MyPACS.net: Radiology Teaching Files > Case 11573121

previously visited STAGHORN KIDNEY
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 44 year old female
History:

Low back pain; rule out disc herniation/stenosis.

Images:[small]larger

Fig. 1: AP LUMBAR SPINE: Staghorn calculi in left kidney (yellow circle). Note advance degenerative spondylosis at L4-L5.

Fig. 2: LATERAL LUMBAR SPINE: Staghorn calculi in left kidney (yellow circle). Note advance degenerative spondylosis at L4-L5.

Fig. 3: T2 CORONAL / SLICE 1: Staghorn calcifications are demonstrated as hypointense (dark areas) in left kidney.

Fig. 4: T2 CORONAL / SLICE 2: Staghorn calcifications are demonstrated as hypointense (dark areas) in left kidney.

Fig. 5: T2 CORONAL / SLICE 3: Staghorn calcifications are demonstrated as hypointense (dark areas) in left kidney. Notice also advance degenerative spondylosis at L4-L5.

Fig. 6: T2 CORONAL / SLICE 4: Staghorn calcifications are demonstrated as hypointense (dark areas) in left kidney. Notice also advance degenerative spondylosis at L4-L5.
Findings:

XRAY:
X-rays of the lumbar spine and abdomen show diffuse calcification of the left renal calyx and hilar region compatible with staghorn calcification. No history of prior IVP was reported. No other soft tissue calcifications are revealed. There is advanced degenerative disc disease and spondylosis at L4-5 with associated facet arthropathy.


MRI:
L4-L5: There is advanced degeneration of the intervertebral disc with Modic II and III endplate reactive changes. Prominent anterolateral spondylosis is identified measuring 3-4 mm. The dorsal aspect of the intervertebral disc shows approximately 4 mm of annular bulge and spondylosis combined with facet arthropathy to create compression upon the traversing L5 nerve roots. Additionally, there is moderate stenosis of the neural foramen effacing the exiting L4 nerve roots. Spinal canal caliber is therefore stenosed by approximately 30%. Configuration of the canal is triangular. There are small effusions in the zygapophyseal joints.


In the retroperitoneal structures, there are diffuse low-signal T1, low-signal T2 changes of the hilus and calyces of the left kidney. This is consistent with calcification which correlated to the x-ray examination compared at the same time. This calcific process is compatible with a staghorn kidney. The renal parenchyma of the left kidney is isointense to the contralateral right normal kidney. Remaining retroperitoneal structures viewed in this examination are within normal limits.



 

Diagnosis: STAGHORN CALCIFICATION OF THE LEFT KIDNEY.

ADVANCED DEGENERATIVE DISC DISEASE AND SPONDYLOSIS AT L4-L5 WITH PROMINENT 4 MM DORSAL BULGING AND SPONDYLOSIS AND FACET ARTHROPATHY. 

30% CENTRAL CANAL STENOSIS L4-L5.

Discussion:

Staghorn calculus

Renal stone that develops in the pelvicaliceal system, and in advanced cases has a branching configuration which resembles the antlers of a stag. Staghorn calculi are composed of magnesium ammonium phosphate (struvite), which forms in urine that has an abnormally high pH (above 7.2). This high pH usually develops because of recurrent urinary tract infection with microorganisms such as Proteus mirabilis.

Radiographically, struvite stones are of relatively low density, but may have a laminated appearance when combined with calcium salts. Low density struvite stones may not be appreciated on plain radiographs, but can be readily detected by US or CT. Intravenous urography or retrograde pyelography may also be used to demonstrate the typical branching appearance of staghorn calculi.


Click here to read more about staghorn calculus.
References:

REFERRING PHYSICIAN: RONALD BARTAY, DC

Comments:
No comments posted.
Additional Details:

Case Number: 11573121Last Updated: 11-07-2007
Anatomy: Genitourinary (GU)   Pathology: Benign Mass, Cyst
Modality: Conventional Radiograph, MRExam Date: 10-26-2007Access Level: Readable by all users
Keywords: staghorn kidney, staghorn calculi, renal calcifications, renal stones, struvite

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