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Pearls and Pitfalls in the Diagnosis of Ureterolithiasis with Unenhanced Helical CT¹

(CME available in print version and on RSNA Link)

¹ From the Department of Diagnostic Radiology, Wilford Hall Medical Center (59 MDW/MTRD), 2200 Bergquist Dr, Suite 1, Lackland Air Force Base, TX 78236-5302. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received April 8, 1999; revisions requested April 20 and received May 26; accepted May 26. Address reprint requests to N.C.D. (e-mail: ncdalrymple@earthlink.net).

Several signs to assist interpretation of unenhanced helical computed tomographic (CT) scans obtained for suspected ureterolithiasis have been described. Because signs such as perinephric stranding are not always readily apparent, a methodical approach to interpretation of CT studies is important in determining the presence or absence of ureterolithiasis. Evaluation of the poles of the kidneys is helpful in detecting subtle stranding of the perinephric fat. Inspection of the intrarenal collecting system within the poles of the kidneys is helpful in identifying subtle collecting system dilatation and can help prevent mistaking an extrarenal pelvis for hydronephrosis. Careful inspection of the ureter throughout its course is the most reliable method of distinguishing between ureteral stones and phleboliths. However, when the ureter cannot be followed antegrade, the pelvic portion can often be identified in a retrograde fashion. When secondary signs of obstruction are present but no stone is present, differential diagnostic considerations include a recently passed stone, pyelonephritis, urinary tract obstruction unrelated to stone disease, and protease inhibitor deposition disease.

Index Terms: Ureter, calculi, 82.81 • Ureter, CT, 82.12115 • Ureter, stenosis or obstruction, 82.843

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