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BACKGROUND
A 61-year-old man presents with a chief complaint of painless hematuria. He has had 6 episodes over the past 2 years. For approximately 1 day, he had several episodes of hematuria followed by the passage of blood clots the next morning. He denies having trauma, flank pain, dysuria, urinary frequency, fevers, or weight loss. He denies traveling outside the country. He has not had any recent surgery, catheterization, or other procedure involving instrumentation. He has no chronic medical problems and specifically denies a history of renal stones. He denies drug use, including over-the-counter analgesics. He smoked cigarettes for 25 years but quit 2 years ago.
The patient's physical examination is unrevealing. He has no palpable masses, abdominal or costovertebral tenderness, prostate enlargement or tenderness, or penile abnormality. Laboratory studies show mild normocytic anemia with a normal coagulation profile. Urinalysis reveals a large amount of RBCs with no nitrites or detectable leukocyte esterase.
Intravenous pyelography (IVP) (see Image 1) and CT scanning at the level of kidneys (see Image 2) are performed. What is the diagnosis?
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Hint
This condition has a well-known association with smoking and with exposure to aniline dyes and phenacetin.
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Authors:
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Renita Butler, MD,
Resident,
Department of Radiology,
University of Texas Southwestern Medical Center, Dallas
Pramod Gupta, MD,
Staff Physician,
Department of Radiology,
Dallas VA Medical Center,
Dallas, Tex
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eMedicine Editor:
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Erik D. Schraga, MD,
Department of Emergency Medicine,
Kaiser
Permanente,
Santa Clara Medical Center, Calif
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