Presentation
Constipated, vomiting and febrile. On Tamsulosin for benign prostatic hypertrophy.
Patient Data
Obstruction due to calculus in the pelvic right ureter. Proximal ureteric dilatation and hydronephrosis. Perinephric fluid collection and stranding.
Numerous small medullary calculi in both kidneys.
Gall bladder calculus.
Similar appearances of ureteric obstruction by calculus. The right ureter is dilated and obscured by fluid attenuation. The right perinephric fluid collection is not present and developed subsequently.
Case Discussion
This patient initially presented to ED with right flank pain and hematuria due to an obstructive 7mm calculus in the distal right ureter with upstream hydroureteronephrosis and mild increased stranding around the right kidney.
2 days later, the patient represented to ED with worsening pain, constipation, vomiting, and was febrile. This time imaging showed right perinephric urinoma and stranding typical of forniceal rupture. The obstructive 7mm right VUJ calculus was unchanged in position.
The patient has a history of medullary sponge kidney and demostrates the typical features of medullary calculi.
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