A 69-year-old man with a history of recurrent pancreatitis treated with corticosteroids now has increasing fatigue for 2 years. He does not drink alcohol and has no evidence of gallbladder disease. On examination, there are no abnormalities. Laboratory studies show his serum creatinine is 5 mg/dL and urea nitrogen is 48 mg/ dL. His serum IgG4 is elevated. Ultrasound imaging shows bilateral hydronephrosis. What is abdominal CT imaging most likely to show in this man?
Bilateral hydronephrosis, without hydroureter or bladder dilation, suggests that the problem involves both ureters. Obstructive uropathy has led to chronic renal failure with uremia. The elevated IgG4 suggests a fibroinflammatory process with IgG4-secreting plasma cells in the retroperitoneum; this process is part of autoimmune pancreatitis and may also involve the biliary tract, salivary glands, and lungs, but is not associated with the other listed choices. Nephrolithiasis could cause ureteropelvic junction obstruction, but bilaterality would be uncommon. Polypoid cystitis results from inflammation but may mimic a tumor mass, and could obstruct one or both ureteral orifices with hydroureter. Renal cell carcinoma is likely to be unilateral but may cause only focal obstruction. Urothelial carcinomas may be multifocal but are unlikely to obstruct both ureters simultaneously.
Nephrolithiasis
Polypoid cystitis
Retroperitoneal fibrosis
Renal cell carcinoma
Male Genital Tract