DMS100



Journal Club 1. Name of topic:“Detection of Ureteral Stones with Transvaginal Sonography”2. Who published the article?Carolina Vega in the Journal of Diagnostic Medical Sonography 3. Brief synopsis of article:Urolithiasis - a condition where mineral and acid salts form stones in the urinary systemLeading mineral in Urolithiassis formation is calciumCertain foods cause kidney stonesHigh-protein dietsHigh-salt dietsMore common in Caucasian people and in men than in womenSeveral risk factors affect womenMedicationsPregnancyUnderlying diseasesUrinary tract infectionsTransvaginal Sonography is commonly the chosen method to detect stones It detects ureterolithiasis much easier than transabdominal sonography Transvaginal sonography uses higher frequencies The transducer is closer to the ureterIt can assess ureteral calculi and pelvic abnormalities in one examCase Study:WomanEarly twenties Persistent right lower quadrant painPatient felt “achy” and experienced crampsAppendicitis was suspectedSonogram of the right lower quadrant was ordered12 MHz linear transducer was used on a Philips iU22 ultrasound machineResults:No inflamed appendixDilated distal right ureterPelvic sonogram orderedResultsFound nothingTransabdominal and Transvaginal scans done using 5 MHz curvilinear transducerThere was a posterior acoustic shadowing and color Doppler twinkle artifact which means stonesStone was measured in sagittal and transverseStone: 4mm long and 3 mm wideSonogram was very clear; did not require extra imagingDiagnosis: ureteral stone with hydroureterBecause of the stones small size it was expected to pass on its ownPatient was sent home and told to drink a lot of fluidsPatient returned to emergency room less than a week later complaining of the same right lower quadrant painRenal sonogram orderedShowed moderate hydronephrosis in the right kidneyModerate dilation of right ureterStone was seen in the distal ureter; transabdominally Transvaginal and transabdominal sonograms served as appropriate exams in order to evaluate the patient’s condition.Transvaginal sonogram was specifically able to reveal that the stone in the right ureter was the cause of the pelvic pain.Any stone smaller than 5 mm in width is able to be passed down the urinary tract to relieve pain in lower abdominal region.Two commonly used procedures to remove stones include:Extracorporeal Shock Wave Lithotripsy (ESWL)Most common for kidney stone treatmentsUltra-intensity US waves that decompose or break the stones in smaller pieces which could then be removed via urinary tractPercutaneous Nephrolithotomy (PNL)Surgical incision into the affected area to remove the stoneHigh chance of good prognosis and efficiency3. Conclusion of article:Stones are likely to reoccur in patients who have medical histories with stones in the pelvic/lower abdominal region.Overall significance of the finding is that a transvaginal sonogram was most effective to quickly locate and help diagnose a stone in the right ureter.No harm was done to the patient during examination procedure; sonogram did not expose patient to RT (radiation therapy) and was able to help patient understand the cause of right lower regional pain and the treatment necessary. ................
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