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BACKGROUND
An 81-year-old woman presents to the emergency department with left upper quadrant pain associated with constipation and fever for the last 3 months. The patient had recently been examined by her primary care provider and told that her left kidney ”was not working right” and that she had kidney stones. She is concerned about a hard lump on the left side of her abdomen.
On physical examination, the patient‘s vital signs are temperature 36.2°C, blood pressure 155/67 mm Hg, pulse 85 beats per minute, respiratory rate 18 breaths per minute, and O2 saturation 97% on room air. In general, the patient is a pleasant, talkative, alert woman in no acute distress. Her heart and lung findings are unremarkable. She has mild abdominal distention with normal bowel sounds and tenderness in the left upper quadrant with a palpable mass along the left colic gutter. The patient has no rebound, guarding, or rigidity, but mild tenderness over the left costovertebral angle is elicited.
Laboratory data reveal an international normalized ratio of 1.24, an activated partial thromboplastin time of 27 seconds, and a creatinine value of 1.7 mg/dL. The patient‘s WBC count is 13.8 X 109/L with a hematocrit of 29% and platelets of 379 X 103/µL. Urinalysis shows 61 WBCs per high-powered field, but the results are otherwise normal, with no bacteria.
Abdominal and pelvic CT with intravenous and oral contrast enhancement was performed.
What is the diagnosis?
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Hint
This condition commonly affects middle-aged women with staghorn calculi in the kidney.
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Authors:
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Jeremy Logan, MD,
Department of Radiology,
University of New Mexico Hospital,
Albuquerque
Gautam Dehadrai, MD,
Department of Radiology,
Norman Regional Hospital,
Norman, Okla
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eMedicine Editor:
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Rick G. Kulkarni, MD,
Assistant Professor,
Yale School of Medicine,
Section of Emergency Medicine,
Department of Surgery,
Attending Physician,
Medical Director,
Department of Emergency Services,
Yale-New Haven Hospital, Conn
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