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Objective To determine if the measurement of ureteric stone in coronal reconstruction plane is different from the measurement in axial plane and whether the difference can impact the management decision in patients with ureteric colic. Methods All patients who underwent unenhanced multidetector computed tomographic (MDCT) scan for the evaluation of reno-ureteral colic in outpatient clinics and emergency room were evaluated. The scans were evaluated on Picture Archiving Computer System with a 3-mm axial and reformatted 3-mm coronal sections. Maximal stone diameter was measured in 2 dimensions in the axial and reformatted coronal sections by 2 reviewers. Only scans with isolated, unilateral, solitary ureteric calculi were included in the final analysis. All patients were monitored up to 4 weeks after MDCT to determine the clinical outcome. Results A total of 331 patients (272 male and 59 female; mean age ± standard deviation, 39.8 ± 13.8 years) were included. One hundred seventy-one (51.7%) stones passed spontaneously during the follow-up period. There was a 20% underestimation of maximal stone diameter in axial plane for all stones and a 17% for the stones that passed spontaneously or with medical expulsive therapy, as compared with measurement on coronal reconstruction. Conclusion Measuring the transverse stone diameter on axial images of MDCT scan underestimates size of ureteric stone. This can have an impact on counseling of patients and their clinical outcome, coronal reformatted images be used for size estimation.

Background Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Ascending subhepatic appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. Aim of the work To study the role of multidetector computed tomography in diagnosis of subhepatic appendicitis. Subjects & methods In the current study, we included fifteen patients diagnosed radiologically and confirmed surgically as subhepatic appendicitis. Ultrasonography followed by multidetector computed tomographic examination were performed to all patients before surgery. Results The clinical diagnosis of the patients included in this study at presentation was acute cholecystitis in four patients, pyelonephritis in three, and ureteric colic in three. Five patients were referred with uncertain diagnosis. The presence of subhepatic appendicitis was confirmed sonographically only in two patients. Computed tomography (CT) identified correctly subhepatic appendicitis in all cases. Conclusion Our study indicates the usefulness of multidetector CT in diagnosing atypical ascending subhepatic appendicitis.

Objective: The factors associated with a successful outcome for the treatment of urinary lithiasis are well described. We reviewed current methods of imaging utilised in stone treatment planning, with specific reference to their ability to identify predictors of outcome. Methods: A literature search for articles concerning the investigation and management of patients with urolithiasis was conducted through PubMed ( www.ncbi.nlm.nih.gov/PubMed/ ). In addition a hand search of the abstract books from the most recent major urological conferences was performed to identify data of interest that have so far been presented in abstract form only. Results: Non-contrast computed tomography is superior in terms of diagnostic efficacy, with sensitivity and specificity approaching 100%. The intravenous urogram and contrast CT with 3-dimensional reconstruction provide the best anatomical detail. Conclusion: Although non-contrast helical computed tomography is the most sensitive investigation for suspected ureteric colic, the anatomical and functional information afforded by intravenous urography remains important for treatment planning in some patients.

Resume Les auteurs rapportent le cas d’une patiente de 35 ans accusant depuis 7 ans des episodes ressemblant a des coliques nephretiques rebelles en rapport avec une hernie discale thoracique. Le diagnostic a ete pose tardivement en l’absence de troubles neurologiques. Les differentes explorations radiologiques ne retrouvaient pas de lesions au niveau de l’appareil urogenital expliquant cette symptomatologie. L’imagerie par resonance magnetique medullaire a ete performante dans la mise en evidence d’une hernie discale posterolaterale compressive en T10-T11. L’evolution a ete favorable apres une decompression chirurgicale radiculo-medullaire. A notre connaissance, l’association coliques nephretiques et hernie discale thoracique n’a jamais ete rapportee dans la litterature medicale.

Urinary tract obstruction is a common problem. It may be acute or chronic, affect the upper or lower urinary tract, or both, and often presents as a urological emergency. In non-acute cases, appropriate management is necessary to prevent irreversible nephron loss and renal failure. In recent years, the techniques available to accurately diagnose the site and extent of obstructive uropathy have become more sophisticated, and many of the conditions responsible lend themselves to less invasive and even laparoscopic keyhole techniques. This chapter examines the various types of obstructive uropathy, their causes and diagnoses and the current surgical techniques available for treatment.

Objective : Sonography is unfrequently used for direct visualisation of ureteric calculi. In a sonography prospective study with 3 experienced examinators, sonographical results in primary detection of ureteric calculi were compared to plain renal radiography and intravenous urography. Methods : In a prospective study, patients with suspected renal or ureteric colic were examined using both sonography and excretory urography. The only diagnostic criterion for sonography was the evidence of a calculus, while for excretory urography direct and indirect indications of a calculus were permitted. Results: Sixty two patients were examined using ultrasound and excretory urography. In detecting ureteric calculi, sensitivity of sonography and excretory urography was 93% and 76%, and specificity was 93% and 100%, respectively. In the present study, plain renal radiography was relatively less conclusive as a diagnostic tool for the detection of ureteric calculi and does not seem to be necessary as an additional procedure to sonography. In the case of renal calculi, sonography and excretory urography achieved a sensitivity of 94% and 77%, respectively, and a specificity of 100% each. Conclusions: Ultrasonographic examination carried out by a well-experienced investigator, using the graded compression technique, should be used as the primary examination method. Additional excretory urography remains open if there is a discrepancy between clinical symptoms or findings and sonographical diagnosis.

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We report on three children who were referred with episodic incapacitating loin pain and normal intravenous urograms. All three had been off from school and had given up all sports. Manipulation of the 11th or 12th rib reproduced the pain exactly. Following resection of the appropriate rib and costal cartilage all three children are completely pain-free, and have returned to normal activities. The Floating Rib Syndrome, which is an easy clinical diagnosis, must not be forgotten in the differential diagnosis of loin pain in children.