Noncontrast multidetector-row computed tomography scanning for
detection of radiolucent calculi in acute renal insufficiency caused by
bilateral ureteral obstruction of ceftriaxone crystals
Affiliations: Department of Urology, the Second Affiliated Hospital,
Nanchang University, Nanchang, Jiangxi, China | Department of Urology, the First Affiliated Hospital,
Sun Yat-sen University, Guangzhou, Guangdong, China | Department of Radiology, the Second Affiliated
Hospital, Nanchang University, Nanchang, Jiangxi, China | Wake Forest Institute for Regenerative Medicine, Wake
Forest University School of Medicine, Winston-Salem, NC, USA
Note: [] Corresponding author: Yuanyuan Zhang, Wake Forest Institute for
Regenerative Medicine, Wake Forest University School of Medicine,
Winston-Salem, NC 27157, USA. E-mail: yzhang@wakehealth.edu
Abstract: Noncontrast computed tomography (CT) has great advantage with higher
sensitivity and more clear modalities in detecting urinary tract radiolucent
calculi in patients with acute renal insufficiency (ARI) compared to other
image diagnosis approaches. We report two cases (female, 28 years old; male, 39
years old) with persistent flank pain and acute anuria after the administration
of ceftriaxone (4.0 g daily) for 2 days intravenously. No abnormality was found
in the kidney-ureter- bladder (KUB) areas with plain abdomen X-rays. A
diagnosis of bilateral hydronephrosis was made by ultrasound examination in
both cases. Serum creatinine levels reached up to 257 and 810 μ mol/L
(normal serum creatinine level is 40–130 μ mol/L), respectively. Vague
density spots were noticed in the pelvis with noncontrast multidetector-row CT
(MDCT) scanning. However, distinguishable clusters of high-density shadows were
seen in pelvic areas with maximum intensity projections (MIP, CT values in
30–128 HU). Ceftriaxone crystal calculi were found on both sides of
distal ureters under endoscopy. Renal function recovered in both patients after
double-J ureteral stents were installed. Out results demonstrated that noncontrast MDCT scanning and MIP
reconstruction as an effective diagnostic tool could provide clear images in
detection of radiolucent calculi in urinary tract when conventional X-rays
image are not suitable in the patients with obstructive anuria and ARI of unknown origin.
