INDICATION: ABD PAIN PAINFUL URINATION

TECHNIQUE: Noncontrast CT study of the abdomen and pelvis was
obtained. No intravenous contrast was given due to elevated
creatinine of 2.0.

COMPARISON: None.

FINDINGS - ABDOMEN CT: Lung bases are clear bilaterally.

There is severe bilateral hydronephrosis and hydroureter, which
is worse on the right side. There is mild thinning of the right
renal cortex. No lymphadenopathy, ascites, or bowel obstruction
is visualized. The remainder of the abdomen is unremarkable,
without urinary tract calculus.

FINDINGS - PELVIS CT: There are at least two urinary bladder
diverticula, one on each side (best seen on axial images 76 and
80, sequence 2). There is a 4.9 x 4.1 x 3.7 cm (AP x width x
craniocaudal) dimension urinary bladder calculus noted. This
calculus appears to surround an 8 cm long pencil-like foreign
body, in an onion ring-like configuration. There is urinary
bladder wall thickening-trabeculation, which is worse on the
left side. No focal ureterovesicular junction region lesions
are seen. There is a possible ovoid-shaped low-density lesion
in the left ureterovesical junction region (axial image 85).
Underlying left ureterocele cannot be excluded.

A 3 cm region of the pencil-like foreign body is extraluminal,
extending towards the left inguinal region. A subtle
inflammatory process adjacent to the tip of the foreign body is
suggested. There is mild stranding of the right inguinal
region, consistent with patient's history of right inguinal
repair. No focal bony lesions are seen.

IMPRESSION:
5 cm urinary bladder stone surrounding a pencil-like
foreign body. 3 cm region of this pencil protrudes beyond the
urinary bladder lumen towards the left inguinal region. There
is severe hydronephrosis and hydroureter bilaterally, worse on
the right side. There is thinning of the right renal cortex.
There is thickening of the urinary bladder wall and urinary
bladder diverticulum formation, consistent with chronic urinary
bladder outlet obstruction.

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