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Caveat emptor: caliceal stones and the missing calix
S Meretyk1, S Bigg, R V Clayman
1Department of Surgery, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
The Journal of Urology
|April 1, 1992
Summary
A "missing calix" on imaging may indicate a hidden pyocalix, posing a sepsis risk with extracorporeal shock wave lithotripsy. Percutaneous drainage and stone removal are recommended treatments for these challenging kidney stones.
Area of Science:
- Urology
- Nephrology
- Medical Imaging
Background:
- A 'missing calix' on imaging studies, often due to stones, can be the sole indicator of an occult pyocalix.
- Patients with pyocalix may lack typical infection signs like fever and have sterile urine, complicating diagnosis.
Observation:
- Extracorporeal shock wave lithotripsy (ESWL) in patients with stone-laden missing calices can precipitate life-threatening sepsis.
- The absence of visualization of a stone-containing calix suggests a potential underlying infection.
Findings:
- Percutaneous drainage of the affected calix is the primary treatment.
- Subsequent percutaneous stone removal is crucial for managing the condition.
- Endoinfundibulotomy may be required to restore renal pelvis-calix communication.
Implications:
- Prompt and appropriate intervention for stone-laden missing calices prevents severe complications like sepsis.
- This approach highlights the importance of recognizing imaging anomalies suggestive of occult infections.
- Optimized treatment strategies improve patient outcomes in complex urinary stone cases.