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A case of gross haematuria

A 74 year old woman present with gross haematuria and vague right side loin pain.

IVU show bilateral normal contrast excretion.

Right kidney measure 12.5cm in size with right full staghorn stone.

Left kidney measure 7.5cm in size with displacement inferiorly.

Subsequent CT scan show a 10cm well defined mass with mixed fatty, and soft tissue components in the left suprarenal area.

The left kidney is displaced downwards and spleen displaced upwards.

A fat plane is still seen between in the left kidney and the mass lesion.

The left adrenal is not seen.

No significant arterial enhancement is seen in the lesion.

No significant abdominal lymphadenopathy is seen.

No abnormal fluid collections are identified.

1. Question: What is the diagnosis of the left side retroperitoneal lesion ?
  1. AML Kidney
  2. RCC Kidney
  3. Myelolipoma Adrenal
  4. CA Adrenal
Answer 1 : Myelolipoma, click here to more detail
2. Question: How would you manage the left side lesion ?
  1. Exploration
  2. Renal angiogram with or without embolization
  3. Observation
  4. Further imaging study
Answer 2 : Exploration, click here to more detail
3. Question: How would you manage the Right side staghorn stone ?
  1. PCNL
  2. Open Surgery
  3. Lap Surgery
  4. ESWL Monotherapy
Answer 3 : PCNL +/- ESWL, click here to more detail
4. Question: Which side you operate first ?
  1. Right
  2. Left
  3. Simultaneously Operation
Answer 4 : Left side adrenal tumour, click here to more detail

Remark: The answer are provided by Dr. Simon Hou, Urology Specialist.