Vesicoureteric junction stone with pyelonephritis

Case contributed by Ian Bickle
Diagnosis almost certain


Left flank pain for one day. Fever and nausea. Renal stone?

Patient Data

Age: 40 years
Gender: Male

5 mm stone at the left VUJ.

Minor prominence of the left ureter and renal pelvis.

Marked left perinephric fat stranding.

2 mm right lower pole renal stone.

Case Discussion

The ureter is normal of narrow caliber (1-2 mm) and can be difficult to follow in its entirety especially at the level of the pelvic brim.  In those with minimal inherent intra-abdominal fat, it can be near impossible to trace completely.

In this case, although only minimally dilated, the presence of intra-abdominal fat makes following the ureter straightforward.

The VUJ is the commonest site of obstruction.

Typically stones up to 5-6 mm are treated and pass with medical management.

In this case a good going pyelonephritis has also developed secondary to the obstruction.

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