URORMXOGRAPIEY
CASE PROFILE:
MILK-OF-CALCIUM
RENAL STONE
NOTE - Urograms of interest to our readers are welcome ji-om urologists and radiologists. Contributions, including an abbreviated history and legend for the films, are to be sent to Arthur N. Tessler, M.D., feature editor.
FIGURE 1. (A) Scout radiograph showing calci$cation in upper pole left kidney. (9) Right lateral decubitus radiograph showing a differential density fluid level being fwmed by heavier milk-of-calcium urine settling out below cyst or diverticulum &id.
A sixty-one-year-old black man with multiple symptoms of prostatism was admitted to this medical center. The patient had no other history of symptoms attributable to the genitourinary tract. Blood, calcium, and phosphorus levels were normal, as were the remainder of his blood chemistries.
A scout radiograph for an intravenous pyelogram examination revealed the presence of an irregular collection of calcium projected over the upper pole of the left kidney (Fig. 1A). The patient was then placed in the right lateral decubitus position and a second film was taken, employing a horizontal x-ray beam. This film revealed the
260
UROLOGY
/ AUGUST1975
/ VOLUMEVI,
NUMBER2
FIGURE 2. (A) Retrograde pyelogram showing no connection between calcijkation and collecting system. (B),Upper gastrointestinal series thirteen years prior to this admission showing little or no change in renal density.
presence of a calcium-fluid level, indicating that the calcific density seen on the scout film was in liquid form (Fig. 1B). A retrograde pyelogram was performed to determine patency of communication between the collecting system of the kidney and this calcific density. No communication was demonstrated (Fig. 2A). Figure 2B is a film from an upper gastrointestinal series performed thirteen years prior to this admission. Little or no change in the calcific collection was noted.
This case demonstrates the hallmark of milk-ofcalcium renal stone, that is, a calcium-fluid level seen when horizontal beam roentgenography is employed. In addition, it indicates the benign course in this case and the lack of need for surgical intervention.
UROLOGY / AUGUST 1975 / VOLUME VI, NUMBER 2
261
Charles M. Citrin, M.D. The George
Washington University Medical Center 90123rd Street, N.W. Washington, D. C. 20037
CASE PROFILE:
MILK-OF-CALCIUM
RENAL STONE
NOTE - Urograms of interest to our readers are welcome ji-om urologists and radiologists. Contributions, including an abbreviated history and legend for the films, are to be sent to Arthur N. Tessler, M.D., feature editor.
FIGURE 1. (A) Scout radiograph showing calci$cation in upper pole left kidney. (9) Right lateral decubitus radiograph showing a differential density fluid level being fwmed by heavier milk-of-calcium urine settling out below cyst or diverticulum &id.
A sixty-one-year-old black man with multiple symptoms of prostatism was admitted to this medical center. The patient had no other history of symptoms attributable to the genitourinary tract. Blood, calcium, and phosphorus levels were normal, as were the remainder of his blood chemistries.
A scout radiograph for an intravenous pyelogram examination revealed the presence of an irregular collection of calcium projected over the upper pole of the left kidney (Fig. 1A). The patient was then placed in the right lateral decubitus position and a second film was taken, employing a horizontal x-ray beam. This film revealed the
260
UROLOGY
/ AUGUST1975
/ VOLUMEVI,
NUMBER2
FIGURE 2. (A) Retrograde pyelogram showing no connection between calcijkation and collecting system. (B),Upper gastrointestinal series thirteen years prior to this admission showing little or no change in renal density.
presence of a calcium-fluid level, indicating that the calcific density seen on the scout film was in liquid form (Fig. 1B). A retrograde pyelogram was performed to determine patency of communication between the collecting system of the kidney and this calcific density. No communication was demonstrated (Fig. 2A). Figure 2B is a film from an upper gastrointestinal series performed thirteen years prior to this admission. Little or no change in the calcific collection was noted.
This case demonstrates the hallmark of milk-ofcalcium renal stone, that is, a calcium-fluid level seen when horizontal beam roentgenography is employed. In addition, it indicates the benign course in this case and the lack of need for surgical intervention.
UROLOGY / AUGUST 1975 / VOLUME VI, NUMBER 2
261
Charles M. Citrin, M.D. The George
Washington University Medical Center 90123rd Street, N.W. Washington, D. C. 20037
