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Table of Contents
CASE REPORT
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 109-111  

The accuracy of noncontrast spiral computerized tomography in detecting lucent renal stones: A case report and literature review


Department of Surgery, Division of Urology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission29-May-2014
Date of Acceptance24-Jun-2014
Date of Web Publication6-Jan-2015

Correspondence Address:
Saleh Binsaleh
Department of Surgery, Faculty of Medicine, King Saud University, P.O Box 36175, Riyadh 1149
Saudi Arabia
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DOI: 10.4103/0974-7796.148649

PMID: 25657560

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   Abstract 

Renal stones are one of the most common diseases in the urology field that are easily diagnosed by one of the standard imaging techniques. Noncontrast spiral computerized tomography (CT) can detect up to 95% of the renal, ureteric and bladder stones, especially those with calcium composition, and considered nowadays one of the most accurate methods for detecting undetectable stones by other modalities. We report a case of a 60-year-old female who presented with colicky right flank pain due to large calcium oxalate renal stone that is undetected by standard imaging technique including spiral CT scan. Uretroscopy diagnosed and ultimately treat this patient problem.

Keywords: Lucent stones, renal stone diagnosis, spiral computed tomogram


How to cite this article:
Adwan A, Binsaleh S. The accuracy of noncontrast spiral computerized tomography in detecting lucent renal stones: A case report and literature review. Urol Ann 2015;7:109-11

How to cite this URL:
Adwan A, Binsaleh S. The accuracy of noncontrast spiral computerized tomography in detecting lucent renal stones: A case report and literature review. Urol Ann [serial online] 2015 [cited 2020 Sep 28];7:109-11. Available from: http://www.urologyannals.com/text.asp?2015/7/1/109/148649


   Introduction Top


Renal stones are one of the most common diseases in the urology field that are easily diagnosed by one of the standard imaging technique like plain X-ray of the kidneys, ureters and bladder (KUB), ultrasonography scan (USS), intravenous pyelography (IVP), and recently the noncontrast spiral computerized tomography (CT) which can detect up to 95% of the renal, ureteric and bladder stones and considered nowadays one of the most accurate methods for detecting undetectable stones by other modalities.


   Case report Top


This report is about a 60-year-old consented female patient who presented with 5 days history of right flank pain that was colicky in nature and radiating to the groin. This pain was associated with burning micturation and mild nausea. The physical examination was unremarkable including normal vital signs. Laboratory investigation revealed the presence of microscopic hematuria and normal renal function. KUB plain X-ray was done and revealed no radio-opaque shadow in the area of urinary tract. Ultrasonography was carried out and showed moderate hydronephrosis with no hydroureter or renal stones [Figure 1]. Noncontrast thin cuts hi-speed advantage spiral CT (General Electric Medical Systems, Milwaukee, USA) using flank pain protocol-helical technique with breath-holding at 120 kV, 200 mA with 5 mm collimation and viewed using the abdominal window) was done to evaluate the possibility of ureteric stone and was unremarkable apart from mild hydronephrosis and perinephric fat stranding [Figure 2]. Patient was assured as the pain did subside after oral analgesics and advice to follow-up after few days to evaluate the hydronephrosis with the impression of possibly passed stone. Patient was seen in an emergency department again after few days with worsening flank pain and worsening hydronephrosis that was evident by repeated USS. She was admitted and underwent diagnostic retrograde pyelography and then ureteroscopy that revealed the presence of 2 cm × 2 cm stone in the right renal pelvis [Figure 3] that was subsequently easily fragmented by laser intracorporeal lithotripsy. Patient had a smooth postoperative course and discharged the same day. Stone analysis revealed the following composition: 60% calcium oxalate, and 40% uric acid. It was negative for ammonium, magnesium, cystine or inorganic phosphorus.
Figure 1: Ultrasonography scan demonstrating moderate hydronephrosis with no renal stone. Arrow indicate dilated pelvicalyceal system

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Figure 2: Computerized tomography scan of the same patient was unremarkable apart from mild hydronephrosis and perinephric fat stranding

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Figure 3: Large renal stone as seen during ureteroscopy

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   Discussion Top


Imaging has an essential role in the diagnosis, management, and follow-up of patients with urinary stone disease. A variety of imaging modalities are available to the practicing urologist, including conventional radiography, IVP, ultrasound scan, magnetic resonance urography, and computed tomography scans, each with its advantages and limitations. [1] Traditionally, IVP was considered the gold standard for localizing radiolucent and ureteric calculi, but this modality has largely been replaced by nonenhanced spiral CT scans at most centers. [2] The usefulness of spiral CT scan in the study of urolithiasis nowadays is supported by a large literature which clearly supplies with documentary evidence the high sensitivity and specificity of such a method in diagnosing the presence of urolithiasis in general and, above all, of the ureteric stones. Such a method not only makes an accurate evaluation of the stones location possible, but it can also assess the calculi dimensions and the indirect signs of affected kidney functionality without having to use the contrast medium. [3] Although initial studies revealed that all stones, regardless of their dimensions, were detected with a sensitivity and specificity up to 100% using spiral CT scans, [4-6] other studies showed decreasing values based on stone composition. In one study, USS showed 93% sensitivity and 95% specificity in the diagnosis of ureterolithiasis, compared to CT scan that showed 91% sensitivity and 95% specificity, while the correspondence for IVP was 87% and 94% respectively. [7] In our case, although having a sizable calcium oxalate stone, most common imaging modalities used failed to give the correct diagnosis at initial presentation requiring more invasive approach to give a diagnosis and subsequent treatment.


   Conclusion Top


Spiral nonenhanced CT scan is one of the most sensitive and specific diagnostic modalities for stone detection but in certain cases it fails to give accurate answers. Hence patient follow-up and combination of diagnostic techniques might be necessary.

 
   References Top

1.
Dhar M, Denstedt JD. Imaging in diagnosis, treatment, and follow-up of stone patients. Adv Chronic Kidney Dis 2009;16:39-47.  Back to cited text no. 1
    
2.
Passavanti G, Pizzuti V, Costantini FM, Bragaglia A, Franci L, Paolini R. The meaning and usefulness of spiral CT for radiolucent ureteric stones diagnosis: Our experience. Arch Ital Urol Androl 2003;75:46-8.  Back to cited text no. 2
    
3.
Kalra MK, Maher MM, D′Souza RV, Rizzo S, Halpern EF, Blake MA, et al. Detection of urinary tract stones at low-radiation-dose CT with z-axis automatic tube current modulation: Phantom and clinical studies. Radiology 2005;235:523-9.  Back to cited text no. 3
    
4.
Gaucher O, Hubert J, Blum A, Regent D, Mangin P. Evaluation of spiral computed tomography in the demonstration of kidney stones. Ex vivo study. Prog Urol 1998;8:347-51.  Back to cited text no. 4
    
5.
Thibeau JF, Sourtzis S, Bellemans MA, Vandendris M. Comparison of spiral computed tomography without contrast media and intravenous urography in the diagnosis of renal colic. Prog Urol 1999;9:233-8.  Back to cited text no. 5
    
6.
Wang JH, Lin WC, Wei CJ, Chang CY. Diagnostic value of unenhanced computerized tomography urography in the evaluation of acute renal colic. Kaohsiung J Med Sci 2003;19:503-9.  Back to cited text no. 6
    
7.
Miller OF, Rineer SK, Reichard SR, Buckley RG, Donovan MS, Graham IR, et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 1998;52:982-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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