Presentation
Left flank pain and dipstick hematuria
Patient Data
Calculus at the left VUJ on the bladder images of an ultrasound KUB examination. See the intense posterior acoustic shadowing from the calculi and non-dilated proximal ureter - remarkable for a stone 8mm in short axis.
Kidneys views did not demonstrate any evidence of hydronephrosis.
Short axis 8mm and long axis 13mm calculus in the intravesical component of the ureter - the short segment that tunnels through the bladder wall.
Case Discussion
Urolithiasis is common across the world. It typically presents with flank pain with or without hematuria.
A plain abdominal (KUB) is typically performed initially with a identification rate of 60-70% as most calculi are composed of calcific components. The gold standard imaging investigation is now CT-KUB with a sensitivity rate of 99% for stones as small as 1mm. Ultrasound is largely reserved for complications such as pyonephrosis and hydronephrosis, with may merit percutaneous nephrostomy insertion.
The sensitivity and specificity of ultrasound in detecting renal calculi is much lower than CT, and is particularly poor for stones less than 3mm, with only just over a quarter seen, than are present on CT-KUB.
Ultrasound may be used first in the pediatric and pregnant population, as it may identify a calculus preventing the use of ionizing radiation in these groups.
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