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Abdomen » Kidneys/Ureters
Giant Hydronephrosis due to a Ureteral Stone
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 78-year-old cachectic woman presented with abdominal distension and abdominal pain. On physical examination, the abdomen was grossly distended and a large abdominal mass was palpable on the left side.
 
 
 
Caption: 
Description: 
 
 
Caption: Transverse Upper Abdomen
Description: Transabdominal Ultrasound detected massive hydronephrosis with atrophy of the renal parenchyma and hydroureter on the left side
 
 
Caption: Sagittal Left Abdomen
Description: Transabdominal Ultrasound detected massive hydronephrosis with atrophy of the renal parenchyma and hydroureter on the left side
 
 
Caption: Sagittal Left Lower Abdomen
Description: Exploration of the lower portion of the ureter revealed a giant ureteral stone measuring 6 cm causing ureteral obstruction.
 
Differential Diagnosis intra-abdominal cystic masses
 
Final Diagnosis Giant Hydronephrosis due to a Ureteral Stone
 
Discussion Giant hydronephrosis is a rare urological entity.  It  was first defned as the presence of more than 1 l of  fluid in the collecting system.  This situation is a rare urological entity in adults.  It is usually  secondary  to ureteropelvic  junction  obstruction.  Other causes include stone disease, trauma, renal ectopia and ureterovesical junction obstruction.
Giant hydronephrosis is thought to develop gradually over a long time period, although rapid exacerbations of the condition have been reported.  Patients always present with abdominal enlargement and most of them are asymptomatic

 
Case References
  1. Yilmaz  E,  Guney  S.  Giant  hydronephrosis  due  to  ureteropelvic junction  obstruction  in  a  child.  CT  and  MR  appearances.  Clin Imaging 2002; 26: 125-128.
  2. Ardicoglu  A,  Yuzgec  V,  Atikeler MK,  Özdemir  E.  Case  of  adult giant  hydronephrosis  as  unusual  cause  of  intraabdominal mass.Int Urol Nephrol 2003; 35:  7-8.
  3. Kaya  C,  Pirincci N, Karaman MI.  A  rare  case  of  an  adult  giant hydroureteronephrosis due to ureterovesical stricture presenting as a palpable abdominal mass. Int Urol Nephrol 2005; 37: 681-683.
  4. Giant hydronephrosis in adults: the great mimic. Early diagnosis with ultrasound. W. T. Yang and C. Metreweli;Postgrad Med J. 1995 July; 71(837): 409–412.

 
Technical Details This case provided courtesy of the author, Danilo Sirigu, MD and the web site http://www.ecomovies.it.  This site  provides an extensive collection of ultrasound video cases.
 
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