Presentation
Recurrent urine infection in a pediatric residing in a semi-arid environment.
Patient Data
A uniformly circular, large solitary focus (with a 26.8 mm mean diameter) is noted parading intravesically within the urinary bladder lumen and squarely placed towards the left ureteral orifice with the mentioned focus displaying crescenteric hyperechoic upper rim and exhuberant hypoechoic distal shadows. Color Doppler mapping of the aforementioned focus yields twinkling artefacts and these features are consistent with an intravesical bladder calculus.
Low level debris is noted within the bladder lumen in the background of bladder wall thickening, albeit the bladder empties completely on voiding with no significant retention post micturition. The bilateral renal pelvicalyceal and proximal ureteral compartments are splitted with evidence of anechoic uremic fluid up to the upper calyces for the left and the lower calyces for the right kidney (ureterohydronephrosis).
Case Discussion
A large solitary calcific focus (urolithiasis) within the postero-medial bladder luminal base that slightly is shifted to the left ureteral orifice. Bladder debris and diffuse wall thickening noted is primarily likely due to an inflammatory process (cystitis). The bilateral ureterohydronephrosis (Grade II on the right and Grade III on the left) is likely attributable to partial proximal bladder outflow obstruction.
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