5-day history of a small, painful perineal mass with lower urinary obstructive symptoms. The patient’s past medical history was unremarkable except for recurrent urinary tract infections (UTIs). There were no symptoms of constipation or diarrhea.
A careful examination of the perineum revealed a small median penoscrotal opening. A small amount of urine could be expressed from this opening after the patient had voided. Examination of the genitalia was normal. A voiding cystourethrogram (VCUG) was performed (Figure). What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 76-year-old male presented to the emergency room for acute urinary retention. He was unable to urinate for more than 5 hours.
He denied any history of bladder tumor or hematuria. He reported that he was operated on 12 years ago for vascular problems but he didn’t know the exact type of intervention. A physical examination revealed a painful overly distended bladder with prostate enlargement in the digital rectal examination.
The patient had a recent abdominal CT scan (Figure). What is the diagnosis?
Submitted by Hendrik Isbarn, Meike Adam, Roland Dahlem, Felix K.H. Chun, and Margit Fisch, University Hospital Hamburg Eppendorf, Department of Urology
A 20-year-old female patient was referred to our institution due to microhematuria and left-sided flank pain, which started about 4 weeks ago. She did not have a prior history of stone disease or other urologic conditions.
A CT scan of the abdomen revealed which pathology?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital University, Tunis, Tunisia
A 45-year-old woman who underwent a cesarean operation 12 years ago was referred to our department for urinary leakage. Her physical examination was normal, as was the vaginal examination.
Her methyleneblue test was positive. Her serum creatinine level was normal, and her urine culture was negative. Her abdominal and pelvic ultrasonographies were normal. She underwent a retrograde cystography (Figure). What is the diagnosis?
Submitted by drs. Siavash Falahatkar, Aliakbar Allahkhah, and Samaneh Esmaeili, Urology Research Center, Guilan University of Medical Science, Rasht, Iran
A 52-year-old female patient was referred for dull abdominal pain. She had weight gain of about 13.2 pounds during the course of 6 months. The patient had dull abdominal pain and did not have a prior history of urinary tract disease.
Based on the findings of the unenhanced and enhanced CT examination of the abdomen, which diagnosis would be most accurate?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital-University, Tunis, Tunisia
A 59-year-old man underwent an endoscope resection of a bladder tumor 4 months before presentation. The pathological study concluded a transitional cell carcinoma, pT1G2. He was treated with adjuvant weekly endovesical instillation of BCG therapy for 6 weeks.
He is asymptomatic, and the physical examination is unremarkable. Computed tomography (CT) was performed and revealed an endoluminal bladder lesion (Figure, see arrow).
What is the diagnosis?
Submitted by Ricardo Borges, MD, Urology Resident, Centro Hospitalar de Coimbra, Portugal
A 71-year-old male presented with a history of vertiginous syndrome, ataxic gait, and the diagnosis of ischemic cerebellar stroke. The physical examination revealed an asymptomatic right flank mass.
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital-University, Tunis, Tunisia
A 77-year-old male patient presented with a history of left lumbar pain and 48 hours of anuria. He denied any history of hematuria or recurrent urinary infection.
However, he has a varied medical history, which includes coronary heart disease imposing a coronary artery bypass, two episodes of prostate endoscopic resection, endoscopic ureterotomy for ureteral stricture, bladder neck sclerosis, and nephrectomy for a non-functioning right kidney (renal stone)
The physical examination didn’t reveal any lumbar or pelvic mass. The digital rectal examination was normal. Kidney function tests: urea = 32 mmol/l, creatinine = 891 µmol/l, and potassium = 6.2 mmol/l.
His ultrasonography revealed a mild left hydroureteronephrosis. He underwent percutaneous nephrostomy to drain the right kidney. After the improvement of his renal function, a direct antegrade opacification through the nephrostomy stent was performed (Figure).
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital-University, Tunis, Tunisia
A 67-year-old male patient was referred to our department for left-sided flank pain and microhematuria. He denied any history of flank trauma or fever. MRI was performed.
What is the diagnosis?
Submitted by Dr. Pasquale Casale, Department of Urology, Children's Hospital of Philadelphia, University of Pennsylvania
A 38-year-old woman presented with a history of recurrent UTIs and a suprapubic mass.
What is the diagnosis?
Submitted by Dr. Ahmed Al-Sameraaii, FRACS (Urology), St. George Hospital, Sydney
An 82-year-old female patient was referred to our institution due to right flank pain and a lump in the right lumbar region that started about 4 weeks prior. She did not have a prior history of stone disease but several episodes of uncomplicated lower urinary tract infections with 2 months history of generalized fatigue and malaise.
A computed tomography (CT) scan of the abdomen revealed which pathology?
Submitted by Dr. Pasquale Casale, Department of Urology, Children's Hospital of Philadelphia, University of Pennsylvania
A 44-year-old woman presented with a history of right back pain and hypertension.
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital-University, Tunis, Tunisia
A 49-year-old woman was evaluated for intermittent left flank pain for about 6 months. She had no significant medical history. She had no urinary trouble, fever, or any other significant complaint.
Her physical examination revealed a painless, paraumbilical mass about 12 cm vertically and 10 cm transversely. It was mobile and slightly tender. Her external genitalia were normal. Laboratory examinations were unremarkable. A plain abdominal X-ray showed no noticeable abnormality. Her abdominal ultrasonography revealed a solitary left kidney with a giant cystic lesion on it.
What is the diagnosis?
Submitted by Dr. Sallami Sataa, Department of Urology, La Rabta Hospital-University, Tunis, Tunisia
A 45-year-old woman was admitted because of the sudden onset of right flank pain without preceding trauma. On arrival, she was conscious and her vital signs were normal.
Her physical examination revealed only tenderness of the right flank. The Ultrasonography showed a right perirenal collection.
An emergent computed tomography (CT) scan of the suspected right retroperitoneal lesion was performed.
What is the diagnosis?
Submitted by Dr. Adilson Prando, Head, Department of Radiology and Diagnostic Imaging, Hospital Vera Cruz, Campinas, Brazil
A 66-year-old female patient was referred to our institution for imaging staging of a left ovarian carcinoma found at surgery 2 months before presentation. The patient was asymptomatic and did not have a prior history of urinary tract disease.
Based on the findings of the unenhanced and enhanced computed tomography (CT) examination of the abdomen, which diagnosis would be more adequate?
Submitted by Sanjay Kolte, MCh, Sparsh Urology & Kidney Hospital, Dhantoli, Nagpur, India
A 45-year-old male presented with pain in the suprapubic region and with micturition frequency for 3 months. He was a diabetic. There was no history of any surgery in the past. He was a non-smoker and not hypertensive. There was no history of trauma. The examination findings were unremarkable. An ultrasound showed a generalized thickening of the bladder wall. The prostate was normal and not enlarged.
A computed tomography scan showed a cystic mass 4 cm x 3 cm in size with internal echoes in the left half of the fundus of the bladder wall. A cystoscopy showed the mass protruding inside the lumen of the bladder with intact overlying mucosa. What is the diagnosis?
by Elsawi Medani Osman, Assistant Consultant, Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
A 75-year-old gentleman presented with a large, painless right hemiscrotal swelling, which gradually increased in size over the last 6 years. His testicular tumor markers were negative. The ultrasound (US) showed a heterogeneous mass located outside the tunica albugenia with fat components.
The subsequent computed tomography (CT) showed the displayed images (left). What is the diagnosis?
by Mahmoud Benatta, Urology Department, Ehu Oran, Oran, Algeria
A 65-year-old man with no prior urologic history was referred for left lumbar pain. He denied any lower urinary tract symptoms or fever. His physical examination revealed left lumbar pain at palpation and a tense and matted mass in the percussion.
The creatinine level was normal and so was the urine analysis. Tomodensitometry concluded a left renal giant hydronephrosis with complex lithiasis (Figure 1). An intravenous urography was also performed (Figure 2). What is the diagnosis?
by Dr. Poovendran, M.S., DNB (Genito Urinary Surgery), Consultant Urologist, Vivekanandha Medical Care Hospital, Triuchengode, Tamil Nadu, India
A 35-year-old male presented with a history of straining for micturition over the course of 1 year. He had spent at least 15 minutes for every episode of urination. The examination revealed a distended bladder. The ultrasonography (USG) revealed a distended bladder with wall thickening and a 2 cm wide, thin-walled cystic swelling with post-acoustic enhancement mimicking a ureterocele. Post-void residue was 290 mL. The Doppler study demonstrated urine jets from both ureteral orifices. There were no changes noted from the cyst swelling. There was no evidence of ectopic kidney. Transrectal USG revealed normal seminal vesicles and a 20 cc prostate with a 2 cm cystic swelling from the 5 to 7 o'clock position of the bladder neck. The intravenous urogram revealed a bilateral single kidney and ureter, with a filling defect within the bladder. The cystogram was normal except for effacement of the cyst into the prostatic fossa.
Transurethral unroofing was done and further examination didn't reveal any ureteral opening. The biopsy revealed flattened epithelium lining the cyst wall.
What is the diagnosis?