Presentation
Nontoxic-appearing female presents to the ER with mild periumbilical pain and diarrhea for the past few days.
Patient Data
Symmetric, echogenic structures are seen at the bilateral ureterovesical junctions and demonstrate shadowing with twinkle artifacts. There is no evidence of hydronephrosis.
Case Discussion
An echogenic, shadowing, mass with twinkle artifact at the UVJ is a typical appearance of urinary calculus. However, in this case, the presence of bilateral, large, symmetric ureteric stones would be very unusual given the absence of obstruction/hydronephrosis, the patient's age, and the clinical presentation.
This is the post-procedural appearance from the endoscopic treatment of vesicoureteral reflux with an injection of the bulking agent "Deflux" at the bilateral ureterovesical junctions (UVJs). "Deflux" is a biodegradable dextranomer-hyaluronic acid copolymer that essentially provides a mass effect at the UVJ, making the valve more competent and preventing reflux. Its appearance can persist for up to 3 years after the procedure and be an incidental finding in this case. After speaking with the parents, the patient did have a history of a urologic procedure to prevent recurrent UTIs. Given the imaging appearance and the procedural history, this patient likely had a deflux procedure.
Unable to process the form. Check for errors and try again.