Medical history A 58-year-old female patient comes to the emergency department presenting fever for the last 2 days, associated with dysuria and left thoracolumbar pain. She reports recurrent pyelonephritis in the last 4 years. She also had a diagnosis and surgical treatment of colon carcinoid tumor fifteen years ago, and has irregular cancer monitoring nowadays. Routine urinalysis presents parameters suggestive of urinary tract infection (UTI). A computed tomography (CT) of the abdomen and pelvis was requested. Image 1: Contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis, coronal reconstruction, without intravenous contrast medium.Image 2: CT scan , axial section, L2 level, after intravenous administration of contrast medium (arterial phase).Image 3: CT scan of the abdomen and pelvis, coronal reconstruction, after intravenous administration of contrast medium (arterial phase).Image 4: CT scan of the abdomen and pelvis, coronal reconstruction, after intravenous administration of contrast medium (excretory phase). Question:Considering the clinical case and the complementary images showed above, which condition below best explains the clinical evolution of this patient? Left hydronephrosis due to iliac lymphadenopathy Left xanthogranulomatous pyelonephritis Left hydroureteronephrosis secondary to idiopathic retroperitoneal fibrosis Left hydroureteronephrosis secondary to calculus obstruction of the ureter Test question (Cruz Vermelha’s Hospital - PR - Urologia - 2014) It is a chronic disease, often leading to destruction of the renal parenchyma. It is more common in middle-aged women. Fever, general malaise and palpable renal mass may be present. Granulomas, abscesses and Foam Cells (macrophages loaded with lipids) are found in the renal parenchyma.Question:The description above characterizes which of the diseases below: pyelonephritis complicated by calculations clear cell renal neoplasia renal infarction due to renal artery stenosis xanthogranulomatous pyelonephritis grade IV hydronephrosis due to ureteral obstructive process Time is Up! Time's up
