A DTPA scan and CT of the Urinary tracts was requested to ascertain the size, location and function of an enlarged LT kidney.
The images and findings are as follows:
DTPA renal scan
Regional scintigraphy was performed following intravenous injection of tracer.
There is normal perfusion to the right kidney in the flow phase of the study with photopaenia demonstrated in the left flank at the site of the known large left kidney.
Delayed images demonstrate good extraction, excretion and clearance on the right kidney with only small areas of extraction in the large left renal kidney.
Differential function left 15%: right 85%
There is normal perfusion and function by the right kidney with markedly reduced perfusion and function by the large left renal kidney. Due to the marked impairment of function by the large left kidney obstruction can be neither confirmed or excluded.
CT Urinary tracts
The post contrast study has been performed in the arterial and the delayed phases and correlated with the nuclear study.
There is an enlarged (18cm), grossly hydronephrotic left kidney which is shows a thin rim of enhancing nephrographic cortex. (3-4mm).
The left ureter is normal in calibre.
In the delayed series there is some excretion noted and it would be in order of 10-15% which would correlate very well with the nuclear medicine functional study.
There is a normal right kidney with a normal collecting system and ureter on that side and normal appearances of the bladder.
No other relevant findings on the study.
Normal right kidney collecting system and bladder.
Chronic left PUJ obstruction with gross hydronephrosis and thinning of the renal cortex.