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Age: 22

Sex: Male

Indication: Right flank pain

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Case #9


Findings

  • Mild right hydronephrosis and right ureteral dilation
  • 8 mm echogenic structure in the distal right ureter near the ureterovesicular junction
  • Echogenic foci with posterior acoustic shadowing and associated twinkle artifact in the upper and lower poles of the left kidney measuring up to 5 mm
  • No left hydronephrosis
  • Mild mural thickening of the urinary bladder with small amount of layering debris
  • Ureteral jets are visualized bilaterally in the bladder


Diagnosis

Obstructing ureteral calculus

Sample Report

8 mm calculus in the distal right ureter near the ureterovesicular junction with associated mild right hydroureteronephrosis.

Nonobstructing left renal calculi measuring up to 5 mm.

Mild mural thickening of the urinary bladder with small amount of layering debris. Recommend correlation with urinalysis for evidence of urinary tract infection.


Discussion

  • CT is generally the preferred imaging modality in the workup of patients with suspected obstructive uropathy, but ultrasound has an important role in followup imaging as well as in the acute assessment of children and pregnant women with flank pain
  • Parts of the ureter may be difficult to assess on ultrasound depending on patient body habitus and preparation, so the finding of hydronephrosis may require subsequent CT imaging to more confidently rule out an obstructing calculus or mass
  • When looking at the bladder, make sure to closely assess the ureterovesicular junctions along the posterolateral bladder wall as these are common places for stones to lodge
  • Ultrasound characteristics of renal calculi include:
    • Rounded echogenic structures
    • Posterior acoustic shadowing
    • Twinkle artifact on color Doppler analysis


Images

Echogenic structure near the right ureterovesicular junction (red arrow) with associated posterior acoustic shadowing (yellow arrow), concerning for a distal ureteral calculus.

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