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What Does The Following X-ray Report Indicate?
Question: I passed stone through urine 2week ago.after that I went for KUB and X-ray and in result I have found 4 tiny stone in my left kidney aNd largest one was 9mm. After 5-6 days I went for IVP and it has found no stone but left PCS was dilated and delayed excretion by left kidney, normal exception by right kidney, normal uptake ,concentration by both kidney.no filling defect or radio opaque shadow noted, no post void residue is seen, no radio opacities seen on contrast study.urinary bladder is normalocated in shape size position outlay. As per this report doctor told me KUB, X Ray & IVP report is contradictory because in IVP there is no stone.
After that doctor ask me to go for Plain CT KUB,for clear reason of dilated PCS and delayed exception by left kidney.the report of Plain CT KUB are as below-
Mildly dilated extra- renal pelvis on left side with abrupt tapering at PUJ with mildly prominent calyces. ..likely PUJ narrowing. A tiny calcification seen in upper pole along the posterior pelvic wall, appears outside the PCS.prominent extra renal pelvic in right kidney.
Both kidney are otherwise normal in size shape and outline.
Ureter not dilated.no obvious radio opacities along ureteric line seen.
Urinary bladder is normal in outline.no obvious focal wall pathology or any filling defect noted.
After that tell me if stone is not present in my KUB then why left PUJ is narrowing and dilated.what may be other cause.doctor further advice me to go for DTPA Renogram.can this test will able to give me the answer what is the reason for narrowing and dilated PCS .if not which test will short out the cause.
After that doctor ask me to go for Plain CT KUB,for clear reason of dilated PCS and delayed exception by left kidney.the report of Plain CT KUB are as below-
Mildly dilated extra- renal pelvis on left side with abrupt tapering at PUJ with mildly prominent calyces. ..likely PUJ narrowing. A tiny calcification seen in upper pole along the posterior pelvic wall, appears outside the PCS.prominent extra renal pelvic in right kidney.
Both kidney are otherwise normal in size shape and outline.
Ureter not dilated.no obvious radio opacities along ureteric line seen.
Urinary bladder is normal in outline.no obvious focal wall pathology or any filling defect noted.
After that tell me if stone is not present in my KUB then why left PUJ is narrowing and dilated.what may be other cause.doctor further advice me to go for DTPA Renogram.can this test will able to give me the answer what is the reason for narrowing and dilated PCS .if not which test will short out the cause.
Brief Answer:
Read Detail answer bello
Detailed Answer:
Hello
Thanks for your query,based on the facts and reports that you have posted it appears that you have delayed function of the Left kidney with dilatation of PC system due PUJ obstruction..
In intrauterine life during development of urinary system ureter the tube that carries urine from kidney to bladder consists of three parts these three portions unite to form one single unit called Ureter .
In 1 % of cases there is fault in process of joining renal pelvis and upper one portion that results in narrowing of the ureter what is called as Pelvi Ureteric Junction Obstruction.(PUJ obstruction).This makes passage of urine through that particular part of the ureter to be delayed or obstructed resulting in to stagnation of urine in kidney which over a period of time(years ) causes dilatation of Renal pelvis and delayed kidney function. If the obstruction is complete these changes are manifested within intrauterine life itself or first few months or 1-2 years after birth .However if the obstruction is partial it takes few years to notice these changes (As in your case).
Presence of PUJ obstruction if detected on IVP is confirmed by a another
Radiological investigations called Retrograde Pyelography.(RGP) where a small tube is passed endoscopically in the lower end of Ureter and a radio opaque XXXXXXX (Urograffin)is injected through this tube (Ureteric Catheter ) and X-ray films are shooted while XXXXXXX is being injected ,This helps to visualize the entire ureter with the site and degree of obstruction.
The test called DTPA scan detects the status of both the kidneys.But it does not demonstrate anatomical site and degree of obstruction,
Please get RGU and DTPA scan done to assess the site ,degree of obstruction and status of kidney function on Lt side .
Further treatment will be decided on results of these tests and final outcome of these tests.
Hope I have answered your query ,please feel free to ask if you have more questions ,
I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Read Detail answer bello
Detailed Answer:
Hello
Thanks for your query,based on the facts and reports that you have posted it appears that you have delayed function of the Left kidney with dilatation of PC system due PUJ obstruction..
In intrauterine life during development of urinary system ureter the tube that carries urine from kidney to bladder consists of three parts these three portions unite to form one single unit called Ureter .
In 1 % of cases there is fault in process of joining renal pelvis and upper one portion that results in narrowing of the ureter what is called as Pelvi Ureteric Junction Obstruction.(PUJ obstruction).This makes passage of urine through that particular part of the ureter to be delayed or obstructed resulting in to stagnation of urine in kidney which over a period of time(years ) causes dilatation of Renal pelvis and delayed kidney function. If the obstruction is complete these changes are manifested within intrauterine life itself or first few months or 1-2 years after birth .However if the obstruction is partial it takes few years to notice these changes (As in your case).
Presence of PUJ obstruction if detected on IVP is confirmed by a another
Radiological investigations called Retrograde Pyelography.(RGP) where a small tube is passed endoscopically in the lower end of Ureter and a radio opaque XXXXXXX (Urograffin)is injected through this tube (Ureteric Catheter ) and X-ray films are shooted while XXXXXXX is being injected ,This helps to visualize the entire ureter with the site and degree of obstruction.
The test called DTPA scan detects the status of both the kidneys.But it does not demonstrate anatomical site and degree of obstruction,
Please get RGU and DTPA scan done to assess the site ,degree of obstruction and status of kidney function on Lt side .
Further treatment will be decided on results of these tests and final outcome of these tests.
Hope I have answered your query ,please feel free to ask if you have more questions ,
I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have gone through DTPA and the report are as follow.
Left kidney-normal in size with normal perfusion, parenchymal tracer uptake and normal clearance.
Right kidney-small in size with adequate perfusion, paeenchymal tracer uptake and normal clearance proportional to its size.
Scan parameter:-
Time to peak (Tmax)(min)-left kidney (4.5), right kidney (4.5)
Differential function (%)-left kidney (84.3), right kidney (15.7)
Differential GFR (ml/min)-left kidney (64.8), right kidney (12.1),
Total GFR (ml/min)-76.9
Impression-small sized right kidney with adequate function and normal clearance proportional to size.
Normal functioning left kidney with normal clearance.
I would like to know that in my CT KUB left PUJ JUNCTION was dilated and abrupt termination than how this report DTPA was not showing this issue.as I was earlier mention that I passed stone through urine before 15 days after that IVP CT KUB performed and shown that my left PCS was dilated and no stone was present. What should I do further.doctor told me that I need not to worry.and I m fine.nothing to do that.but some time I pass yellowish urine and little bit pain in my abdomen left side.is this result of passed stone wound. What I should do.
Left kidney-normal in size with normal perfusion, parenchymal tracer uptake and normal clearance.
Right kidney-small in size with adequate perfusion, paeenchymal tracer uptake and normal clearance proportional to its size.
Scan parameter:-
Time to peak (Tmax)(min)-left kidney (4.5), right kidney (4.5)
Differential function (%)-left kidney (84.3), right kidney (15.7)
Differential GFR (ml/min)-left kidney (64.8), right kidney (12.1),
Total GFR (ml/min)-76.9
Impression-small sized right kidney with adequate function and normal clearance proportional to size.
Normal functioning left kidney with normal clearance.
I would like to know that in my CT KUB left PUJ JUNCTION was dilated and abrupt termination than how this report DTPA was not showing this issue.as I was earlier mention that I passed stone through urine before 15 days after that IVP CT KUB performed and shown that my left PCS was dilated and no stone was present. What should I do further.doctor told me that I need not to worry.and I m fine.nothing to do that.but some time I pass yellowish urine and little bit pain in my abdomen left side.is this result of passed stone wound. What I should do.
Brief Answer:
You need not worry as both the kidneys are functioning well
Detailed Answer:
Hello
Thanks for follow up and uploading DTPA scan report.Your Rt Kidney is small but functioning to its full capacity and Left one is normal functioning normally.
Since both the kidneys are functioning well you need not worry at all.Ultimately it is kidney function that is important than any anatomical defect which is reported in X-Ray,I.V.P and C.T scan.It should be taken as a human error in perception or difference of opinion.,
Thanks and Regards.
Dr.Patil.
You need not worry as both the kidneys are functioning well
Detailed Answer:
Hello
Thanks for follow up and uploading DTPA scan report.Your Rt Kidney is small but functioning to its full capacity and Left one is normal functioning normally.
Since both the kidneys are functioning well you need not worry at all.Ultimately it is kidney function that is important than any anatomical defect which is reported in X-Ray,I.V.P and C.T scan.It should be taken as a human error in perception or difference of opinion.,
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can it be possible that due stone passed through urine previously there might be some wound in PUJ , due to that left PCS was dilated and later on it recovered by itself and the report shows normal functioning. Can it be possible.
Brief Answer:
P.C.Systemdilataion can be due to stone pwhich has passed recently .
Detailed Answer:
Hello
Thanks for follow up.PC system dilatation can be due to stone impacted at PJU .This dilatation remains for couple of days even after stone has passed out .This is likely this what has happened in your case during interval of CT scan and DTPA scan.
Second possibility of PC dilatation is due to spasm of PU junction while doing IVP or CT Scan
Thanks and Regards.
Dr.Patil.
P.C.Systemdilataion can be due to stone pwhich has passed recently .
Detailed Answer:
Hello
Thanks for follow up.PC system dilatation can be due to stone impacted at PJU .This dilatation remains for couple of days even after stone has passed out .This is likely this what has happened in your case during interval of CT scan and DTPA scan.
Second possibility of PC dilatation is due to spasm of PU junction while doing IVP or CT Scan
Thanks and Regards.
Dr.Patil.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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