Presentation
Middle age patient with suprapubic pain, urinary frequency, urgency, and hesitancy. Background history of recurrent urinary tract infections.
Patient Data
Typical sonographic features of urinary bladder stones showing smooth hyperechoic border with posterior acoustic shadows.
The diagnosis was confirmed by a twinkling artifact in a color Doppler scan.
Case Discussion
A middle age male patient with typical sonographic features of urinary bladder stones in grayscale, confirmed by the presence of twinkling artifact on color Doppler.
The twinkling artifact is more sensitive for detecting small stones (e.g. urolithiasis, cholelithiasis) than acoustic shadowing.
Another useful clue to confirm the presence of a urolith is the rolling stone sign. This is seen when the stone becomes mobile upon patient repositioning.
Peripherally calcified urinary bladder polyps and masses, as differential diagnoses, could show posterior acoustic shadowing; however, the twinkling artifact is specific for stones.
Unenhanced CT is the gold standard diagnostic imaging test for urolithiasis. It provides the measurement of stone density, which aids in the management options for urologists.
The management is either trans-urethral cystolithotripsy or the classical surgical removal.
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