• Jiagui Chai, Runlin Feng, Yuhang Li, and Changxing Ke.
• Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
• Medicine (Baltimore). 2024 Sep 13; 103 (37): e39651e39651.

RationaleThe current diagnostic approach for urinary tract urothelial carcinoma (UTUC) relies on symptoms and imaging. Nevertheless, the diagnosis can be challenging in advanced cases presenting with atypical imaging and symptoms. This article presents an unreported case with atypical imaging and symptoms to provide some experience in diagnosing advanced UTUC.Patient ConcernsA 55-year-old male patient was admitted to the hospital with a 2-month history of persistent left scrotal pain and intermittent left lower back pain.DiagnosesComputed tomography and magnetic resonance imaging revealed a left kidney infection. Paradoxically, the patient did not present with a fever, and the white blood cell count was within normal limits. To further clarify the diagnosis, urine cytology was performed. Surprisingly, malignant tumor cells were discovered. The diagnosis of UTUC was considered.InterventionsThe patient underwent radical tumor resection.OutcomesThe surgery was successfully performed. The patient received regular chemotherapy after surgery. No recurrence was found during the follow-up.LessonsThis case is a rare and enlightening clinical scenario. When imaging reveals renal infection accompanied by varicocele or renal vein embolism, it is crucial to consider the possibility of advanced UTUC.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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