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Age: 48

Sex: Female

Indication: Left flank pain in patient with bilateral percutaneous nephrostomy tubes

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Case #41


  • Multiple echogenic foci with corresponding posterior acoustic shadowing in the distal left ureter, which measure up to 4 mm
  • Bilateral renal cortical thinning with medullary nephrocalcinosis
  • The nephrostomy tubes and renal collecting systems are not well assessed due to posterior acoustic shadowing from medullary nephrocalcinosis without definite hydronephrosis


  • Ureteral calculi
  • Medullary nephrocalcinosis

Sample Report

Multiple echogenic foci concerning for calculi in the distal left ureter, which measure up to 4 mm.

No definite hydronephrosis, though assessment is limited by posterior acoustic shadowing from bilateral medullary nephrocalcinosis. This also limits assessment of the bilateral nephrostomy tubes.

Bilateral renal cortical thinning.


  • Medullary nephrocalcinosis can result from a variety of disorders affecting calcium metabolism and excretion and commonly coexists with nephrolithiasis
  • Make sure to always try to see and assess the distal ureters when imaging the urinary bladder


Echogenic foci in the distal left ureter (red arrows) consistent with ureteral calculi.

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