Wunderlich syndrome with spontaneous renal hemorrhage into renal angiomyolipoma.

Wunderlich syndrome is a rarely entity. We report our case of a 60-year-old female, who presented in the emergency medicine department with acute right flank pain, tender mass right upper quadrant abdomen, hypotension, and visible hematuria. Urgent computerized tomogram confirmed bleeding in the right renal angiomyolipoma. Selective angioembolization was done. The patient recovered and was sent home after 1 week. On follow-up after 1 month, she is doing fine, and on ultrasound, AML had interval decrease in size.

Leaking abdominal aortic aneurysm mimicking ureteric colic: So rare but so real in Middle East.

Aortic aneurysms are very rare in Middle East unlike Europe and America. Therefore, this pathology is very likely to be missed in acute presentation to the Emergency Medicine Department. We present a case of leaking abdominal aortic aneurysm mimicking right ureteric colic, which was missed in the initial assessment.

Renal cell carcinoma: Atypical metastasis to inguinal lymph nodes.

Renal cell carcinoma (RCC) is a common tumor of the urinary tract. It is known to have variable presentations due to the extremely vascular nature of the organ. RCC are known to metastasize to lungs, bone, and brain commonly but atypical metastasis to various sites are reported in literature but as very rare pathology. We report a case of a 60-year-old female who presented with multiple inguinal and axillary lymph node enlargements which on excision biopsy showed metastatic RCC. RCC can present with synchronous metastatic deposits in the various organs. RCC can metastasize to some atypical sites as well such as thyroid, orbit, and neck as mentioned earlier in literature. The patient presenting with extra-regional lymph nodes like inguinal and axillary is extremely rare, and so far only one clinical case could be found from India in 2008. A 61-year-old female presented in the emergency department with left flank pain and hematuria. Imaging showed left swollen kidney but multiple lymph nodes in retroperitoneum, left inguinal and axillary region. Excisional biopsy confirmed metastatic renal clear cell carcinoma. The case was referred to an oncologist after left radical nephrectomy for further treatment. Renal cancer is quite common aggressive disease. Due to its vascular nature, it may present quite atypically as evident from literature. Although treatment of metastatic carcinoma is still controversial surgery is the mainstay of treatment and guidelines consider metastasectomy and cytoreductive nephrectomy as valid option followed by targeted systemic therapies. RCC has quite a high potential to metastasize in the versatile pattern, in our case, it is evident that valid management is still surgery but needs support from the multidisciplinary team.

Spontaneous retrograde migration of ureterovesical junction stone to the kidney; first ever reported case in the English literature in human.

We present a case of spontaneous retrograde migration of ureterovesical junction stone to the kidney. A 26-year-old Bahraini male, diagnosed with left lower ureteric stone 7 months before this presentation. On his recent presentation, the stone has migrated down but not passed, confirmed on imaging. Operative removal was planned. X-ray kidney ureter bladder (KUB) in the morning of surgery did not reveal stone in the ureter, but the same shadow was seen in the kidney. An urgent computerized tomography-KUB was done, and this confirms the stone has migrated to the kidney. Surgery was canceled, and the stone was dealt with extracorporeal shockwave lithotripsy and was fragmented in the first session. This retrograde migration of lower ureteric stone to the kidney is not reported in the English literature in human before.

An undiagnosed giant right renal hydatid cyst treated laparoscopically: Case report and review of literature.

Hydatid disease caused by the tape worm Echinococcus granulosus is a rare occurrence in the urinary system in general. We are hereby presenting a case of a gentleman in his fourth decade with a giant right renal hydatid cyst. The clinical manifestations, radiological features, and serology were all not suggestive of hydatid disease; however, typical Echinococcus scolices were detected histologically following cyst aspiration. The giant cyst was successfully treated laparoscopically.

Calciphylaxis mimicking penile gangrene: a case report.

Calciphylaxis is a rare, but life-threatening, disease, mostly seen in patients with renal failure, especially those undergoing dialysis. It is characterized by violaceous tender areas of cutaneous plaques, necrosis, and eschar formation, mostly involving toes and fingers, but rarely the penis. Peripheral pulses are mostly preserved. The parathyroid hormone (PTH) level is elevated, along with raised calcium phosphorus product. There is radiological evidence of blood vessel and soft tissue calcification. Predisposing factors are obesity and diabetes. It is rarely encountered by a urologist and closely resembles penile gangrene.

Tuberculous pyonephrosis involving duplex kidney: first reported case.

We report a case of tuberculosis (TB) involving duplex kidney that has not been reported in the literature so far. Conservative surgery was done, which was effective in our case.