Interesting case

12/2/2012

IB 4252
Sex : Woman Age : 70 years
Address : Kalasin Occupation : -

History
Chief complaint
Left flank pain 1 month PTA

History
Present illness
1 month PTA, she complained with dull aching pain at left flank. She had low grade fever. Urination was normal.

History
Present illness
1 week PTA, the pain was not improved. She decided to go to Kalasin Hospital. The ultrasound was performed. The abnormal findings was her left kidney. Finally, CT scan was done and sent her to Srinagarind Hospital.

History
DM Type II No drug allergy No previous Sx

Physical examination
Elderly woman BT 36.8 PR 70 RR 20 BP 110/70 HEENT : mild pale, no jaundice, LN-ve Heart : NAD Lungs : NAD

Physical examination
Abdomen
Soft, no point of tenderness No mass, liver & spleen : impalpable Shifting dullness : negative

Ext : no edema PR : empty rectum, no mass CVA : tender at left side

CBC+plt
Hb 7

Bun 8 Na 130

Cr 0.7 K 2.7

Hct 21 WBC 16800 Plt 327000 PMN 98

L1

HCo3 20 98Cl UA Sp.gr 1.008 WBC 10-20 pH 6 RBC 0-1

Imaging
Film CXR Film KUB Ultrasound CT scan

Woman, 70 years
What is next step?

Woman, 70 years
Provisional Dx
Left Perirenal Collection

Etiological DDx
Perirenal hematoma Perirenal abscess Renal tumor

Operation
Dx
Left Perirenal hematoma

Procedure
Ultrasound guided percutaneous drainage
Fluid for culture, AFB, cytology

Thank You