A 45-year-old man, complained of severe left loin pain for one day. The pain was colicky and sharp and radiated to the left groin. Physical examination was essentially normal. Urine examination was positive for RBC and negative for WBC. A KUB followed by an IVU, a few days later was performed. What is the possible diagnosis?
Renal Cell Carcinoma
- First: KUB shows a radio-opacity (arrow) in the left paravertebral region at the level of L4, along the course of the left ureter. This was confirmed to be a ureteric calculus.
- Second: A tomogram obtained during the IVU examination shows left hydronephrosis (dilated renal calyces (arrowheads) and pelvis (open arrowheads)), and proximal hydroureter (open arrows). The ureteric stone (arrow) is situated at the lower end of the dilated left ureter.
- Ureteric stones are renal stones that have passed down the pelvicalyceal system and become lodged within the ureter. The majority of them are therefore radio-opaque. IVU is usually the second investigation after a KUB.