CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 15 Solitary or Multiple Filling
Defects in the Pelvocalyceal System

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GU 15-1 Cystine stones. (A) Plain film
shows multiple radiopaque calculi. (B)
Excretory urogram demonstrates the stones as
lucent filling defects in the opacified renal
pelvis.

4. Fig GU 15-2 Xanthinuria. A large lucent stone (arrows) almost fills
the right pelvocalyceal system.

5. • Fig GU 15-3 Blood clot. Large filling defect with a
smooth contour (arrows). A CT scan showed the
attenuation value of the blood clot to be 62 H, a
density higher than that of transitional cell
carcinoma but lower than that of a nonopaque
stone.13

6. • Fig GU 15-4 Transitional cell carcinoma of the
renal pelvis in two patients. (A) A small filling
defect (arrow) in the renal pelvis simulates a
blood clot, stone, fungus ball, or sloughed
papilla. (B) A huge mass fills virtually all the
renal pelvis.

7. • Fig GU 15-5 Transitional cell carcinoma of the renal
pelvis. A small filling defect occupies an interpolar calyx
(arrows). Although the defect might at first be mistaken
for a large but otherwise normal papilla, the many
small contrast stipples and the suggestively irregular
border make its neoplastic nature evident.14

8. • Fig GU 15-6 Sloughed papillae in papillary necrosis. A ring of
contrast material (long arrows) surrounds a triangular lucent filling
defect, which represents an almost complete papilla that has been
separated from the rest of the renal parenchyma. The short arrows
point to less severe extension of contrast material from the calyces
into the papillae.7

9. • Fig GU 15-7 Fungus ball in renal candidiasis.
Retrograde pyelogram demonstrates a large
filling defect (arrows) in the left renal pelvis.15

10. • Fig GU 15-8 Acute pyelonephritis. Linear
striations (arrow) in the right renal pelvis.