A 38-year-old man with chronic migraine, 6 months history of worsening of back pain, hematuria, anorexia and malaise. He was found to have hypertension. IVP is shown below. Which of the following is most likely associated with the patient's clinical findings?
no doubt about this. answer is A. and to add, if a ct scan is done, one can almost definitely observe a berry/saccular aneurysm of the anterior communicating artery of the circle of Willis.
@seetal ......can u xplain ur ans....bcoz in APKD kidneys are enlarged bilaterally ..........back pain and brain symptoms can be due to metastasis and anorexia and malaise due to loss of appetite which is due to release of TNF by the tumor.......hypertension due to the growth compressing the vessels causing ischemia and therefore release of renin........
there are also cystic cavities with air fluid levels in both the kidneys....but i am not able to explain anorexia which favors carcinoma....again the age of the patient is against the carcinoma.....:notsure:
i still think its A.. because both kidneys look lobulated to me. renal cell carcinoma is not bilateral and more calcified picture than bilateral...... y cant i see renal cell carcinoma as an option??
It is a pyelogram and not an XRay so those probably arent renal cysts...but I am still a little confused about the options, but if it was the exam and i wasnt being penalised I would go for C
hang on.... could this be APKD tht progressed on to renal cell carcinoma seeing tht the signs of anorexia etc point to RCC but his IVP to me is APKD!!!
The IVP shows right hydronephrosis (can be bilateral) due to ureteral compression; note how the ureter is tapered and characteristically drawn medially by the fibrotic process.
This characteristic medial deviation of the ureter at the L4-L5 vertebral level is a classic radiographic picture of retroperitoneal fibrosis. Given a likely drug associated with this condition, ergotamine for the treatment of migraine this diagnosis is the most likely cause of RPF!
The IVP shows right hydronephrosis (can be bilateral) due to ureteral compression; note how the ureter is tapered and characteristically drawn medially by the fibrotic process.
This characteristic medial deviation of the ureter at the L4-L5 vertebral level is a classic radiographic picture of retroperitoneal fibrosis. Given a likely drug associated with this condition, ergotamine for the treatment of migraine this diagnosis is the most likely cause of RPF!
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Related Threads
?
?
?
?
?
USMLE Forums
402.5K posts
115.2K members
Since 2009
A forum community dedicated to the United States Medical Licensing Examination. Come join the discussion about schools, exams, news, prep, reviews, accessories, classifieds, and more!