Milk of Calcium in a Pyelocaliceal Diverticulum
Milk of Calcium in a Pyelocaliceal Diverticulum
A 41-year-old white man presented to his family physician because of sudden-onset colicky pain in the right flank. His past history was significant for painful gastroesophageal reflux; long-standing hypercholesterolemia; and 4-vessel coronary artery bypass graft surgery at age 38, followed by a left direct inguinal herniorrhaphy 4 months later. He smoked a half pack of cigarettes per day for 15 years before his heart surgery, drank alcohol rarely, and never used illicit drugs. His medications were lovastatin, 10 mg PO with the evening meal; gemfibrozil, 600 mg PO before the morning meal; and 50 tablets of Tums per day.
On examination, he was afebrile, with stable vital signs. His abdomen was soft, but there was moderately severe right costovertebral and right lower quadrant tenderness. The complete blood cell count and serum electrolytes, blood urea nitrogen, creatinine, calcium, phosphorus, and uric acid levels were normal. Urinalysis showed 0 to 2 red blood cells and 0 to 2 white blood cells per high-power field. The urine culture revealed no growth. An unenhanced abdominal and pelvic spiral CT scan showed a 3-mm stone in the distal right ureter and milk of calcium in a pyelocaliceal diverticulum located in the upper pole of the left kidney (Figure 1). Three weeks later, intravenous pyelography demonstrated no change in the milk of calcium, but the stone in the distal right ureter had passed (Figures 2a, 2b, and 2c). Omeprazole, 10 mg PO bid, was prescribed for his gastroesophageal reflux, and he found it no longer necessary to take Tums.
(Enlarge Image)
The nonenhanced spiral (helical) CT scan was performed with the patient in the prone position. The left kidney demonstrates an upper pole pyelocaliceal diverticulum (arrowhead) with layering of milk of calcium (arrow). The stone in the distal right ureter is not shown.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
Which of the following is a correct statement?
View the correct answer.
<p>Extracorporeal shock wave lithotripsy is not effective for milk of calcium in pyelocaliceal diverticula.</p>
A 41-year-old white man presented to his family physician because of sudden-onset colicky pain in the right flank. His past history was significant for painful gastroesophageal reflux; long-standing hypercholesterolemia; and 4-vessel coronary artery bypass graft surgery at age 38, followed by a left direct inguinal herniorrhaphy 4 months later. He smoked a half pack of cigarettes per day for 15 years before his heart surgery, drank alcohol rarely, and never used illicit drugs. His medications were lovastatin, 10 mg PO with the evening meal; gemfibrozil, 600 mg PO before the morning meal; and 50 tablets of Tums per day.
On examination, he was afebrile, with stable vital signs. His abdomen was soft, but there was moderately severe right costovertebral and right lower quadrant tenderness. The complete blood cell count and serum electrolytes, blood urea nitrogen, creatinine, calcium, phosphorus, and uric acid levels were normal. Urinalysis showed 0 to 2 red blood cells and 0 to 2 white blood cells per high-power field. The urine culture revealed no growth. An unenhanced abdominal and pelvic spiral CT scan showed a 3-mm stone in the distal right ureter and milk of calcium in a pyelocaliceal diverticulum located in the upper pole of the left kidney (Figure 1). Three weeks later, intravenous pyelography demonstrated no change in the milk of calcium, but the stone in the distal right ureter had passed (Figures 2a, 2b, and 2c). Omeprazole, 10 mg PO bid, was prescribed for his gastroesophageal reflux, and he found it no longer necessary to take Tums.
(Enlarge Image)
The nonenhanced spiral (helical) CT scan was performed with the patient in the prone position. The left kidney demonstrates an upper pole pyelocaliceal diverticulum (arrowhead) with layering of milk of calcium (arrow). The stone in the distal right ureter is not shown.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
(Enlarge Image)
(A), Plain x-ray film taken with the patient supine reveals milk of calcium in an upper pole pyelocaliceal diverticulum of the left kidney. (B), Plain x-ray film with the patient in the left lateral decubitus position shows layering of the milk of calcium that is within the pyelocaliceal diverticulum. (C), Following administration of contrast, the postvoid film shows the milk of calcium within the pyelocaliceal diverticulum in relation to the collecting system. There is no evidence of ureteral obstruction.
Which of the following is a correct statement?
Milk of calcium in the urinary tract is composed mainly of uric acid.
Milk of calcium in the urinary tract is only found in pyelocaliceal diverticula.
Milk of calcium in the urinary tract should be treated in all persons, regardless of symptoms.
Extracorporeal shock wave lithotripsy is not effective for milk of calcium in pyelocaliceal diverticula.
View the correct answer.
<p>Extracorporeal shock wave lithotripsy is not effective for milk of calcium in pyelocaliceal diverticula.</p>
