Renal calculus(Nephrolithiasis)

Renal Calculus (Nephrolithiasis)

Diagnostic Sonography Case Study No: CS-003

Step-i

Clinical history

Clinical History: A 42-year-old male presented with acute onset right flank pain radiating to the groin, associated with nausea and hematuria. Clinical suspicion of renal/ureteric calculus was raised. Ultrasound examination was advised for evaluation of urinary tract obstruction.

Fig-1. Ultrasound image of the right kidney demonstrates a hyperechoic focus with posterior acoustic shadowing, measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus. No dilatation of the pelvicalyceal system may is seen,

Fig-1.1 Ultrasound image of the right kidney demonstrates a hyperechoic focus with posterior acoustic shadowing on color Doppler showing "Twinkling artifact" measurese of 14.7 mm in maximum diameter withinthe renal pelvis consistent with a renal calculus. No dilatation of the pelvicalyceal system may is seen,

Key diagnostic ultrasound signs:

a- Hyperechoic focus within kidney/ureter
b- Posterior acoustic shadowing
c- Twinkling artifact on Doppler
d- Hydronephrosis (if obstructive)
e- Dilated ureter (in ureteric calculus)

Hyperechoic Focus: Renal stones appear as bright echogenic foci due to high acoustic impedance.

Posterior Shadowing: A clean acoustic shadow behind the stone confirms calcification.

Twinkling Artifact: Color Doppler may show twinkling artifact, improving detection.

Clinical Correlation: Patients typically present with flank pain, hematuria, nausea.

Renal Calculus ✔ Echogenic focus
✔ Posterior acoustic shadow
✔ Twinkling artifact
✔ Possible hydronephrosis Renal Mass ✖ No posterior shadow
✖ Solid vascular lesion Blood Clot ✖ Mobile, no shadow
✖ No twinkling artifact Papillary Calcification ✖ Small non-obstructive foci
✖ Usually no hydronephrosis

Findings:
A well-defined echogenic focus is noted within the kidney showing posterior acoustic shadowing. Findings are consistent with renal calculus.

Conclusion:
Ultrasound findings are suggestive of Renal calculus.

Recommendation:
Clinical correlation advised. Further evaluation with NCCT KUB may be considered for confirmation and stone characterization.

You have reached the end of this Renal Calculus – Ultrasound Case Study. Largest calculus size: 8 mm
Location: Right renal pelvis