IS IT A URETERIC CALCULUS OR ……?


This was a 34 year old man , who presented with features of right iliac fossa pain of 3 months duration , with increasing pain over the last 1 week.He gives history of some difficulty in passing urine.

On clinical examination , he had diffuse RIF tenderness , with rebound tenderness.

Ultrasound showed the following.

Right kidney shows mild pelvi calyceal dilatation.

APPENDIX UR CALC_3 APPENDIX UR CALC_4

Scan ( with a regular abdominal probe ) over RIF shows an echogenic object with posterior acoustic shadowing within a dilated ” tube ” .

APPENDIX UR CALC_1 APPENDIX UR CALC_2

Can we jump to the diagnosis of ureteric calculus now ?

Is there an incongruity between the size of the calculus and the ” ureteric dilatation ” and the pelvi calyceal dilatation ?

Colour Doppler shows vascularity of the wall . It was non pulsatile and non collapsible.

APPENDIX UR CALC_5

Now this looks more like an inflamed appendix with a prominent fecolith of size 11.4 mms , throwing a shadow.

The following pictures are with a high resolution probe.

APPENDIX UR CALC_10 APPENDIX UR CALC_11 APPENDIX UR CALC_13

The following picture shows the long and short axis views.

1APPENDIX UR CALC_12

Careful attempt to establish any continuity of the dilated ” tube ” to the ureter or dilated pelvis , showed that the dilated structure was separate from the right ureter .

A diagnosis of Acute appendicitis with fecolith was made . CT scan of the abdomen confirmed the diagnosis and after surgery the patient is doing well.

This patient had some misleading signs and symptoms . It is always better to establish the ” connection” between the dilated ureter and the kidney. Usually appendix is picked up better with high resolution transducers. But in this patient , it was well picked up with a routine abdominal transducer. The colour doppler was useful in this patient also.

3 thoughts on “IS IT A URETERIC CALCULUS OR ……?

  1. We presented cost-effectiveness of abdominal ultrasonography in appendicitis at the 45th AIUM annual convention on March 13,2001(JUM20:567,2001) from NMC,Rangpur,Bangladesh.

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