A 45 year old lady with history of hysterectomy and bilateral salpingho oophorectomy, presented to her gynaecologist for symptoms of lower urinary tract – dysuria and frequency.
She was sent for a routine evaluation of the abdomen and pelvis.
The following pictures show a normal liver, gall bladder, pancreas and spleen .
Both the kidneys appeared to be normal . No calculus was seen . There was no evidence of any obstruction.
Urinary bladder wall was mildly thickened . 3D showed fairly normal bladder mucosa . Ureteric jets were seen normally.
The distal ureters were not visualised .
Post void bladder was studied and showed the following .
Lo and behold – a distal right ureteric calculus is clearly seen now .
Usually we pick up all ureteric calculi and distal ureteric pathologies with a full bladder . Usually distal ureteric calculus will cause some amount of obstructive features in the ureter and the kidney . That was also absent in this patient .
But occasionally like this patient , the distal ureters can be compressed with a full bladder and such findings could be missed unless we do a post void study, especially when they have a LUTS symptoms . In this patient the bladder wall also showed mild thickening.
