ACUTE URETERIC OBSTRUCTION CAN HAPPEN EVEN WITH SMALL CALCULUS
Acute ureteric obstruction can be severe, regardless of stone size.
A calculus as small as 2 mm can cause severe obstruction or even calyceal rupture.
It is the edema and reactive thickening of the ureteric wall or the intra mural portion of the ureter in the bladder adding to the severity
Case:
61/ M
DM
Acute ureteric colic
Image 1: Hydronephrosis (*) with increased density of urine suggesting underlying infection. There is significant perinephric edema.
Image 2: Bladder in supine position, shows a 2 mm calculus in the intra mural portion of the VUJ. However, we need to rule out a recently passed out calculus.
Image 3: Bladder image in prone sows the calculus impacted in the intra mural portion of the ureter.
Inference
- With significant perinephric edema and hydronephrosis, findings suggests acute ureteric obstruction
- Increased density of urine in the renal pelvis suggests underlying infection
Management:
Being a diabetic patient, this needs immediate antibiotics and follow up to check stone passage.
Follow up:
If possible, documentation of the calculus can be done on a limited ultrasound. Thereafter, a follow up by ultrasound of the bladder should suffice.
Further readings:
1. Interesting article with general overview by the American Family Physician Journal
2. CT imaging in urolithiasis
3. Stone size (width) and spontaneous passage rate of ureteric stone after 20 weeks. (0-3 mm - 98% vs > 6.5 mm - 9 %)
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