06 January 2011

The life-saving kidney stone

I was a little surprised when I heard the unit clerk call out to me, "Dr S, the radiologist is on line three for you. Says it's about room 8."

Room 8? I mused as I disengaged from the patient I was with and went to answer the phone, That's odd. Why would he be calling me about Room 8?

The man in Room 8 was a guy with a classic kidney stone. Came in with sudden onset right flank pain, writhing and covered in sweat. He had blood in his urine. It was as clear as could be. He felt better after some meds and went off to CT.  Now as a rule, the radiologists only call us for Bad Things or Weird Things, and in this case I was not suspecting either. Would the radiologist call me just for a routine stone?

I pulled up the images on the computer as I answered the phone.  Sure enough, there was a big ol' stone there in the right mid ureter. I saw it just as the radiologist was telling me about it. 3x7mm -- that's gonna hurt to pass. But what? The kidney? OK, I'll scroll up through that as well.   

Oh.

A largish dense mass on the inferior pole. Almost certainly renal cell carcinoma.  That's why he was calling me.

So the patient went back to scan for contrast-enhanced images to verify it, and sure enough, that's what it was. 

(image source; my patient's tumor was smaller -- about 5 cm)

The good news for my patient was that the cancer seemed quite localized and without evidence of metastases. This is very important, since Renal Cell Carcinoma is amenable to a surgical cure when caught early, and pretty lethal when it has spread. I reviewed the images with our urologist who thought that he was a great candidate for nephron-preserving surgery, i.e. a partial nephrectomy. 

So I had to drop the hammer on him. Worse, it was Christmas Day. Worse (for me), it was my first shift back since my wife's diagnosis. Neither of us were really in a good place to deal with a new cancer diagnosis. But this case had an unusual bright side. Were it not for that kidney stone, I told the patient, you would never have needed that CT scan. Without this early detection, we would never have found this cancer while it was still curable. Kidney stones suck, but this particular kidney stone saved your life!

Sometimes it's all about Luck.

6 comments:

  1. Good news for him. Holding good thoughts for your wife and her dx.

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  2. I always always wish the best for Liza too.

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  3. LiberalNephDoc1/08/2011 9:25 PM

    I had a run of patients like this last year - three I think, all of them young - 30s. One was on on-the-job accident and two of them laid their motorcycles down - they all had trauma CTs that incidentally identified renal masses (and I see them now due to their solitary kidney status) Weird.

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  4. I wonder how often this sort thing happens? I was involved in a car accident and they found a brain aneurism when they did my head CT. It's minor and just needs to be watched but I would have no idea had I not been in the accident.

    How long will it be until all of us go in for a "routine" full body scan that is able to detect all of these things on a routine basis? Every 3-5 years you get your full body scan - sort of like you turn 50 and you get your colonoscopy. I have no doubt we will reach this point one day.

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  5. I went to the er for what I thought was a UTI or kidney stone, I was surprised to find out it was stage IV RCC. I had my right kidney removed and now am taking Sutent. I had no idea anything was wrong until I had pain and blood in my urine. I thank God everyday for this second chance.

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  6. Best wishes for your wife's recovery.

    ..And add me to the list of "a kidney stone changed my life". The films for my first [and to date only] kidney stone uncovered a 12 cm pelvic mass. It was ovarian CA in situ. Removed, with totally clear margins and no node involment, 10 days later.

    The kicker is that my annual GYN exam was six weeks prior, with a totally clear bill of health ~ even after the requisit bi-manual exam.

    I changed GYN's pronto!

    Pattie, RN

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