“ All are seen on CT except indinavir calculi and some matrix calculi. About 50% of 5-mm stones will pass spontaneously. Recurrence is high...
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All are seen on CT except indinavir calculi and some matrix calculi. About 50% of 5-mm stones will pass spontaneously. Recurrence is high without treatment. Complications are obstruction, infection and stricture.
CT
• Hyperdense calculus—commonly at a calyx, renal pelvis, PUJ, ureter or VUJ
• Hydronephrosis, hydroureter, perinephric stranding (fat oedema)
• Hypodense kidney (oedema)
• Perinephric fluid collection suggests ruptured fornix due to obstruction
• Beware false positives—phleboliths; parapelvic cyst and extra-renal pelvis mimic hydronephrosis
US
• Sensitivity is about 25%—normal renal sinus fat commonly mimics calculi
• Look for pelvi-calyceal dilatation, marked acoustic shadowing, speckle artefact with colour Doppler
Plain abdominal x-ray shows a large opacity projected over the pelvis, in keeping with a bladder calculus.
Plain abdominal x-ray shows a large right staghorn calculus. Even large staghorn calculi can be mistaken for renal sinus fat on ultrasound—look for loss of signal behind the stone.
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