Diagnostic Ultrasound - Abdomen and Pelvis

Bladder Calculi
Diagnoses: Urinary Tract
TERMINOLOGY
• Concretions of mineral salts/crystal within bladder lumen
IMAGING
• Mobile avascular echogenic focus/foci in bladder with
acoustic shadowing on US
• Smooth round or ovoid laminated calcification in bladder
region on plain radiograph
• Associated bladder wall thickening and internal echoes or
debris may be seen
• Calcific density in bladder, of varying size and shape, often
lamellated on NECT or CECT
• Low signal intensity on all MR sequences
TOP DIFFERENTIAL DIAGNOSES
• Bladder neoplasm
• Blood clot
• Fungal ball
• Prostatomegaly
KEY FACTS
PATHOLOGY
• Stasis: Bladder outlet obstruction, neurogenic bladder,
bladder diverticula
• Infection, especially proteus mirabilis
CLINICAL ISSUES
• Most asymptomatic
• May present with hematuria, suprapubic pain, and repeated
UTI
• Complication: Malignant bladder tumors in patients with
stones from indwelling Foley catheters
DIAGNOSTIC CHECKLIST
• Carcinoma resulting from chronic bladder irritation may
coexist with bladder stone
(Left) Longitudinal
transabdominal ultrasound
shows a large, echogenic
stone within the urinary
bladder. The stone is lobulated
in contour and associated with
posterior acoustic shadowing
st. Note the diffuse bladder
wall thickening ſt related to
chronic bladder outlet
obstruction, a known risk
factor for development of
bladder calculi. (Right)
Transverse oblique
transabdominal US of the
bladder shows a partly
obstructing stone at the
right UVJ and mildly dilated
upstream ureter .
(Left) Longitudinal
transabdominal ultrasound
shows multiple tiny layering
echogenic stones ſt within
the urinary bladder. Note the
mild bladder wall thickening
st. (Right) Longitudinal
oblique transabdominal
ultrasound shows a small,
echogenic stone with
posterior acoustic shadowing
st seen adherent to the
bladder wall.
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