Category Archives: Spot diagnosis

Spot diagnosis 42

This 50 year old man presented with left loin pain which he had for 3 months, associated with some hypogastric pain. The patient had normal body mass index and there was no urological history. Clinical examination was normal. Serum creatinine and blood urea were 0.9 mg/dl and 39 mg/dl, respectively. Abdominal ultrasound showed bilateral grade II hydronephrosis with bilaterally dilated ureters, but no other abnormalities.

There was no post-void residual. Intravenous urography confirmed bilateral grade II-III hydronephrosis and bilaterally dilated ureters and showed a marked deformation and compression of the bladder, with elevation of bladder base, giving the appearance of a “pear” or “ reversed teardrop” (Figure 1 and 2).

A cystoscopy was performed which was difficult due to angulation of the bladder neck which showed an elongated prostatic urethra, normal bladder mucosa and a cranial elongation of the bladder which made the visualization of the whole bladder difficult. The ureteric orifices were situated very close to the bladder neck.

  1. What differential diagnoses should be considered?
  2. Are further investigations needed?
  3. What are likely diagnosis?
  4. What treatment should be done?

The case provided by Dr. Justin Aurelian, Prof.Dr.Th.Burghele Hospital, Bucharest, Romania. European Urology Today)


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Spot diagnosis 41

A 77 year old man presented as an emergency with severe right inguinal pain of sudden onset radiating caudally and voiding difficulties. Due to the pain the patient was unable to lie still. The history consisted of 35 pack years of cigarette smoking and moderate alcohol consumption but was otherwise unremarkable. Current medication clopidogrel and Tamsulosin. Body mass index was 32 and on physical examination a mass was palpable in the middle lower abdomen. Urinalysis show microhaematuria but no sign of infection.

Ultrasound show a fluid filled non-echogenic structure in the middle lower abdomen and mild dilation of both renal pelvicalyceal systems, more pronounce on the right side. A plain abdominal x-ray showed calcifications in the lower pelvis (shown above) A transurethral catheter was inserted but drained only 30 ml of urine and did not alleviate the pain.

What are likely differential diagnoses?

What further diagnostic management is helpful?


(Case provided by Proph. Malte Böhm and Dr. Hans Peter Stockamp, Drill-Kliniken, Drillenburg, Germany. European Urology Today)


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Spot diagnosis 40


A middle age female presented with recurrent UTI . Urine culture show multiple gram negative  organisms. IVU was done. What is the most likely diagnosis?


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Spot diagnosis 39

A 52 year old female KUB . described what you see? what is the next step?

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Spot Diagnosis 38

  1. What is the name of this scrotal skin lesion.

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Spot Diagnosis 37

What is this type of x ray ? described what you see in this x ray?

what is the treatment?

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Spot Diagnosis 36


This patient underwent an evaluation for microhematuria and pyuria. Past history was remarkable for an extensive travel history including trips to Africa and China. An IVU was obtained and shown.

What is the most likely diagnosis?


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