Case In Point An Intriguing Diagnosis Middle-Aged Woman With Ureteral Calculi

摘要

For 3 months, a 46-year-old woman had had intermittent right-sided loin pain. She had no dysuria, increased frequency or urgency, daytime wetting or dampness, nocturia, or bed-wetting. There was no change in the color or the odor of her urine. She had no history of trauma. Her medical history was unremarkable. On examination, she was afe-brile. Mild tenderness was noted over the right flank. The remainder of the physical examination findings were normal. Urinalysis revealed 0 to 4 white blood cells (WBCs) and 10 red blood cells per high-power field. There were no casts or crystals. A urine culture was negative. A plain radiograph of the abdomen showed an opacity on the right side at the level of the third lumbar vertebra (L3), in a position compatible with a ureteral calculus (Figure 1). The opacity measured 10 x 13 mm. The diagnosis of a ureteral calculus was confirmed with a nonenhanced helical CT scan (Figure 2). The patient's serum calcium, phosphate, alkaline phosphatase, uric acid, electrolyte, and creatinine levels were normal. The prothrom-bin and activated partial thrombo-plastin times were also normal.