Case Study - November 2009

This is a plain abdominal X-ray in a 24-year-old Indian man with admitted as an emergency with an 8-week history of left flank pain.

  1. What does the X-ray show?
  2. What other investigations are needed?
  3. What treatment is needed?

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. The plain X-ray shows a large opacity (2cm by 1cm) in the line of the left ureter, consistent with a large ureteric calculus
  2. CT is needed to confirm this and the patient also needs a detailed metabolic assessment if a stone is confirmed
  3. A stone of this size is unlikely to pass spontaneously and requires surgical intervention; the preferred treatment modality for a stone in this situation would be ureteroscopy & laser lithotripsy

The CT scan confirmed a large calculus in the mid-part of the left ureter with marked dilatation of the ureter above. The patient was informed by relatives and medical friends that his stone would pass spontaneously. He declined appropriate treatment and took his own discharge from hospital untreated.

illustrative image for answer to question $n

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