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Age: 16

Sex: Female

Indication: Right flank pain

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Case #16


Findings

  • Nonobstructive bowel gas pattern
  • No abnormal intraabdominal mass effect
  • Irregular calcification measuring approximately 4 mm overlying the expected location of the right ureterovesicular junction


Diagnosis

  • Ureterovesicular junction (UVJ) stone

Sample Report

Nonobstructive bowel gas pattern.

No abnormal intraabdominal mass effect.

Irregular calcification measuring approximately 4 mm overlying the expected location of the right ureterovesicular junction. This calcification could alternatively be in the bladder or fecal stream. Consider noncontrast CT of the abdomen and pelvis for further evaluation.


Discussion

  • Though less common than in adults, kidney stones do occur in children
  • Obstructing stones often present with less typical symptoms in children, so the ordering provider may not have this on his or her differential diagnosis
  • While ultrasound is a good initial test, it is difficult to evaluate the entire ureter and, in addition, ureteral stones may not have associated hydronephrosis
  • Noncontrast CT is the best confirmatory test, though this should be used judiciously in children due to the radiation dose


Images

Red arrow: calcification overlying the expected location of the right UVJ. Subsequent noncontrast CT in this patient confirms the right UVJ stone (red arrow) and additionally shows right hydronephrosis (yellow arrow) and a small nonobstructing left renal stone (blue arrow). Normal intravenous pyelogram in a different patient showing the expected course of the ureters.

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