Presentation
Right flank pain.
Patient Data
Horseshoe kidney anatomy with a parenchymal isthmus. Within the right ureter, immediately anterior to it crossing the isthmus, are two 3 mm ureteric calculi lying immediately adjacent to one another. This is causing periureteric fat stranding that extends for a short segment distal to the point of obstruction. There is upstream dilatation of the right renal pelvis, mild hydronephrosis, and some right perinephric fat stranding. No left ureteric calculus or hydronephrosis.
Previously demonstrated 8mm calculus within the right pelvicalyceal system is no longer visible. There is now a 4 mm stone in the same region. Three calculi within left pelvicalyceal system, the largest of which measuring 10 mm, are stable. Renal cysts within the upper pole of the left kidney are stable.
The appendix is normal. Scattered pancreatic calcifications and small bilateral fat containing inguinal region hernias. No free intraperitoneal gas or fluid. The remainder of the imaged intra-abdominal structures are unremarkable on non-contrast imaging. No suspicious bony lesion.
Conclusion
Two small calculi within the proximal right ureter where the ureter crosses anterior to the isthmus of the horseshoe kidney results in mild upstream hydronephrosis.
Case Discussion
Horseshoe kidney can cause stasis which explains the increased risk of renal calculi formation.
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