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[Clinical Picture] Uric acid bladder stones in congenital cyanotic heart disease

A 54-year-old man was admitted with a 4-year history of recurrent urinary tract infections. He had a history of osteoarthritis of the left hip and benign prostatic enlargement. Physical examination showed clubbing with cyanosis (figure), and a grade 4/6 systolic murmur throughout the praecordium. Electrocardiogram showed right ventricular hypertrophy with features of pressure overload (appendix). His haemoglobin was raised at 200 g/L, with a haematocrit of 0·53. A CT scan of the genitourinary system showed multiple large urinary bladder stones (figure), urinary bladder wall thickening, trabeculations and diverticulae, and bilateral hydroureters and hydronephrosis.