Urolithiasis with pre-vesical stone

Case contributed by Dr Sajoscha Sorrentino

Presentation

Left flank pain.

Patient Data

Age: 25
Gender: Female
Modality: X-ray

Plain film shows a pre-vesical stone on the left.

13 minutes after infusion of contrast medium there is contrast of the right pyelon and in the bladder, but yet no contrast of the left pyelon.  There is also contrast outlining the left kidney, whereas it has already cleared from the right (delayed nephrogram).

Two hours after infusion you can appreciate a distension of the left ureter and a hydronephrosis of the left pyelon.

Case Discussion

This examination demonstrates the typical IVP features of collecting system dilatation and a delayed nephrogram secondary to a distal obstructing calculus. In this case, the calculus is well seen radiographically.  

Treatment depends on the location of the stone, composition and size.

Irrespective of stone composition, patients who present with renal colic require assessment. Approximately 90% of stones less than 4mm are likely to pass down the ureter and into the bladder, and thus often require no more than analgesia and hydration 1

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Case Information

rID: 16548
Case created: 27th Jan 2012
Last edited: 8th Oct 2015
System: Urogenital
Tag: ivp
Inclusion in quiz mode: Included

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