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Wegener's granulomatosis: a rare cause of hydronephrosis.

Lillaz J, Bernardini S, Algros MP, Bittard H, Kleinclauss F - Case Rep Med (2011)

Bottom Line: Alithiasic ureterohydronephrosis was diagnosed by imaging.After surgical excision of the ureteral lesion, the Wegener's granulomatosis diagnosis was established.This report is the clinical description of a case of "atypical" Wegener's granulomatosis revealed by the onset of a ureteral disease mimicking a neoplastic process.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Renal Transplantation, University Hospital Saint Jacques 2, Place Saint Jacques, 25030 Besançon, France.

ABSTRACT
A seventy-one-year-old woman was hospitalized at our institution for a right-sided "renal colic" associated with an infectious background. Alithiasic ureterohydronephrosis was diagnosed by imaging. A urinary diversion was thus performed using a double J endoureteral stent. The etiologic assessment of the hydronephrosis showed the presence of a periureteral mass that caused extrinsic ureteral compression. After surgical excision of the ureteral lesion, the Wegener's granulomatosis diagnosis was established. This report is the clinical description of a case of "atypical" Wegener's granulomatosis revealed by the onset of a ureteral disease mimicking a neoplastic process.

No MeSH data available.


Related in: MedlinePlus

Abdominal computerized tomography performed after urinary diversion by ureteral stent. The figure shows a right iliac ureteral mass (white arrow) below the right iliac artery cross.
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fig1: Abdominal computerized tomography performed after urinary diversion by ureteral stent. The figure shows a right iliac ureteral mass (white arrow) below the right iliac artery cross.

Mentions: The treatment led to an increase in creatinine clearance, but the chronic fever and biological inflammatory syndrome persisted. At this stage, the bacteriological urine and blood samples had excluded urinary sepsis. A computerized tomography urography was then carried out. It showed a periureteral infiltration involving iliac vessels (Figure 1). Urine cytology showed nonspecific inflammatory and dystrophic cells but did not confirm the presence of a transitional cell carcinoma. The urinary sediment showed microscopic hematuria and proteinuria. The X-ray and computerized tomography of the patient's chest were normal. This led us to carry out a flexible ureterorenoscopy, which revealed an intraluminal mass. The biopsy of this mass showed inflammatory tissues but no transitional cell carcinoma. A PET scan was then performed. High fixation levels were found in the right ureter, ENT area, left lung, L4-L5 vertebra and spleen (Figure 2), which caused us to suspect lymphoma. This hypothesis was, however, ruled out by complementary tests. The clinical examination of the ENT area was normal.


Wegener's granulomatosis: a rare cause of hydronephrosis.

Lillaz J, Bernardini S, Algros MP, Bittard H, Kleinclauss F - Case Rep Med (2011)

Abdominal computerized tomography performed after urinary diversion by ureteral stent. The figure shows a right iliac ureteral mass (white arrow) below the right iliac artery cross.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3090674&req=5

fig1: Abdominal computerized tomography performed after urinary diversion by ureteral stent. The figure shows a right iliac ureteral mass (white arrow) below the right iliac artery cross.
Mentions: The treatment led to an increase in creatinine clearance, but the chronic fever and biological inflammatory syndrome persisted. At this stage, the bacteriological urine and blood samples had excluded urinary sepsis. A computerized tomography urography was then carried out. It showed a periureteral infiltration involving iliac vessels (Figure 1). Urine cytology showed nonspecific inflammatory and dystrophic cells but did not confirm the presence of a transitional cell carcinoma. The urinary sediment showed microscopic hematuria and proteinuria. The X-ray and computerized tomography of the patient's chest were normal. This led us to carry out a flexible ureterorenoscopy, which revealed an intraluminal mass. The biopsy of this mass showed inflammatory tissues but no transitional cell carcinoma. A PET scan was then performed. High fixation levels were found in the right ureter, ENT area, left lung, L4-L5 vertebra and spleen (Figure 2), which caused us to suspect lymphoma. This hypothesis was, however, ruled out by complementary tests. The clinical examination of the ENT area was normal.

Bottom Line: Alithiasic ureterohydronephrosis was diagnosed by imaging.After surgical excision of the ureteral lesion, the Wegener's granulomatosis diagnosis was established.This report is the clinical description of a case of "atypical" Wegener's granulomatosis revealed by the onset of a ureteral disease mimicking a neoplastic process.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology and Renal Transplantation, University Hospital Saint Jacques 2, Place Saint Jacques, 25030 Besançon, France.

ABSTRACT
A seventy-one-year-old woman was hospitalized at our institution for a right-sided "renal colic" associated with an infectious background. Alithiasic ureterohydronephrosis was diagnosed by imaging. A urinary diversion was thus performed using a double J endoureteral stent. The etiologic assessment of the hydronephrosis showed the presence of a periureteral mass that caused extrinsic ureteral compression. After surgical excision of the ureteral lesion, the Wegener's granulomatosis diagnosis was established. This report is the clinical description of a case of "atypical" Wegener's granulomatosis revealed by the onset of a ureteral disease mimicking a neoplastic process.

No MeSH data available.


Related in: MedlinePlus