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Evaluation of the Patient with Flank Pain and Possible Ureteral Calculus¹

¹ From the Department of Diagnostic Imaging, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030 (E.P.T., P.M.S.); and Department of Diagnostic Imaging, Evergreen Hospital Medical Center, Kirkland, Wash (W.P.S.). Received October 23, 2001; revision requested January 14, 2002; revision received July 23; accepted August 8. Address correspondence to E.P.T. (e-mail: etamm@di.mdacc.tmc.edu).

View larger version (147K): [in a new window]   Figure 1a. Transverse nonenhanced CT images in a patient with a left ureterovesicular junction calculus. (a) Supine and (b) prone images of the bladder show a nonmobile impacted calculus (arrow) at the left ureterovesicular junction.

View larger version (153K): [in a new window]   Figure 1b. Transverse nonenhanced CT images in a patient with a left ureterovesicular junction calculus. (a) Supine and (b) prone images of the bladder show a nonmobile impacted calculus (arrow) at the left ureterovesicular junction.

View larger version (172K): [in a new window]   Figure 2a. Transverse nonenhanced CT images of the upper abdomen. (a) Proximal right ureteral calculus (arrow) and associated secondary signs of perinephric stranding and periureteral stranding (arrowhead) are shown. (b) At a more superior level, dilatation of calyces in the right renal lower pole (arrow) can be seen, consistent with obstruction.

View larger version (170K): [in a new window]   Figure 2b. Transverse nonenhanced CT images of the upper abdomen. (a) Proximal right ureteral calculus (arrow) and associated secondary signs of perinephric stranding and periureteral stranding (arrowhead) are shown. (b) At a more superior level, dilatation of calyces in the right renal lower pole (arrow) can be seen, consistent with obstruction.

View larger version (148K): [in a new window]   Figure 3a. Transverse nonenhanced CT images. (a) Distal left ureteral calculus (arrow) is seen. Circumferential soft-tissue thickening confirms that the lesion is within the ureter (arrowhead). (b) At a more superior level, a dilated ureter (arrow) can be seen.

View larger version (134K): [in a new window]   Figure 3b. Transverse nonenhanced CT images. (a) Distal left ureteral calculus (arrow) is seen. Circumferential soft-tissue thickening confirms that the lesion is within the ureter (arrowhead). (b) At a more superior level, a dilated ureter (arrow) can be seen.

View larger version (135K): [in a new window]   Figure 4. Transverse nonenhanced CT image of the pelvis shows phlebolith (thin arrow) with a tail (thick arrow) representing the associated vein.

View larger version (132K): [in a new window]   Figure 5. Transverse nonenhanced CT image of the pelvis shows a right ureterovesicular junction calculus (thick arrow), as well as three phleboliths posterolateral to the bladder. One phlebolith has a semicircular shape consistent with a low-attenuating center (short white arrow).

View larger version (166K): [in a new window]   Figure 6a. Transverse nonenhanced CT images of the right lower quadrant. (a) High-attenuating material (arrow) in the appendix can be mistaken for a ureteral calculus. (b) At a more superior level, air (arrowhead) within the appendiceal lumen helps differentiate the high-attenuating material from a ureteral calcification.

View larger version (158K): [in a new window]   Figure 6b. Transverse nonenhanced CT images of the right lower quadrant. (a) High-attenuating material (arrow) in the appendix can be mistaken for a ureteral calculus. (b) At a more superior level, air (arrowhead) within the appendiceal lumen helps differentiate the high-attenuating material from a ureteral calcification.

View larger version (152K): [in a new window]   Figure 7. Transverse nonenhanced CT image of the pelvis shows a fat-containing mass (solid arrow) with a central prominent calcification (open arrow), consistent with a dermoid cyst. This finding was identified incidentally in a patient undergoing evaluation for flank pain.

View larger version (155K): [in a new window]   Figure 8. Transverse nonenhanced CT image of lower pelvis shows radiation seeds near seminal vesicles (thin arrows) and the bladder base (thick arrow). A more inferior image (not shown) depicted multiple seeds throughout the remainder of the prostate.

View larger version (154K): [in a new window]   Figure 9a. (a-c) Transverse contrast-enhanced CT images obtained from superior (a) to inferior (c) levels in a patient with transitional cell carcinoma of the right ureter show enhancing progressive thickening of the right ureter (arrow).

View larger version (158K): [in a new window]   Figure 9b. (a-c) Transverse contrast-enhanced CT images obtained from superior (a) to inferior (c) levels in a patient with transitional cell carcinoma of the right ureter show enhancing progressive thickening of the right ureter (arrow).

View larger version (175K): [in a new window]   Figure 9c. (a-c) Transverse contrast-enhanced CT images obtained from superior (a) to inferior (c) levels in a patient with transitional cell carcinoma of the right ureter show enhancing progressive thickening of the right ureter (arrow).