Continuing liquid accumulation and lack of motility

Hi.

Our patient is 67 years old. She is suffering from kidney disease along with urinary tract infection and a number of effusions. Doctors, still, don’t see dialysis is needed. Infection, also, started to alleviate after antibiotic treatment. But liquid accumulation continues even after evacuation (through urinary catheter). She is conscious and recognizes people. She can hear, see, and hardly speak. She can move her head to say yes or no, but none of the other parts including arms and legs. Her diet is based on vegetable soups and fruit homogenates. Therefore, the patient’s general state is not getting better, or maybe is getting worse.

We need to know how to treat this continuing liquid accumulation, this lack of motility, and, the most important, to know the causes that may lead to such conditions. For further information, please feel free to ask any question.

For your reference, I include two reports (original text in French):

– Reprot 1: Thoracic, abdominal, and pelvic computed tomography scan.

– Reprot 2: Abdominal and pelvic ultrasonography.

Regards.

=== Report 1 ===

Technique: Spiral 1 mm acquisition without injection of contrast agent (kidney failure) to explore thorax, abdomen, and pelvis with axial, coronal, and sagittal reconstruction.

Results:

In thorax:

– Left, basal parenchymal opacification.

– Mild left, basal atelectasis through contact.

– Small mediastinal lymph nodes (10 mm for large diameter).

– Bilateral pleural effusion along with pericardial effusion.

In abdomen and pelvis:

– Normal-sized, normal-density liver.

– Undilated intrahepatic and extrahepatic bile ducts. Normal-sized, lithiasic (ultrasound monitoring is advisable) gall bladder.

– Both pancreas and spleen are unremarkable.

– Normal adrenal glands.

– Left kidney in place, slightly increased in size (14 cm for large axis), bumpy contours, undilated outer cavities. To the right, 3 cm small structure which would be a hypoplastic kidney.

– Empty bladder.

– Slight ascitic effusion.

– Free ischioanal fossae.

Conclusion:

In thorax:

– Left, basal parenchymal opacification with small left, basal atelectasis through contact.

– Bilateral pleural effusion along with pericardial effusion.

In abdomen and pelvis:

– Slight ascitic effusion.

– Single left kidney (right kidney reduced to a 3 cm small preform).

=== Report 2 ===

In abdomen:

Liver:

– Normal-sized, with regular contours, with uniform echotexture.

– Undilated intrahepatic bile ducts.

– Thin, patent (unobstructed) common bile duct.

Gall bladder:

– With filling in progress, thin-walled, with uniform transonic content, acalculous.

– Normal portal vein diameter measured on hilar pathway.

Right kidney:

– Not shown.

Left kidney:

– With normal topography, dimensions, and morphology.

– With nonuniform cortical echotexture due to the presence of some simple cysts.

– Dilation of left ureteral, pelvic, and caliceal cavities without obstacle shown.

– Parenchymal index respected.

Spleen and pancreas:

– Without abnormal size or echotexture.

– No deep lymph nodes.

– No ascites.

In pelvis:

Bladder:

– With filling in progress, with thin and regular wall, with uniform transonic content, without lithiasis imaged, bleeding because of inflated balloon.

– No obvious, suspicious pelvic masses.

– Free pouch of Douglas.

Note: Presence of bilateral pleurisy of average amount is worth mentioning.

Conclusion:

– Left, moderate ureterohydronephrosis in normal-sized kidney with some simple renal cysts.

– Elsewhere, ultrasonographic examination with no other notable abnormalities.

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