Goubaa Mohamed MD Djerba Tunisia

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Patient A is a 17-year-old male who presented with the history of urinary tract infection. Ultrasound and Radiography examinations were performed. Patient âgé de 17 ans, se présentant pour une histoire d'infection récidivante du tractus urinaire. l'échographie et une radiographie ont été réalisées.


Perineal scanning Voie périnéale

Radiography La radiologie


Click on the image below
Cliquez sur les images en bas


le coeur

Bladder Abdom
Vessie abdom

Perineal Scan
Voie périnéale


Ultrasound demonstrates the mirror anatomy of the abdominal viscera : a normally liver positioned left and the spleen and pancreatic tail on the right side (scans 1 and 2). Echocardiography (scan 3) confirmed a structurally normal heart mirrored and unusually positioned in the right chest.
Abdominal and perineal images of the urinary bladder demonstrate a bladder with some wall thickening and containing sedimentation. A bladder stone is also identified by its hyperechoic focus with posterior acoustic shadowing (Scans 3and 4). These ultrasound findings are most consistent with a bladder infection and secondary sedimentation and a bladder calculus.

L'échographie montre une image en miroir de tous les viscères : le foie normal est à gauche alors que la rate et la queue du pancréas sont à droite (clichés 1 et 2). L'échocardiographie confirme l'image en miroir du cœur qui est retrouvé dans l'hemithorax droit au lieux du gauche.
Les images de la vessie par voie abdominale puis périnéale monte un certain épaississement de la paroi avec une sédimentation de fines particules dans la lumière vésicale et une grosse lithiase formant une opacité avec cône d'ombre postérieur (clichés 3 et 4). Ces signes confirment l'infection urinaire, la sédimentation et la formation de calcul.


Situs inversus & bladder calculus Situs inversus et Calcul de la vessie ________


Bladder calculus

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Vesical calculi refer to the presence of stones or calcified materials in the bladder .

Bladder outlet obstruction remains the most common cause of bladder calculi in adults. Also, patients who have static urine and develop urinary infections have a higher tendency of forming bladder calculi. Another etiologic factor of bladder stones is foreign bodies in the bladder that act as a nidus for stone formation (1). Metabolic abnormalities are not a significant cause of stone formation in patients with urinary diversions.

As a general rule, most vesical calculi are formed within the bladder, but some may initially have formed within the kidneys and subsequently passed into the bladder where additional deposition of crystals may cause the stone to grow. If the stone is calcium oxalate (3), then the kidney is the usual site of initial formation. In general, most are mobile within the bladder, though fixed stones occasionally can be present when formed on a suture, the intravesical portion of a papillary tumor or polyp, contraceptive device (5),Urachal anomaly (2), or on retained stents.

Signs of vesical calculi include microscopic or gross hematuria, pyuria, bacteriuria, crystalluria, and urine cultures demonstrating urea-splitting organisms.

Ultrasonography :
Ultrasound is very helpful in either initially detecting or in confirming the stones (as in this case). Bladder stones appear as high intensity echoes within the bladder, have an associated acoustic shadow. The color Doppler examination is of minor importance in the evaluation of patients with stone disease (4). The stone need not be calcified to be detected by ultrasound. Unless embedded in the bladder wall, the calculi shift to the dependent portion of the bladder with change in patient position (7).

differential : Calcified tumor of the urinary bladder (6), tuberculosis, Schistosomiasis, thickening caused by radiation and blood clot.
Other differential diagnoses are normal bladder trabeculae, mural folds, surgery scars.

Medical therapy
: The only potentially effective medical treatment for bladder calculi is urinary alkalinization for the dissolution of uric acid stones. Stone dissolution may be possible if the urinary pH is greater than or equal to 6.5.
Surgical therapy
: Currently, 3 different surgical approaches to this problem exist. Unlike renal and most ureteral calculi, ESWL has shown little efficacy in most centers.
* The first approach in adults (4) is transurethral cystolitholapaxy (Lithotripsy). After cystoscopy is performed to visualize the stone, an energy source is used to fragment it, and the fragments are removed through the cystoscope.
* The second approach in adults (and primary approach in the pediatric population)is percutaneous suprapubic cystolitholapaxy. Percutaneous lithotripsy has become the treatment of choice for the pediatric population because it avoids potential injury to the small caliber urethra while providing a less invasive approach than open surgery.
* The third approach, open suprapubic cystostomy to remove the stone(s) intact can be employed with larger and harder stones and when open prostatectomy and/or bladder diverticulectomy are indicated.

1: J Ultrasound Med. 2002 Nov;21(11):1303-5. Sonographic appearance of a bladder calculus secondary to a suture from a bladder neck suspension. Huang WC, Yang JM. Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan, Republic of China.
2: J Laparoendosc Adv Surg Tech A. 2002 Aug;12(4):281-3. A rare case of urachovesical calculus: a diagnostic dilemma and endo-laparoscopic management. Ansari MS, Hemal AK. Department of Urology, All India Institute of Medical Sciences, New Delhi. akhemal@hotmail.com
3: J Ultrasound Med. 2002 Sep;21(9):1047-51. Sonography of a human jackstone calculus. Perlmutter S, Hsu CT, Villa PA, Katz DS. Department of Radiology, Winthrop-University Hospital, Mineola, New York 11501, USA.
4: Schweiz Rundsch Med Prax. 2002 Apr 3;91(14):603-9. [Urolithiasis and ultrasound diagnosis. Value of ultrasound in diagnosis of urolithiasis] [Article in German] Knonagel H, Muntener M. Urologische Klinik, Spital Limmattal, Schlieren/Zurich. hartmut.knoenagel@spital-limmattal.ch
5: Can Assoc Radiol J. 2001 Feb;52(1):33-4. Bladder stone caused by an ectopic intrauterine contraceptive device: case report. Atasoy C, Fitoz S, Akyar S. Ankara University School of Medicine, Department of Radiology, Ibn-i Sina Hospital, Ankara, Turkey. cetinatasoy@hotmail.com
6: J Ultrasound Med. 1985 Dec;4(12):681-2. Calcified tumor of the urinary bladder: sonographic diagnosis and distinction from a bladder calculus. Sumers EH, Gittes RF.
7: J Urol. 1979 Jan;121(1):119-20. Ultrasound evaluation of bladder calculi. Rosenfield AT, Taylor KJ, Weiss RM.