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IV pyelogram in a case of back pain

6K views 12 replies 6 participants last post by  vienna4u 
#1 ·
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?



A. Adult polycystic kidney disease
B. Amyloidosis
C. Renal cell carcinoma
D. Drug
E. Homocystinuria
 
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#3 ·
I think C is the right answer........


@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........
 
#6 ·
All,

It looks like A and C are popular answers.

Please look at the imaging again paying more attention on the right side-renal pelvis!

No worries if you still don't get it! I got it wrong and so I like to share with you all. Answer on the way!

BTW-this is not from NBME!!!!!
 
#7 ·
All,

It looks like A and C are popular answers.

Please look at the imaging again paying more attention on the right side-renal pelvis!

No worries if you still don't get it! I got it wrong and so I like to share with you all. Answer on the way!

BTW-this is not from NBME!!!!!
i still think its A.. because both kidneys look lobulated to me. renal cell carcinoma is not bilateral and more calcified picture than bilateral....:eek:.. y cant i see renal cell carcinoma as an option??
 
#11 ·
Retroperitoneal fibrosis related to ergotamine

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!

Here we go!!!!
 
#13 ·
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!

Here we go!!!!
wow good one....The IVP picture of RPF is characteristic as you say... but the association with Migraine and its treatment would not have struck me

I was going for ureteral compression due to tumor
thanks...:)
 
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