Surprise of an Acute Obstructive Nephrogram

Special Article - Surgical Case Reports

Austin J Surg. 2015;2(2):1053.

Surprise of an Acute Obstructive Nephrogram

Wani Bhushan N1* and Banode Pankaj2

Department of Surgery, MVPS DVP Medical College, India

*Corresponding author: Wani Bhushan N, Department of Surgery, MVPS’s Dr Vasantrao Pawar Medical College, Nashik, Department of Radiodiagnosis, JNMC Sawangi, India

Received: November 24, 2014; Accepted: March 18, 2015; Published: March 19, 2015

Abstract

The urographic nephrogram has an important role in the diagnosis of alterations to the renal parenchyma. The appearance of a unilateral, striated nephrogram becoming progressively denser during IV urography has been attributed to several processes. Here we are reporting a surprise finding of an acute obstructive nephrogram in a case on left ureteric colic and discussed a physicis behind the same.

Keywords: IV urography; Obstructive nephrogram; Acute obstructive uropathy; Striated nephrogram; Ureteric colic

Introduction

An obstructive nephrogram involving the entire kidney, owing to an acute ureteral obstruction is a well known phenomenon [1] and has been classically described. The urographic nephrogram plays an important role in the diagnosis of alterations to the renal parenchyma. The appearance of a unilateral, striated nephrogram becoming progressively denser during IV urography has been attributed to several processes; thus history, clinical examinations are of paramount.

Case

A 46 year old man presented with severe, colicky pain in left iliac fossa associated with nausea and vomiting, radiating to groin; with history of burning micturition of 3 months. He was admitted with provisional diagnosis of left ureteric calculus and worked up in that direction. All haematological investigations were with normal limits. Urine microscopy, it was found to be infected with presence of plenty pus cells and calcium oxalate crystals. Ultrasonography revealed left lower ureteric calculus without evidence of hydronephrosis and hydroureter.

Intravenous Urography (IVU) was done; control film showed a soft tissue shadow in left renal area. A 5 minutes film after contrast injection, demonstrated diffuse nephrographic effects, with delay in opacification of the collecting system on the left with normal nephrogram on right side. In 15 minutes film, it was a dense nephrogram on the left side and a normal appearance of the collecting system on the right side. In 30 minutes film the density of left nephrogram had increased till one hour film and then gradually decreased. A 6, 12 and 24 hours films showed gradual disappearance of contrast on left side with radio-opaque impacted stone at lower ureter (Figure 1).

Citation: Wani Bhushan N and Pankaj B. Surprise of an Acute Obstructive Nephrogram. Austin J Surg. 2015;2(2): 1053.