Hidden VUJ calculus

This male patient reveals the difficulties the radiologist often faces when trying to discover the location of a ureteric calculus. At first the patient complained of pain in the left iliac region suggested a case of mid ureteric calculus. However, despite the hydronephrosis of the left kidney and a mild hydroureter on the left side, it was very difficult to locate a calculus which was actually located at its distal end, namely the left vesico-ureteric junction. a lot of factors were unfavourable to locate this calculus at the left vesicoureteric junction. First, the patient had a rather hyper distended bladder. Also, the left hydroureter was mild. Besides, the patient also had significant bowel gas. finally, the calculus itself was rather small at 6.5 mm.

The urinary bladder:

 

The Left Kidney and left VUJ:

  

The left VUJ calculus:

 

References:

http://www.ultrasound-images.com/ureteric-calculi.htm