As the CT scan had shown increased adipose tissue that compressed the bladder and the rectum, the diagnosis of pelvic lipomatosis was made based on the clinical and the radiological findings. Since renal function was unimpaired and symptoms attenuated, the conservative management with close follow up was decided.
- The differential diagnoses : any pelvic mass that compress bladder and the ureters.
- No further investigations is needed.
- Pelvic lipomatosis is the likely diagnosis.
- No treatment should be done. conservative management with close follow up only.
An emergency CT scan was performed which showed a large aneurysm of the right common iliac artery in the Process of rupturing, and a small aneurysm of the left iliac artery. The patient was still haemodynamically stable when he was transferred to the vascular surgery department to undergo immediate surgery. However, he developed multiple complication =s, underwent surgery several times and eventually died in hospital a month later.
When the gas seen in the wall of the bladder, it is emphysematous cystitis. When the gas outlining the collecting system, it is emphysematous pyelitis. This infection is caused by gas forming organism. Renal pelvic gas may be due to reflux of gas after instrumentation. But large amount of gas as we see in the bladder and the left upper calyx, mostly caused by Colovesical fistula due to Diverticulitis, Crohn’s disease and carcinoma of colon.
As you see there is DJ stent , but the DJ stent end at a level above the ischeal spine , the landmark at which the ureter enter the bladder.
this give us a hint that the DJ stent not reach the bladder.
The next step is URS and removal of the stent.
this is Angiokeratoma of the scrotum
This x ray is a plane X ray of 20 year old women with stage horn stone and other 7 stones in the middle and lower pole stone, Rt. pyelolithotomy has been done and the stone has been extracted, as shown above.
As we see, there is calcified bladder wall and as a result of that there is a bilateral ureteric dilation.
this is due to schistosomiasis of the bladder (Bilharzial infection)