This 72 year old man with limited English , presented to the Emergency Department with a vague history of epigastric pain. There was a clinical concern regarding the presence of an abdominal aortic aneursym.
The tranverse images of the abdominal aorta - demonstrate an area of hypoechogenicity to the left of the aorta. Note the abdominal aorta is normal calibre. Additional images demonstate the presence of severe hydronephrosis of the left kidney. There is only a thin mantle of cortical tissue. A renal calculus (non obstructing) is visible in the lower pole of the kidney. There is marked dilatation of the proximal ureter to 18mm diameter- see the view of the ureter in transverse- as this is followed distally a area of hyperechogenicity with distal shadowing is seen consistent with a lage calculus. An image obtained from a CT KUB is included in the series
The presence of a large obstructing ureteric calculus has resulted in severe hydronephrosis of the left kidney. The changes present on the scan are longstanding ( and probably unrelated to the presenting symptom)
The images are remarkable for the degree of ureteric dilatation.
Hydronephrosis in this case is classified as severe. There are three areas of narrowing where a stone is likely to be held up in the ureter- at the pelvi -ureteric junction, where the iliac vessels cross the pelvis and at the vesicoureteric junction.