Case Report Renal Scan Performed On A 60 Year Old Female (Coursework Sample)
Patient: Female, 60
Medical history: reported to hospital with left flank pain. Pain started within the last 1-2 days, associated with nausea and vomiting. She has a history of diabetes, hypothyroid, left UPJ obstruction and UPJ repair in November 2017. She has failed to follow up as recommended following that procedure.
Reason for the Nuclear Medicine scan: Hydronephrosis.
(Here Discuss the pathology and cite)
Previous: CT of the abdomen and pelvis due to left flank pain on March 2018
The right kidney appears homogenous, with no mass or hydronephosis. But there's moderate left sided hydronephrosis. There are a few calcifications notes within the wall of the left renal pelvis
Patient preparation: patient was advised to be hydrated prior to the study. procedure was explained, IV was started. Patient was supine. Field of view was the kidneys and bladder.
Indications and Contraindications: (must be cited)
Collimator: low energy high resolution
Matrix: 128x128 for the initial flow and dynamic acquisition. 256x256 for pre and post void static images.
Radiopharmaceutical: Tc-99m MAG3, 10 mCi. Patient received 40mg Lasix intravenously 20 minutes after injection of isotope. (Here you can add what Lasix is used for during this scan and cite)
Photopeak/window: 20% centered at 140 keV
Views performed: started the renal scan with a bolus injection for the Initial flow images for 60 seconds, followed immediately by the acquisition of 39 minutes of dynamic images. Static Pre and immediate post void images for 2 minutes each.
Method of localization: active transport followed by tubular secretion.
Radiologist report for the renal scab: blood flow shows asymmetric decreased perfusion to the left kidney relative to the right kidney. Abnormal split function: left kidney 23.4%, right kidney 73.6%
Findings compatible with persistent left UPJ obstruction with asymmetric decreased left renal function. Normal function of the right kidney.
Post void images show persistent radiotracer accumulation in the dilated left renal pelvis. No retention of radiotracer in the right kidney.
In the conclusion also add further imaging or treatment for diagnosed pathology. (Hydronephrosis)
This case report is about a renal scan which was performed on a 60-year-old female. This examination was performed because the patent had reported to the hospital with left flank pain, which had started within the last 1-2 days. The pain was associated with nausea and vomiting. Additionally, she also has a history of diabetes, hypothyroid, left Ureteropelvic junction (UPJ) obstruction. IN November 2017, she underwent a Ureteropelvic junction repair. Also, she has failed to follow up as recommended following that procedure. The Doctor had recommended a renal scan to examine hydronephrosis.
Regarding the previous medical history, the patient had undergone a CT scan in March 2018 for the abdomen and pelvis due to left flank pain. The right kidney appeared homogeneous, with no mass or hydronephrosis. But there was a moderate left-sided hydronephrosis. There were a few calcifications notes within the wall of the left renal pelvis.
Hydronephrosis is a condition which occurs when one or both kidneys start swelling as a result of urine not draining from the kidney and starts to build up instead. This can happen as a result of anatomical defect or blockage of the tubes which carry urine from the kidneys. These prevents urine from draining correctly (Mayo Clinic, 2018). This condition can occur at any age. In a child, Hydronephrosis can be diagnosed during infancy or throughout the prenatal ultrasound meetings before a child is born.
The cause of hydronephrosis include; partial blockage of the urinary tract, most often urinary tract blockage occurs at the ureteropelvic junction, the point where the kidney meets the ureter. Sometimes blockages may occur at the ureterovesical junction, where ureter meets the bladder. The other primary cause is vesicoureteral reflux which occurs when the urine begins flowing backward from the bladder to the kidneys through the ureter (Mayo Clinic, 2018). This usually causes the kidneys to swell since it becomes difficult for them to empty the urine.
Hydronephrosis is not a disease, and it may be caused by internal and external conditions which affect the kidneys and the urinary collection system. One of the major cause is acute unilateral obstructive uropathy. A sudden development of obstruction which affects one of the ureters, the tubes which connect the bladder and the kidneys (Healthline, 2018). The blockage may be caused by kidney stones and may also be caused by blood clots. Other potential cause of blockage may include pregnancy which leads to compression due to the growing fetus, tumours near the ureter, an enlarged prostate gland in men and narrowing of the ureter (Healthline, 2018).
Concerning radiopharmaceuticals, the patient was administered with 10mCi of Tc-99m MAG3 (mercaptoacetyltriglycine) this was done intravenously in the right arm. Twenty minutes after injection of isotope the patient also received 40mg of furosemide (a Lasix), this was also done intravenously (Cheng, 2014). The methods of localization used were active transport followed by tubular secretion. The use of the Lasix was to make the kidneys perform harder and make any possible obstructions easier to locate on the images taken (Chang & Nandurkar, 2018). The primary indications of hydronephrosis include flank pain, groin and abdominal pains. Other indications include nausea, renovascular hypertension, and pain during urination, fever and incomplete urination (National Kidney Foundation, 2015). They depend on the cause and severity of the urinary blockage.
Concerning contraindications, the patient should not undertake this medical test if she is preganant. Additionally, if the patient is breastfeeding she should postpone this medical procedure because the radiopharmaceutical is excreted into the breast milk. In case she undergoes the examination she should stop breastfeeding for twenty-four hours to avoid transmitting radiations to the child. If the patient is significantly overweight, she might not be allowed to take the test because most gamma cameras have weight limits ranging from 160 t0 220 kilograms (Chang & Nandurkar, 2018). Also, if the patient is undergoing other nuclear medication, she should postpone this examination to avoid complications. In a normal, the radiopharmaceutical spreads uniformly and is equally absorbed. For abnormal results the tracer is unevenly absorbed, this causes hot spots which are seen as dark spots. They denote the areas where the radioactive material is excessively absorbed and may signify the affected parts.
The patient was identified by checking her wristband and confirming whether her name and the date of birth matched the details provided in the test order. It was then verified that the patient was recommended to undergo the renal scan by the physician. The procedure was explained, IV was started and the patient was advised to drink extra fluids to stay hydrated. Also, the patient was asked to remain in the nuclear room in spine for a few hours to allow the radioactive material to get absorbed and circulate to the field of view; kidneys and bladder.
Both anterior and posterior views were performed after three to four hours after being injected with the radioactive material (Vidal et al., 2017). The views performed started with a renal scan with a bolus injection for the initial flow images for 60 seconds, followed immediately by the acquisition of 39 minutes of dynamic images. Static, pre and immediate post void images for 2 minutes each. The collimator used was Low Energy High-Resolution. The matrix size used for the initial flow and dynamic acquisition was 128x128 while that for pre and post void static images was 256x256. Photopeak/window was 20% centred at 140 keV (Lanis, Onwugbenu & Bourjeily, 2017).
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