A Medical Mystery — Concentric Calcification
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《新英格兰医药杂志》
An elderly man reported having recurrent hematuria over a period of two years. He had undergone transurethral resection of the prostate because of benign prostatic hypertrophy two years earlier. He had evidence of chronic renal insufficiency, with a serum creatinine level of 4.4 mg per deciliter (389 μmol per liter). Multiple urinalyses in the previous several months had revealed gross and microscopic hematuria, pyuria, triple phosphate crystals, and a pH of more than 9.0. For the previous two years, urinalyses had been intermittently positive for nitrates. Multiple urine cultures during the previous nine months had yielded only "contaminants." A computed tomographic scan of the pelvis appears here. What is the diagnosis?
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the March 30 issue and e-mail it to everyone who submits an answer. All answers must be received by February 16, 2006.
Dong Hoon Daniel Kim, M.D.
Victor L. Yu, M.D.
Veterans Affairs Medical Center
Pittsburgh, PA 15240
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the March 30 issue and e-mail it to everyone who submits an answer. All answers must be received by February 16, 2006.
Dong Hoon Daniel Kim, M.D.
Victor L. Yu, M.D.
Veterans Affairs Medical Center
Pittsburgh, PA 15240