Quiz Question: What is your diagnosis?
Computed tomography showed a classic balloon-like shape (“balloon on a
string” sign1) in grade IV hydronephrosis with gross
dilatation of the renal pelvis and calyces. The indistinguishable
corticomedullary differentiation, membrane-like residual cortex
(parenchymal rim), indicates renal atrophy2. In the
present case, the very small caliber of the left ureter suggested
ureteropelvic junction stricture. The diagnosis was urosepsis secondary
to obstructive hydronephrosis. Hydronephrosis is one of the leading
causes of severe urinary tract infection and renal dysfunction which
should beware of ongoing sepsis. Escherichia coli was isolated
from both urine culture and blood culture. After emergent percutaneous
nephrostomy and antibiotic treatment by cefmetazole, he was discharged
two weeks later with recovered renal function.