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Urolithiasis: massive

Case contributed by Dr Ian Bickle

Presentation

Left sided flank pain. On and off. Prior history of renal stones.

Patient Data

Age: 45 years
Gender: Male
X-ray

Enlarged left kidney.

Large number of huge stones in the left kidney - a combination of a central collection system centered stone and cortical stones.

No ureteric stones.

No right sided stones.

CT

Huge laminated left staghorn calculus (see lamination on the bone window images).

Multiple large cortical stones in the left kidney.

The left kidney is enlarged measuring 23 cm BPD, but with several areas of cortical thinning.

No ureteric stones.

Multiple left para-aortic nodes up to 1.5 cm.

Normal right kidney.

Case Discussion

When it comes to kidneys stones they do not come much bigger than this. On the initial plain radiograph, it seems hardly comprehensible despite their projection over an enlarged reniform outline. Retained colonic barium was the other initial consideration, but this was dismissed. CT-KUB illustrates the magnitude of the urolithiasis.

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