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.