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Diagnostic mistakes of radiology visualization of urolithiasis

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 .

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Diagnostic mistakes of radiology visualization of urolithiasis

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  1. Diagnostic mistakes of radiology visualization of urolithiasis M. Pasichnyk , S.Pasichnyk, A. Shulyak Lviv National Medical University Lviv, Ukraine

  2. 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

  3. 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

  4. 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.

  5. KUB (lumbar region) Please note two shadows suspicious of calculus located at LI and LIII-IV on the right side

  6. KUB (pelvic region) Please note two shadows located in the soft tissues above the coxofemoral joint

  7. Topogram of the trunk Note the multiple system ossifications in the soft tissues

  8. CT of trunk There are a lot of calcificates in the muscles of back

  9. CT with contrasting Note the hydroureteronephrosis on the right

  10. CT of the brain Note foci of calcification in the brain

  11. 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)

  12. Management • This particular patient refused from any treatment • Follow-up of this case was impossible

  13. What is your diagnosis? What additional tests would you prescribe? What management would you suggest?

  14. Our diagnosis • Cystocercosis? • Treatment: specific drugs against cystocercosis according to the consultation of infectionist and ureteral stenting

  15. Similar cases from the literature Typical oval calcifiedcysticercusin muscles of a hip (Nigeria) CT – calcifiedcysticercus located in a brain near the ventriculus, but in that patient not causing other changes (CT with contrasting) (Egypt)

  16. What is cysticercosis ? - Similarly to other parasitic diseases, cysticercosisis caused by the use of contaminated food or water. Sometimes autoinfectionof the patient already infected with a tape worm is noted. Unlike in the brain (or eyes), in the visceral organs cysticercusare surrounded by the fibrous capsule, but remain alive for several years. Holger Pettersson, MD Professor of Radiology University Hospital Lund, Sweden, 1995

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