Ureteric calculi

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of ureteric calculi:

Pelvi-ureteric junction calculus:

PUJ stone or UPJ stone:

This patient had pain in the right lumbar region. Sonography of the abdomen showed hydronephrosis of the right kidney with a moderately large calculus (14mm.) at the right Pelvi-ureteric junction (arrows). Such calculi cause partial obstruction of the renal pelvis and may cause severe ureteric colic. Ultrasound images of pelvi-ureteric junction calculus, were taken with a Toshiba Nemio-XG ultrasound machine. (Synonyms: PUJ calculus or UPJ calculus or UPJ stones).

Reference: http://www.jultrasoundmed.org/cgi/reprint/27/10/1441 (free article and images)

Multiple calculi in lower ureters:

The above ultrasound images show multiple, small calculi (3 to 4 mm. in size) in both ureters. Color doppler imaging shows twinkling artefacts posterior to the calculi. There is mild dilation of the right ureter. Ultrasound images taken with an ATL ultrasound machine, courtesy of Mr. Shlomo Gobi, Israel.

3-D Ultrasound image of Vesico-ureteric junction calculus:

3-D sonography of ureteric calculi:

This 3 D ultrasound image shows a calculus lodged at the distal end of the right ureter at the vesico-ureteric junction (arrowheads). 3-D imaging leaves little to the imagination in such cases. Ultrasound image taken using a Philips IU-22 ultrasound system, by Dr. Ravi Kadasne, UAE.

VUJ calculus and its effect on ureteral jet:

This was a young male patient with right ureteric colic. Sonography of the pelvis shows a small right Vesico-ureteric junction calculus of 6 mm. Color Doppler evaluation of the urinary bladder showed multiple and frequent powerful left ureteric jets of urine (see color Doppler image- topmost row-right). However the right ureteral jet was weak and far less frequent. The right kidney showed mild hydronephrosis. This means that there was partial right ureteric obstruction as a result of the stone.

Reference: http://www.ajronline.org/cgi/reprint/159/4/773.pdf

Mid ureteric calculus:

(Calculi or stones in the mid ureter):

This patient had severe pain in the left lumbar region. Sonography of the left kidney and ureter shows moderately severe hydronephrosis in the affected kidney (ultrasound image top- left). The other ultrasound images show marked left hydroureter with dilation of the ureter till the level of the ureteric calculus. The stone in left ureter measures 1.2 cms. and causes severe backpressure changes on the upper urinary tract.

Grades of hydronephrosis (on Ultrasound imaging):

A) Mild hydronephrosis:

This images shows mild dilatation of the pelvis as well as the calyces of the right kidney suggesting mild hydronephrosis. The left kidney also appears to be affected similarly. This must be differentiated from mild dilatation of the renal pelvis alone (called splitting of the pelvis), which is physiological and transient; this means that on emptying of the urinary bladder, this appearance should disappear.

B) Moderate hydronephrosis:

The above ultrasound images show cupping of the calyces with moderate dilation (Right kidney) of the pelvis and calyces. Despite the hydronephrosis the renal parenchyma is still preserved.

C) Severe hydronephrosis:

Case-2: severe hydronephrosis:

The above sonographic images show marked dilatation of the pelvicalyces with sever thinning of the renal parenchyma. In case-2, note almost total absence of normal renal tissue (cortex).

Reference: http://emedicine.medscape.com/article/436259-diagnosis (free article)

http://knol.google.com/k/urinary-tract-obstruction# (free article)

Complications of hydronephrosis:

Pyonephrosis:

This patient showed a right upper ureteric calculus with obstructive changes in the proximal part of the right ureter and pelvicalceal dilatation. In addition, the right kidney also showed particulate debris within the dilated collecting system with breach of the upper pole of right kidney a large hypoechoic collection around this region suggestive of renal abscess formation. These ultrasound images suggest right pyonephrosis with abscess of right kidney. Chronic obstruction caused by the right ureteric calculus (see ultrasound image in top row- left), is the cause of this pathology, in this case. (Images are courtesy of Gunjan Puri, MD, India).

Reference: http://emedicine.medscape.com/article/440548-diagnosis

Hydronephrosis of lower moiety of duplex kidney:

The above ultrasound images show a duplex kidney (duplication of the collecting system) with hydronephrosis of the lower half of the collecting system (lower moiety). This was caused by a calculus in the ureter from the lower half of the collecting system (lower moiety). Ultrasonography helps diagnose this pathology with much ease. The above images show presence of a kidney of greater length than its fellow with 2 separate echogenic renal collecting systems separated by normal renal parenchyma (this is the typical ultrasound appearance of duplex kidney). Images are courtesy of Ravi Kadasne, MD, UAE.

Reference: http://emedicine.medscape.com/article/378075-imaging

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This page was last edited on: Friday April 23, 2010 03:27 PM

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