Presentation
Right-sided renal colic. Elevated inflammatory markers.
Patient Data
Age: 50 years
Gender: Female
From the case:
Obstructive uropathy due to ureterolithiasis
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- Marked hydronephrosis on the right (grade: 3), with accompanying dilation of the proximal ureter.
- Reflective nephrolith in the lower third of the right kidney, causing posterior acoustic shadowing.
- Perirenal fat stranding and small amount of fluid.
- Incidentally an about 55 mm, inhomogeneously hypoechogenic, vascularized lesion is visible in the fundus of the uterus, possibly representing a uterine fibroid.
Findings altogether are in line with severe right-sided obstructive uropathy.
CT was requested to rule out pelvicalyceal rupture due to the presence of perirenal fluid.
From the case:
Obstructive uropathy due to ureterolithiasis
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- Severe right-sided hydronephrosis redemonstrated, along with the kidney stone, proximal ureteric dilation, and perirenal stranding.
- An about 3 mm hyperdense, obstructing stone is visible in the ureter at the level of the L5 vertebra.
- In the urographic phase the right kidney shows delayed contrast excretion.
- Pelvicalyceal system rupture can be excluded.
- The uterine lesion shows irregular internal enhancement. The most likely diagnosis remains uterine fibroid, ob/gyn follow-up recommended.
Case Discussion
The case demonstrates severe obstructive nephropathy and its imaging correlates, which was caused by a small nephrolith becoming lodged in the ureter.
This case is also contributed by Dr. Sándor Szukits.