RadioGraphics 2012; 32:839-844
Adrian Wong, MD , Sadhna Dhingra, MD ,Venkateswar R. Surabhi, MD
History A 22-year-old man from Mexico presented to the emergency department with an insidious onset of fever, nausea, and moderate left lower back and flank pain. He had a history of hematuria and renal stones and had been treated previously for recurrent urinary tract infections, Initial abdominal radiography showed a subtle, long-segment, linear calcification lateral to the L4 vertebral body, in the normal anatomic location of the distal one-third of the left ureter (Fig 1). Unenhanced computed tomography (CT) showed left hydronephrosis with extensive fine calci-fications in the left renal collecting system. At urinalysis, many red blood cells and a trace of white blood cells were seen. Blood test results showed a high white cell count (up to 14.3 x 109/L), but other laboratory values were in the normal range. The patient underwent percutaneous nephrostomy for urinary drainage and received intravenous antibiotic therapy. However, his fever (102.9°F [39.4°C]), leu-kocytosis, and left flank pain persisted. Nine months later, he was referred by his clinician for a follow-up imaging evaluation.