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RENAL UNIT CASE 2 |
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Clinical History: A 52-year-old man was seen by a physician for a routine check up five years after his last medical visit. He had no complaints. Past history included only a fractured fibula at age 33 and appendectomy at age 27. BP was 145/95 mm Hg. Temperature was 38°C. A mass was palpated in the left upper abdomen and flank. It was very slightly tender and moved very little with respiration. The rest of the P.E. was normal. The urinalysis was normal except for the presence of 25-50 RBC/HPF. BUN and serum creatinine were normal. Hematocrit was 48%. Questions: 1. What is the differential diagnosis of a mass in the flank? Does the presence of hematuria, as the only urine abnormality, narrow the differential diagnosis? 2. How would you proceed to evaluate this patient? 3. Figure 1 shows the results of a procedure. What is the procedure? How do you interpret it? 4. Figure 2 shows the results of a second procedure? What would you do next? 5. Figure 3 and Figure 4 show results of a third procedure. Figure 5 and Figure 6 show a similar tumor from another patient. 6. What is the prognosis? What information from clinical and pathological studies would help you to determine the prognosis? (After answering, see Figure 7). 7. What symptoms and signs are lacking in this patient that are frequently encountered in patients with the same disease? Why the fever? The hypertension? |
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