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Steinstrasse and bladder calculus

Case contributed by Hein Els
Diagnosis not applicable

Presentation

Lower abdominal pain. Multiple previous treatments for renal and ureteric calculi.

Patient Data

Age: 50 years
Gender: Male

Two radiodense calculi project over the pelvis of the right kidney. The densities to the right of L4 are most compatible with calculi in the right ureter creating a Steinstrasse sign. Large calcified calculus in the bladder engulfs a displaced JJ-stent. No calculi over the left renal tract. 

Multiple calculi in the right distal abdominal ureter with proximal hydroureteronephrosis. There are also large calculi in the dilated right renal pelvis and in the lower pole of the right kidney. Large densely calcified bladder calculus engulfs the displaced JJ-stent (seen on bone windows, not included).

Incidental findings include prior left renal infarct and a small hypodense nodule at the uncinate process of the pancreas, likely a cystic pancreatic neoplasm which will require further characterization with MRI, among others. 

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