Presentation
Tender mass left renal angle. Obstructive uropathy, lower urinary tract symptoms.
Patient Data
Both kidneys are orthotopic albeit with grossly hydronephrotic change with extensively dilated bilateral ureters (hydroureters) with the left ureter exhibiting tortuous figure of eight coiling tendency proximally. Cortical-medullary differentiation is reduced and there is subtle thinning of the cortical parenchymas bilaterally. The right kidney measures 15.1 x 9.7 cm while the left measures 22.9 x 11.6 cm in size. The urinary bladder is optimally distended with a pre-void volume of 116.6 cc and an immediate 86.1 cc post micturition residual volume. The prostate gland volume of 28.41 grams noted is within normal limits.
Case Discussion
Typical sonographic features favoring grade IV bilateral hydronephrosis with bilateral mega-hydroureters resulting into tortuous/figure of eight coiling of the ureters proximally likely primarily attributed to severe partial distal bladder outflow obstruction.
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