IOTW 9/17/2020

55M w/ hx of L ureteral stent p/w abdominal pain and dysuria

1. How would you grade the level of hydronephrosis in A?
   • Moderate hydronephrosis.
   • Explanation: Mild hydronephrosis is dilatation of the renal pelvis. In higher grade cases of mild hydronephrosis, the dilatation may begin to involve the calyces. Moderate hydronephrosis is when the calyces become so dilated that they obtain a rounded appearance called the “Bear Paw Sign”. Severe hydronephrosis is when there is cortical thinning and loss of borders between the ballooned renal pelvis and calyces.
2. What other positive finding do you see in A?
   • Nephrolithiasis. There is an intraparenchymal stone at the right-most calyx. Notice the shadow artifact.
3. What positive finding do you see in B?
   • There is a ureter stone. Again, notice the shadowing.
4. What finding regarding the bladder do you notice in C?
   • There is a large bladder stone. This was actually found to be obstructing the ureterovesical junction.