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