Images

Doctor's Information

Name : Morteza,Mohammad Ali
Family : Sanei Taheri,Karimi
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------

Case Section

Uroradiology & Genital Male Imaging

Patient's Information

Gender : Male
Age : 55

Clinical Summary

55-year-old man with hamaturia and another 80-year-old man with intermittent hamaturia nad dysuria.

Imaging Findings

A large 7×6 cm spiculated calculus is seen in the bladder in first two images along with thick irregular bladder wall. Urinary catheter has eccentric location. Third image demonstrates this surgically removed stone. Other images belong to another patient with a bladder stone (3.5 cm) which is readily depicted in unenhanced CT images. Note the smooth normal thickness bladder wall and normal sized prostate.

Differential Diagnosis

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Final Diagnosis

Bladder stone

Discussion (Related Text)

Bladder calculi are usually associated with urinary stasis but can form in healthy individuals. In men, prostatic enlargement is the main etiology of vesical obstruction and is responsible for the deposition of layer upon layer of new stone material. In women, cystoceles, enteroceles, or previous urethral surgery, and foreign body (very rare) are predisposing factors of bladder stones Plain radiography of the kidneys, ureters, and bladder (KUB) is the initial imaging study of choice. Urinary bladder stones are commonly laminated. Cystography or IVP demonstrates the stone as a filling defect in the bladder. With the negative initial KUB, the next step is bladder ultrasonography, which may be able to differentiate a calculus from tumor or clot. Ultrasound typically shows a classic hyperechoic object with posterior shadowing, and is able to identify both radiolucent and radiopaque stones. Many centers use ultrsonography as the first imaging study for bladder stones, because this is readily available, relatively inexpensive and rapid modality without any radiation exposure. Unenhanced spiral CT scanning is highly sensitive and specific in diagnosing urinary tract calculi. Even radiolucent pure urate calculi, can be detected with this method.

References

Basler J, Ghobriel A, Cantrill CH. Bladder Stones Workup. http://emedicine.medscape.com/article/2120102. Jun 2012. Last access Dec 2012.

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