4/28/2010

1

Renal and Ureteral Calculi

Nephrolithiasis

• Renal Stones• Small (1-2 mm) –> large (may fill whole

pelvis and calyces = staghorn calculi)• 80% - 90% radio-opaque• Most pass spontaneously, may cause

obstructionobstruction

4/28/2010

2

Nephrolithiasis

• KUB films may help to confirm existence d l tiand location

• CT scanning procedure of choice in adults for evaluation of nephrolithiasis– May be performed without contrast

KUB Calcifications

Extensive Renal Calcification

MSU RADIOLOGY ©2002 All rights reserved, Gerald R. Aben, MD

4

4/28/2010

3

Abdomen Calcificaions• RUQ• RUQ

calcifications Gall bladder(yellow arrows)

• LUQ Renal

MSU RADIOLOGY ©2002 All rights reserved, Gerald R. Aben, MD

5

calcification(Blue Arrow)

Parenchymal Calculi

Left Renal Calculi (parenchymal)

MSU RADIOLOGY ©2002 All rights reserved, Gerald R. Aben, MD

6

4/28/2010

4

Parenchymal Calculi

Left Renal Calculi (parenchymal)

MSU RADIOLOGY ©2002 All rights reserved, Gerald R. Aben, MD

7

Ureteral Calculus

• Left ureteral calculusKUB t fil• KUB scout film

• Small round opacity on the left side (arrow)

• Common site of t l l l tureteral calculus at

the Ureteral Pelvic Junction (UPJ)

4/28/2010

5

Ureteral Calculus• Spot film of the

pelvis• Small opacity• Small opacity

at left ischialspine

• Common location of ureteralureteralcalculus at the UreteralVesicle Junction

Staghorn Calculi• KUB film (no contrast)• Left calculi with shape

of the collectingof the collecting system

• May fill all or part of the renal pelvis

• Kidney with staghorn l li t i ll lcalculi typically poorly

functioning or non-functioning

4/28/2010

6

Bladder Calculi• Laminated

calcification in bladderbladder

• Calculi seen in bladder without contrast

• Always obtainAlways obtain scout radiograph before contrast administration

Ureteral Calculus

• 10 minute film10 minute film• Opacified

ureter • Dilatation

down to the level of the obstruction

4/28/2010

7

Renal Calculi

• Stone d d t idependent in hydronephrosis of the left kidney

Renal Calculi

4/28/2010

8

Ureteral Calculus• Spiral CT without

contrastLarge calcification left• Large calcification left renal pelvis (arrow)

• Obstruction with hydronephrosis

• Probable local t ti f iextravasation of urine

(arrowhead)

Ureteral Calculi

4/28/2010

9

Renal Calculi• Longitudinal

ultrasound right kidneykidney

• Bright echo in upper pole partially hidden by the central echo complexcomplex

• Distal acoustic shadowing (arrow)