MCQ – 71140

A 49-year-old woman was recently diagnosed with carcinoma of the cervix. She presented with bilateral loin pain and fever for 3 days. Physical examination showed ballotable kidneys with local tenderness.There was no haematuria. Laboratory investigations revealed elevated serum creatinine and white cell count.USG was performed followed by Antenatal Pyelogram.What is the possible diagnosis?

A.	Renal Calculus
B.	Renal Cell Carcinoma
C.	Ureteric Calculus
D.	Hydronephrosis

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Correct Answer � D Explanation

Ans:D.)Hydronephrosis.

Image shows:Antegrade pyelogram, performed by injecting contrast through percutaneous nephrostomy catheters (open arrows), shows bilateral hydronephrosis and hydroureters (arrowheads). Persistent narrowing with tapered ends are present at the level of obstruction(arrows). Note there is no contrast filling into the bladder due to the bilateral obstruction.

Diagnosis:Carcinoma of cervix with invasion/compression of both ureters causing complete obstruction .

HYDRONEPHROSIS

• Hydronephrosis is defined as distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis. Analogously, hydroureter is defined as a dilation of the ureter.
• Urinary tract calculus and invasion/extrinsic compression by a pelvic tumour are the two most common causes for hydronephrosis. A plain abdominal radiograph is useful to exclude a urinary
• tract calculus. An IVU or antegrade pyelogram helps to delineate the level and cause of obstruction in most cases.