Imaging urolithiasis: complications and interventions in children

Abstract

Urolithiasis affects people in all age groups, but over the last decades there has been an increasing incidence in children. Typical symptoms include abdominal or flank pain with haematuria; in acute cases dysuria, fever or vomiting also occur. Ultrasound is considered the modality of choice in paediatric urolithiasis because it can be used to identify most clinically relevant stones. Complementary imaging modalities such as conventional radiographs or non-contrast computed tomography should be limited to specific clinical situations. Management of kidney stones includes dietary, pharmacological and urological interventions, depending on stone size, location or type, and the child's condition. With a very high incidence of underlying metabolic abnormalities and significant recurrence rates in paediatric urolithiasis, thorough metabolic evaluation and follow-up examination studies are of utmost importance.

Keywords: Calculi; Children; Computed tomography; Kidneys; Nephrolithiasis; Ultrasound; Urolithiasis.

Fig. 1

Drug-induced urolithiasis (post-diuretic) in a premature 35-week-old boy (born at 26 weeks of gestational age). a Sagittal US of the left kidney shows a large, calcified structure in the renal hilum (arrow), corresponding to a stone. b Follow-up US colour Doppler examination after 5 weeks. Transverse view of the kidney shows the stone to have dissolved, with formation of a calculus in the proximal part of the ureter visualised by virtue of the twinkling artifact (arrow). Obstruction of the ureter resulted in pelvicalyceal dilatation with echogenic concrement in the renal pelvis (asterisk). Case courtesy of Prof. Philippe Petit, Marseille, France

Fig. 2

Colour Doppler axial image of the bladder of a 17-year-old girl who presented with right lower quadrant pain and haematuria shows a stone in the distal part of the right ureter. Twinkling artifact facilitates differentiation of the stone from other echogenic structures

Fig. 3

Pyonephrosis in a 13-year-old boy. Coronal contrast-enhanced CT shows a large multicystic lesion with destruction of the left kidney parenchyma (star) corresponding to left-side pyonephrosis as a complication of severe obstruction of the pelvicalyceal system

Fig. 4

Extracorporeal shock wave lithotripsy in a 15-year-old boy. a Transverse US of the right kidney immediately before the procedure shows a large calculus in the pelvicalyceal system. b Postoperative transverse image shows fragmentation of the stone into smaller pieces likely to pass spontaneously through the ureter. Case courtesy of Prof. Philippe Petit, Marseille, France

Fig. 5

“Steinstrasse” in a 12-year-old boy. Anteroposterior kidney, ureter and bladder radiograph shows steinstrasse, or a column of stone fragments in the distal part of the right ureter (arrow) as a complication of extracorporeal shock wave lithotripsy. Note stone fragments in the kidney and right ureter (asterisk). Case courtesy of Prof. Philippe Petit, Marseille, France

Fig. 6

Double nephrostomy performed for bilateral stenosis post ureteral reimplantation in a male neonate. Anteroposterior radiograph with contrast agent administered through nephrostomy tubes (arrows) confirms the correct localisation of the catheters in the pelvicalyceal systems and shows dilatation of the urinary tract with enlarged ureters (stars). Case courtesy of Pr. Philippe Petit, Marseille, France

Fig. 7

Severe congenital stenotic megaureters causing acute renal failure in a male neonate (different patient from Fig. 6). He underwent a double nephrostomy. Anteroposterior radiograph with contrast agent administered through nephrostomy tubes (arrows) shows severe dilatation of the urinary tracts. Case courtesy of Prof. Philippe Petit, Marseille, France

Fig. 8

Percutaneous nephrostomy for ureter stenosis of a transplanted kidney in a 17-year-old boy. He underwent stenting of the ureter with a double J catheter to enable urine drainage to the bladder. Anteroposterior radiograph with contrast agent administration through the nephrostomy tube (arrow) confirms connection of the pelvicalyceal system to the bladder (star) through the double J catheter (arrowhead). Case courtesy of Prof. Philippe Petit, Marseille, France