Suspected Ureteral Colic
Primary Helical CT Versus Selective Helical CT After Unenhanced Radiography and Sonography
Orlando Catalano1,2,
Antonio Nunziata3,
Francesco Altei1 and
Alfredo Siani1
1
Department of Radiology, S. Maria delle Grazie Hospital, Via Domitiana
Località La Schiana, Pozzuoli (Na),
Italy.
2
Present address: Via Crispi 92, Naples, I-80121, Italy.
3
Department of Diagnostic Imaging, PSI Napoli EST, Via Ciccarelli 1, Naples,
I-80147, Italy.
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Fig. 1A. —39-year-old man with hydronephrosis and ureterolithiasis who
presented left flank pain. Oblique sonographic scan at level of left kidney
shows grade 2 pyelocaliectasis (arrow).
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Fig. 1B. —39-year-old man with hydronephrosis and ureterolithiasis who
presented left flank pain. Oblique sonographic scan at level of bladder shows
stone within distal ureter (arrow).
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Fig. 1C. —39-year-old man with hydronephrosis and ureterolithiasis who
presented left flank pain. CT image shows dilated renal pelvis
(arrowhead) with minimal surrounding fat-tissue stranding.
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Fig. 1D. —39-year-old man with hydronephrosis and ureterolithiasis who
presented left flank pain. CT image shows impacted calculus
(arrowhead) at ureterovesical junction.
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Fig. 2A. —30-year-old man with hydronephrosis and ureterolithiasis who
presented with left-sided pain. Digital unenhanced radiograph obtained with
patient in supine position reveals small calcification (arrow),
suspected for ureteral stone, at level of L3.
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Fig. 2B. —30-year-old man with hydronephrosis and ureterolithiasis who
presented with left-sided pain. Sonographic scan shows dilated intrarenal
collecting system (arrow).
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Fig. 2C. —30-year-old man with hydronephrosis and ureterolithiasis who
presented with left-sided pain. CT scan shows small stone (arrow) in
left ureter and periureteral stranding.
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Fig. 3A. —41-year-old woman with hydronephrosis and completely
obstructing ureterolithiasis who presented with left-sided pain. Sonogram
obtained at level of left flank shows ureteral stone (arrow) and
hydroureter (arrowheads).
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Fig. 3B. —41-year-old woman with hydronephrosis and completely
obstructing ureterolithiasis who presented with left-sided pain. Color Doppler
sonogram obtained with transverse scan of ureterovesical jets shows normal
right color jet (R) and absent left jet (L).
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Fig. 3C. —41-year-old woman with hydronephrosis and completely
obstructing ureterolithiasis who presented with left-sided pain. CT image
shows dilatation of left renal pelvis (open arrow) and upper ureter
(solid arrow) with perirenal stranding.
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Fig. 3D. —41-year-old woman with hydronephrosis and completely
obstructing ureterolithiasis who presented with left-sided pain. CT scan shows
stone (arrow) in left ureter.
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Fig. 4A. —45-year-old woman with hydronephrosis and ureterolithiasis
who presented with right flank pain. Unenhanced radiograph shows small
calcification (arrow) suggestive of ureteral stone in right
pelvis.
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Fig. 4B. —45-year-old woman with hydronephrosis and ureterolithiasis
who presented with right flank pain. Sonography failed to detect calculus, but
sonogram shows grade 2 hydronephrosis (arrow).
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Fig. 4C. —45-year-old woman with hydronephrosis and ureterolithiasis
who presented with right flank pain. CT scan reveals ureteral stone
(arrowheads) in right pelvis with periureteral stranding and
soft-tissue rim sign.
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Fig. 5A. —55-year-old woman with ureterolithiasis who presented with
right flank pain. Color Doppler sonogram obtained with transverse scan of
ureterovesical jets shows right intramural stone (arrow) causing
medial deflection of ureteral jet. Color spots posterior to stone are
twinkling artifacts. Edematous thickening of bladder wall can be seen adjacent
to stone. Stone was recognizable on unenhanced radiography (not shown),
whereas no hydronephrosis was evident at renal sonography (not shown).
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Fig. 5B. —55-year-old woman with ureterolithiasis who presented with
right flank pain. CT scan shows ureterovesical junction stone (arrow)
with thickened adjacent vesical wall. Scan obtained with patient in prone
position (not shown) was necessary to rule out free intravesical calculus.
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Fig. 6. —32-year-old man with ureterolithiasis who presented with
right-sided flank pain. CT scan reveals tiny stone (arrow) at level
of right ureterovesical junction. No indirect CT sign of ureteral colic was
present. Sonography and unenhanced radiography (not shown) failed to detect
any sign diagnostic for ureteral colic. A 1-mm calculus was spontaneously
passed 10 min after CT study and found in urine.
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Copyright © 2002 by the American Roentgen Ray Society.
