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Monthy Case Studies - 2000
Case #34 - April, 2000
A 51-year-old man with chronic renal failure was a patient in a VA medical center in the Midwestern United States. An object that passed from the man's urethra was submitted to a reference laboratory for identification. The hospital laboratory reported seeing no eggs in the urine. The five images shown below were taken with both a handheld digital camera using the close-up setting (Figures A and B) and a dissecting scope with zoom magnification from 7× to 40× (Figures C through E). What is your diagnosis? Based on what criteria?
Figure A
Figure B
Figure C
Figure D
Figure E
Answer to Case #34
The object shown in this case was an artifact, a proteinaceous serum cast of the ureter or urethra. The initial diagnosis of some type of nematode, either Dioctophyme (giant kidney worm) or Ascaris, was based on gross examination. Closer examination showed this object to have a realistic looking surface texture like some type of worm. However, at higher magnification it was apparent that the object was a solid-bodied, homogenous structure that was shredded from probing, rather than a hollow-bodied worm. There was also no evidence of internal structures, such as a gut or reproductive organs.
More on: Artifacts
Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
