Friday, October 27, 2006

A calculus affair:

The mystery of the renal calculus:
Any sonologist worth his degree would have seen numerous renal calculi or kidney stones. But few would ponder over how many of the minute particles, yes particles, are actually calculi. The problem arises when one begins to diagnose stones of less than 4 mm. This is when the diligent radiologist or sonographer, faces the dilemma of labeling an echogenic structure in the kidneys, a stone or an otherwise normal appearance. Many bytes have been spent on the internet discussing these fine details with my colleagues. The hallmark of the renal or any calculus has always been the bright (echogenic) focus with a trailing acoustic shadow (a dark area behind the stone). As these pictures show, the shadow may not be obvious. In some cases, there may be a faint shadow, which further confuses the sonologist. These images by Dr. Ravi Kadasne, radiologist, in UAE, show a case where there is an echogenic lesion or focus followed by a faint shadow behind it. However, CT scan showed no such calcification or lesion. The best advise in these cases would be to do a follow up of the lesion after a few months.

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