1. HISTORY: 60 year-old female with bilateral flank pain off and on for two months with associated fevers, chills, nausea, and vomiting. She denies gross hematuria. There is laboratory evidence of a urinary tract infection. She has a history of renal stones with several interventions, the last approximately 10 years ago. The kidney stones were calcium oxalate and struvite stones. Slide 1

2. Describe the findings on the scout film and noncontrast CT (hover the cursor over CT to scroll). Slide 2

3. Scout Image – Bilateral calcific densities overlying the renal shadows Axial Non-contrast CT: - Right kidney: Enlarged, thinning of renal cortex, multiple large communicating cystic structures (measuring water density) consistent with chronic obstruction, many with calcific stones and fragments up to 4 cm, mild hydroureter, distal ureteral stone - Left kidney: single cystic structure, nonobstructing stones, no hydronephrosis or hydroureter -Multiple surgical clips Slide 3

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7. 1)The diuretic renal scan requested to evaluate function and for obstruction. 2)What information has been incorrectly provided and why? 3) What is the likely diagnosis? Slide 7