A 42-year-old woman with a history of fibromyalgia, interstitial cystitis, and frequent urinary tract infection complains of three weeks of fever, malaise, decreased intake by mouth, weight loss, and left flank pain.  She was seen by her primary medical doctor today and sent here “for blood tests”: “he wants you to figure out what’s wrong with me – I get a UTI every month!”

On arrival, T 37.9 HR 96 146/80 RR 20 98% RA.  She is anxious and is reticent to allow you to examine her completely.  Her general exam is normal, and has left costovertebral pain with percussion and mild suprapubic tenderness to palpation.  Due to her recurrent infections, you suspect an anatomic lesion; computed tomography with IV contrast shows a heterogeneous, hypoechoic mass around a small hyperechoic density in a non-functioning left kidney.  Regarding her presentation, which of the following is the BEST answer:

    A. Based on CT findings, consult Hematology-Oncology
    B. Based on CT findings, consult Infectious Diseases
    C. Based on CT findings, consult Vascular Surgery
    D. Based on CT findings, consult Urology

In the meantime, a quote --   "It is extremely difficult for a physician who puts too much trust in what he reads to form a proper decision from what he sees."   -- Andrew Boorde (1490-1549), Physician and Carthusian monk


12/07/2012 4:25pm

Not 100% sure, but I would say urology consult. This sounds like renal cell carcinoma and urology would likely have to do a cystoscopy and kidney biopsy prior to nephrectomy.


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