黑白配味道不错（黑白配原来是石头）

原创： zyr 阿尔法医学英语 今天

黑白照片很复古，可是小编黑白的片子真的让人觉得眼前一片灰... 别担心，跟随小编的步伐，一起解密这些黑白灰图片中的线索与含义。

每篇以case study为基础，结合探索性问题一起掌握或了解一个征象。嘻嘻～大家还记得上期的问题吗？看看你都答对了吗？

Black &

White

2

黑白配 第二辑

Previously on B&W

A 48-year-old man has sudden-onset sharp right flank pain with nausea and diaphoresis. Part of his CT scan is shown below.

Question 1

What could be in the differential diagnosis for the imaging findings presented?

Question 2

Can you find any indirect CT findings to support your diagnosis?

Figure 1. Axial unenhanced CT shows right hydronephrosis (yellow arrow) and perinephric edema (red arrow) and mildly swollen right kidney

Figure 2. Axial unenhanced CT of the pelvis shows a small calculus (red arrow)at the ureterovesical junction. There is a mild dilation of the distal right ureter(yellow arrow). A linear soft tissue attenuation (blue arrow representing vein)extending to a calcification is called the “tail sign,” which may help in distinguishing a ureteral calculus from a phlebolith, and this calcification is in favor of a phlebolith.

Question 1

Which of the following would be in the differential diagnosis for the imaging findings presented? (Choose all that apply.)

• Retroperitoneal fibrosis
• Obstructing calculus at ureterovesical junction
• Calculus that has been recently passed into the bladder
• Retroperitoneal hematoma

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So the answer is B and C.

Ultrasonography may be able to differentiate these two diagnosis. As for the latter one, the stone is within the ureterovesical junction. Absence of a ureteral jet from the affected side and twinkling or color-comet-tail artifact are two valuable indirect signs of obstruction.

Question 2

Can you find any indirect CT findings to support your diagnosis?

-- scroll right for answer --

Direct finding

a small calculus at the ureterovesical junction

Indirect findings

hydronephrosis/hydroureter to the level of the calculus

perinephric/periureteral edema and right renal swelling

Extention

Acute Obstructing Ureteral Calculus

Clinical Manifestation

Renal colic is defined as acute pain by obstructing ureteral calculus. The common locations for obstruction by a stone are the ureteroplevic junction (UPJ), the pelvic brim where the ureter crosses the iliac vessels, and the ureterovesical junction.

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Imaging Findings

Imaging can provide information regarding the presence, size, location of the stone, degree of obstruction, potential complications, and in some cases, alternative diagnosis for the cause of pain.

Unenhanced CT is the current imaging modality of choice because of its high sensitivity, specificity and accuracy in diagnosing urolithiasis in patients presenting with acute flank pain. Direct and indirect findings have been demonstrated before.

Ultrasonography is recommended as the initial imaging modality in pregnant women and children, although it is poor for detecting stones in midureter.

MRI or MR Urography may be used especially when radiation dose is of concern. Calculi on MRI are of low intensity.

Management

Treatment options depend on the stone size and location and duration of the symptoms. The majority of small (<5mm) stones are likely to pass spontaneously. Ureteroscopy and/or ureteral stent may be used for lower ureteral calculi. Extracorporeal shock-wave lithotripsy may be used for proximal calculi.

Congratulations! You are nearly to the end of this episode but for the following reviewing question.

The following computed tomography (CT) or sonographic findings are seen with urinary calculus, EXCEPT

A. Tail sign on unenhanced CT

B. Rim sign on unenhanced CT

C. Twinkling artifact on colore Doppler sonography

D. Absent uteral jet on colore Doppler sonography

Bibliography

Kawamoto S, Macura KJ, Zagoria RJ. Genitourinary Imaging: Case Review. Third ed. Philadelphia, PA: Elsevier; 2016.

AlphaMedEnglish

edited by zyr

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