UNUSUAL PRESENTATION OF A REGULATION FINDING


A 45 year old lady with history of hysterectomy and bilateral salpingho oophorectomy, presented to her gynaecologist for symptoms of lower urinary tract – dysuria and frequency.

She was sent for a routine evaluation of the abdomen and pelvis.

The following pictures show a normal liver, gall bladder, pancreas and spleen .

KID  DISTAL UR CALCULUS_2 KID  DISTAL UR CALCULUS_1

 

Both the kidneys appeared to be normal . No calculus was seen . There was no evidence of any obstruction.

KID  DISTAL UR CALCULUS_3 KID  DISTAL UR CALCULUS_4

 

Urinary bladder wall was mildly thickened . 3D showed fairly normal bladder mucosa . Ureteric jets were seen normally.

The distal ureters were not visualised .

KID  DISTAL UR CALCULUS_5 KID  DISTAL UR CALCULUS_6

 

Post void bladder was studied  and showed the following .

 

KID  DISTAL UR CALCULUS_7

Lo and behold – a distal right ureteric calculus is clearly seen now .

KID  DISTAL UR CALCULUS_8

Usually  we pick up all ureteric calculi and distal ureteric pathologies with a full bladder . Usually distal ureteric calculus will cause some amount of obstructive features in the ureter and the kidney . That was also absent in this patient .

But occasionally like this patient  , the distal ureters can be compressed with a full bladder and such findings  could be missed unless we do a post void study, especially when they have a LUTS symptoms . In this patient the bladder wall also showed mild thickening.

 

12 thoughts on “UNUSUAL PRESENTATION OF A REGULATION FINDING

  1. Many thanks for posting a case with academic interest.
    One Question :
    You have measured both pre & post void volume in a single scan . We usually take two scan one in Ts & other in Ls for each volume measurement. Which one is more reliable single or double scan ?

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  2. Pingback: Lithiase urinaire : colique néphrétique simple, fébrile et hydronéphrose | thoracotomie

    • When US does not give an answer , a complimentary CT is ideal ; but what I wanted to stress was the fact,that at times a post void bladder brings out the ureteric pathology . Thanks for your comments

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  3. One C.T.Lower Abdomen would have resolved the problem instead of taking too many pictures giving pain and expense to the old lady, am I right krish?

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    • I always thought CT was costlier than USG. One has to consider radiation also. When US does not give an answer , a complimentary CT is ideal ; but what I wanted to stress was the fact,that at times a post void bladder brings out the ureteric pathology

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