Answers to Case1-1-8
1. The ultrasound scan (Fig. 2.22.1a ) demonstrates a large echogenic lesion occupying
the central portion of the left kidney which casts an acoustic shadow. The
coronal MIP* CT image (Fig. 2.22.1b ) shows a large calcified stone which completely
opacifies the left renal pelvicalyceal system. A small stone is also seen in
the infundibulum to a lower pole calyx of the right kidney. The appearance on the
left is of a staghorn calculus which is composed of calcium magnesium ammonium
(phosphate (struvite
2. Firstly the presence of infection should be excluded. If present it should be
aggressively treated, the additional placement of a ureteric stent or nephrostomy
to relieve any obstructive pyonephrosis may be required. The residual renal function
should be measured (by a DMSA or MAG3 nuclear medicine test). Then
depending on the patient’s co-morbidities and the likelihood of recovery of renal
function either percutaneous nephrolithotomy, open pyelolithotomy or nephrectomy
are the main treatment options.