Presentation
Recurrent urinary tract infections, vague suprapubic pain, lower urinary tract symptoms of frequency, urgency, and hesitancy.
Patient Data
Single large vesical stone, that showed smooth hyperechoic border with posterior acoustic shadows and twinkling artifact in the color Doppler scan.
Case Discussion
Vesical calculi are common cause of supra-pubic pain and recurrent urinary tract infections in pediatrics. Diagnostic sonographic features of urinary bladder stone in grayscale can be confirmed by twinkling artifact on the Doppler scan.
The twinkling artifact is more sensitive for detecting small stones (e.g., urolithiasis, cholelithiasis) than acoustic shadowing.
Also, moving the patient for a rolling stone(s) sign can be helpful.
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 the urologists.
The management is usually by classical surgical removal.
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