Clinical Essentials | Overview of Ultrasound Manifestations of Kidney Stones and Ureteral Stones

Introduction: This article is for everyone to sort out the ultrasound manifestations of kidney stones and ureteral stones.

Features of Ultrasound Image of Kidney Stones 1.
Kidney stones are images with high echo in the kidney.

2.
Large stones occupying the central echo (renal sinus) area are called coral stones.

3.
The common sediment-like hyperechoic (calcium milk) or stones inside the calyx diverticulum or hydronephrosis.

4.
Hyperechoic in the renal parenchyma (calcification caused by renal tubular acidosis or sponge kidney).

5.
Hyperechoic from renal hilum to renal medulla (calcification of renal artery wall).

6.
Hyperechoic under the renal capsule (changes after absorption of hematoma caused by trauma or bleeding).

Fig.
1 Kidney stones Fig.
2 Kidney stones Fig.
3 Kidney stones Fig.
4 Coral stones Fig.
5 Renal calcification Fig.
6 Calcium milk Fig.
7 Gout kidney Fig.
8 Arcuate blood vessels Clinical 1.
Kidney stones and ureteral stones are collectively called upper urinary tract stones.
Bladder stones and urethral stones are collectively called lower urinary tract stones.

2.
According to the location of kidney stones, there are kidney stones, renal pelvis stones and coral-like stones occupying the renal pelvis and kidney stones.

3.
Stones include calcium oxalate stones, calcium phosphate stones, magnesium phosphate stones, uric acid stones, cystine stones, xanthine stones, etc.
, among which calcium oxalate stones or calcium phosphate stones are the most common.

In addition, uric acid stones, cystine stones, and xanthine stones are easily penetrated by X-rays, so it is difficult to visualize them on plain radiographs of abdominal X-rays.

4.
Symptoms of kidney stones, in addition to low back pain and hematuria, stones can also be discharged.

Note: Kidney stones less than 5mm have almost no sound shadow, but subtle changes in the ultrasound incident angle can show point-like hyperechoes and sound shadows.

Therefore, when breathing calmly or changing the position of the intercostal scan, sometimes there will be sound and shadow.
Therefore, it is necessary to observe not only when inhaling, but also when exhaling or changing the position of the intercostal scan. Ultrasonographic features of ureteral calculi 1.
Dilated ureteral probing and high echo with acoustic shadow.

2.
With central echoes (central echoes, central echo complex, CEC; renal sinus) separation (hydronephrosis).

3.
Explore the anechoic area around the kidney (natural extravasation of renal pelvic urine).

Fig.
9 Prevalence of ureteral stones (physiological stenosis of ureter) Fig.
10 Ureteral stones (transition of renal pelvis and ureter) Fig.
11 Ureteral stones (intersection of iliac artery) Fig.
12 Ureteral stones (transition of ureter and bladder) Fig 13 Extravasation of renal pelvis Clinical 1.
Most ureteral stones are caused by kidney stones falling into the ureter, and most of them are incarcerated in three physiological stenosis: ①renal pelvic ureter transitional part; ②the intersection of ureter and common iliac artery; ③ureteral bladder transitional part, causing ureter Dilation (hydroureteral), almost all cases cause hydronephrosis.

2.
The indirect sign of ureteral calculi is peri-renal effusion, which is caused by the increase in pressure in the renal pelvis caused by ureteral calculi and the natural leakage of urine to the outside of the renal pelvis, which is called natural extravasation of urine.

In addition to ureteral stones, it can also be found in ureteral cancer or ureteral metastasis, childbirth, and after extracorporeal shock wave lithotripsy (ESWL).

Note: Dilation of the ureter caused by stones in the lower part of the ureter near the transition of the ureter and bladder is generally mild.
Therefore, if the degree of hydronephrosis is found to be very mild on ultrasound examination, it is also necessary to confirm whether there are stones in the transition of the ureter and bladder.

The content of this article is excerpted from "Introduction to Urinary System Ultrasound" (Science Press).

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