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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


Findings

  • 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


Diagnosis

  • 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.


Discussion

  • 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


Images

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

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