diagnostic mistakes of radiology visualization of urolithiasis m. pasichnyk, s.pasichnyk, a. shulyak...

Diagnostic mistakes of radiology visualization of

urolithiasis

M. Pasichnyk , S.Pasichnyk, A. Shulyak

Lviv National Medical University

Lviv, Ukraine

Clinical presentation

• Age: 40 years • Gender: male• Complaints: Acute renal colic. • History of disease: acutely admitted by ambulance

to the Rivne Regional Diagnostic Center• History of life: before hospitalization this patient

had no complaints.• Occupation: worker of the porcine farm

Results of clinical examination

• Pain in right flank, positive Merphy’s sign on the right

• Blood cell count: Hb 122 g/L, er 3x1012/L, L 6.8x109/L, ESR 9 mm/h

• Differentional blood cell count: eosiniphilia (9%).• Urinalysis: normal• Blood biochemistry: normal• Blood coagulation test: normal

Ultrasonography

Right kidney: parenchima normal, hydroureteronephrosis to the upper third of ureter (its diameter 9 mm) without any stone

Left kidney, liver, spleen, regional lymphatic nodes are normal.

KUB (lumbar region)

Please note two shadows suspicious of calculus located at LI and LIII-IV on the right side

KUB (pelvic region)

Please note two shadows located in the soft tissues above the coxofemoral joint

Topogram of the trunk

Note the multiple system ossifications in the soft tissues

CT of trunk

There are a lot of calcificates in the muscles of back

CT with contrasting

Note the hydroureteronephrosis on the right

CT of the brain

Note foci of calcification in the brain

Conclusions of CT

Multiple calcifications of the soft tissues

Hydroureteronephrosis to the upper third of the ureter on the right caused by the periureteral calcification (diameter about 7 mm)

Management

• This particular patient refused from any treatment

• Follow-up of this case was impossible

What is your diagnosis?

What additional tests would you prescribe?

What management would you suggest?

Our diagnosis

• Cystocercosis?

• Treatment: specific drugs against cystocercosis according to the consultation of infectionist and ureteral stenting

Similar cases from the literature

Typical oval calcified cysticercus in muscles of a hip (Nigeria)

CT – calcified cysticercus located in a brain near the

ventriculus, but in that patient not causing other changes (CT with

contrasting) (Egypt)

What is cysticercosis ? - Similarly to other parasitic diseases, cysticercosis

is caused by the use of contaminated food or water. Sometimes autoinfection of the patient already infected with a tape worm is noted. Unlike in the brain (or eyes), in the visceral organs cysticercus are surrounded by the fibrous capsule, but remain alive for several years.

Holger Pettersson, MD

Professor of Radiology University Hospital Lund, Sweden, 1995