The patient was a woman aged 57 who had a funnel chest and a long history of cardio-respiratory restriction and chronic respiratory infection. After an attack of acute cholecystitis the JVP was found to be raised 8 cms and the liver was enlarged to 5 fingers below the right costal margin. The chest was dull to percussion, with crepitations and diminished air entry. She was cyanosed. She died suddenly 8 days later. At postmortem generalised congestion of organs was found with basal purulent bronchitis and bronchopneumonia.
The specimen consists of a coronal slice of the left kidney which measures 15 cms in length. The surface is normal and the cut surface shows intense chronic generalised congestion (cyanotic induration). There is a large intrarenal and extra-renal hydrocalycosis and hydronephrosis, ending sharply at the pelvi-ureteric junction. No aberrant artery was present. The upper ureteric orifice is reduced to a pinhole.