2.CASE HISTORY/EXAMINATION
The patient, a 20-year-old female, was admitted to the Department of
Urology on June 24, 2024, due to ”significant weight gain accompanied by
hypertension for 4 years and detection of a left renal mass 15 days
prior to hospital admission”. Four years ago, the patient experienced
significant weight gain without obvious triggers, accompanied by
elevated blood pressure. She was diagnosed with ”hypertension” at a
local hospital and prescribed antihypertensive medication, but blood
pressure control was poor. A urinary CT scan conducted 15 days prior to
hospital admission revealed a ”left renal pelvis mass and right kidney
atrophy.” She reported no significant flank or abdominal pain, gross
hematuria, chills, or fever. The patient sought further diagnostic
evaluation and treatment at our hospital. Since the onset of her
illness, the patient reported normal appetite and sleep, regular bowel
and urinary habits, but occasional menstrual irregularities with
prolonged periods. Her weight increased from 60 kg to 80 kg. Medical
history: Two years ago, the patient underwent bilateral ureteroscopic
laser lithotripsy at a local hospital. On admission on June 24, 2024,
physical examination revealed: Temperature: 36.4°C, Pulse: 85 bpm,
Respiration: 19 breaths/min, Blood Pressure: 135/110 mmHg, BMI: 31.25.
The patient exhibited central obesity, buffalo hump, moon face,
abdominal distension, soft abdomen, and no tenderness in the bilateral
kidney regions.
3. DIFFERENTIAL DIAGNOSIS, INVESTIGATIONS AND
TREATMENT
Auxiliary examination: CT of the urinary system from an external
hospital indicated right kidney atrophy and a possible left renal pelvis
mass. Further CT plain and contrast-enhanced scans after admission
revealed a slightly hypodense tumor at the left renal hilum,
approximately 3.8×2.8 cm in size, with irregular shape and heterogeneous
enhancement. The left kidney was not compressed. CT urography (CTU)
showed normal imaging of the left renal pelvis and ureter with no
filling defects (Figure 1 ).