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Age: 17

Sex: Male

Indication: Left flank pain

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Case #26


Findings

  • Nonobstructive bowel gas pattern
  • No evidence of free intraperitoneal air
  • No abnormal intraabdominal mass effect
  • Calcific density measuring 5 mm overlying the left hemisacrum near the expected course of the left ureter
  • Additional irregular calcification overlying the right L4 transverse process
  • Partially imaged central venous catheter with tip overlying the superior cavoatrial junction


Diagnosis

  • Ureteral stone

Sample Report

Nonobstructive bowel gas pattern.

No evidence of free intraperitoneal air.

No abnormal intraabdominal mass effect.

Calcific density measuring 5 mm overlying the left hemisacrum near the expected course of the left ureter, which may represent a ureteral stone. Consider noncontrast CT for further evaluation.

Additional irregular calcification overlying the right L4 transverse process has a morphology that would be abnormal for a ureteral calculus and may instead represent calcification in the fecal stream, dystrophic soft tissue calcification, or calcified lymph nodes.

Partially imaged central venous catheter with tip overlying the superior cavoatrial junction.


Discussion

  • The pelvic brim is the third most common location for ureteral stones to lodge (behind the ureteropelvic junction and ureterovesicular junction) and is a very difficult location to identify stones
  • The calcification overlying the right L4 transverse process was shown to represent several small calcified mesenteric lymph nodes on subsequent CT imaging


Images

Red arrow: 5 mm calcific density overlying the left hemisacrum, near the expected course of the left ureter. Normal intravenous pyelogram in a different patient showing the expected course of the ureters.

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