Calcifications of The Urinary Tract

Abnormal Calcifications of the
Urinary tract
Citadel B. Rabanes, MD
First Year
JRRMMC- Department of Radiology
 Calcifications are discussed in terms of their
position, orientation, shape, size, mobility,
opacity, and chemical composition
 Categorized according to location, appearance,
and relation to various pathologic conditions
 Renal calcification
1. Nephrolithiasis
2. Nephrocalcinosis
3. Cyst or solid mass
4. Miscellaneous
 Ureteral calcification
 Bladder calcification
Nephrolithiasis
 Most common cause of calcifications w/in the
kidney
 Calcium mixed w/ oxalate, phosphate, or a
combination of the two

 Causes:
1. disordered excretion of calcium, oxalate, and

uric acid
2. Idiopathic
Nephrolithiasis
Nephrolithiasis
Nephrolithiasis
 Radiopaque – calcium content
 Calcium oxalate stones:
1. Monohydrate- small, highly radiopaque

2. Dihydrate- spiculated or mamillated
 “seed calculi”- in caliceal diverticula
 “milk of calcium”- in epithelium-lined
structure, in caliceal diverticulum, or in

obstructed portion of the collecting system
Nephrolithiasis
FIG 1. SPICULATED
CALCIUM STONE FIG 2. MULBERRY STONE
Nephrolithiasis
FIG 3A. SEED CALCULI FIG 3B. SEED CALCULI
Nephrolithiasis
FIG 4A. MILK OF CALCIUM FIG 4B. MILK OF CALCIUM
STONES STONES
Nephrolithiasis
 Stone particles (calcium carbonate)- form
urine-calculus level
 Staghorn calculus
1. calcium mixed w/ magnesium, ammonium,

and phosphate
2. less opaque
3. Laminated
 Cystine stones- less radiopaque, grow quite
rapidly
Nephrolithiasis
FIG 5. STAGHORN
CALCULUS FIG 6. CYSTINE STONE
Nephrocalcinosis
 Deposition of calcium w/in the renal
parenchyma
 Classified according to anatomic area
involved:
1. Medullary nephrocalcinosis
2. Cortical calcinosis
Nephrocalcinosis
Medullary Nephrocalcinosis
 Most common form
 Uniform deposition of calcium:
1. Hyperparathyroidism
2. Distal renal tubular acidosis
 Asymmetric deposition of calcium:
1. Medullary sponge kidney- w/in papillary tips

in dilated collecting ducts
FIG 8A.MEDULLARY FIG 8B. MEDULLARY
SPONGE KIDNEY SPONGE KIDNEY
Cortical Nephrocalcinosis
 Calcium deposition in the renal cortex
 Secondary to:
1. Chronic glomerulonephritis
2. Acute cortical necrosis
 “tramline” appearance
 Spotty appearance
 Transplanted kidney- due to chronic rejection
Cyst or Solid Mass
 Calcification w/in a cyst wall occurs in
approximately 3% of simple cysts
 Intracystic calcification
1. Thin and peripheral

2. “eggshell” appearance
3. Autosomal dominant PCKD
 Renal cell carcinoma- 20% calcifies
 Primary neoplasms (osteosarcoma of the
renal capsule)
Cyst or Solid Mass
FIG11A. AUTOSOMAL FIG 11B. AUTOSOMAL
DOMINANT PCKD DOMINANT PCKD
Cyst or Solid Mass
FIG 12. RENAL CELL FIG 13. RENAL CELL
CARCINOMA CARCINOMA
Cyst or Solid Mass
 Metastatic lesions of the kidney
 Pattern of calcification of renal mass
=likelihood of associated malignant disease

1. Pure central calcification- malignancy in 87%
of cases
2. Pure peripheral calcification- malignancy in
20% of cases
Cyst or Solid Mass
Miscellaneous Renal Calcifications
 Renal vasculature calcification- DM,
hyperparathyroidism, atherosclerotic disease,
renal artery aneurysm, AV malformation
 Dystrophic calcification- subcapsular
hematoma
 Irregular calcification- sloughed papilla in
papillary necrosis
 Amorphous calcifications- in the “putty”
kidney of renal TB
FIG15. RENAL ARTERY FIG 16. VASCULAR
ANEURYSM CALCIFICATION CALCIFICATION IN DM
FIG 17A. SUBCAPSULAR FIG 17B. SUBCAPSULAR
HEMATOMA HEMATOMA
FIG 18A. SLOUGHED FIG 18B. SLOUGHED
PAPILLA PAPILLA
Ureteral Calcifications
 Stone that has migrated from the kidney
1. “giant” ureteral calculus
 Stones impacted at points of anatomical
narrowing
 Stones that form at sites of stasis w/in the
ureter
1. Ureteral diverticulum
2. Ureterocele
 “steinstrasse” (stone street)- after ESWL
FIG 20A. URETERAL STONE FIG 20B. URETERAL STONE
FROM THE KIDNEY FROM THE KIDNEY
FIG 22A. CALCULUS IN FIG 22B. CALCULUS IN
URETEROCELE URETEROCELE
FIG 23A. DEVELOPMENT OF FIG 23B. DEVELOPMENT OF
STEINSTRASSE STEINTRASSE
 Mistaken as ureteral stones:
1. Phleboliths in the pelvis
2. Phleboliths in the gonadal vein in the upper
abdomen
3. Silastic fallopian tubes band
 Ureteral wall cacifications- schistosomiasis,
TB, amyloid infiltration, tumor

FIG 25A. GONADAL VEIN FIG25B. GONADAL VEIN
PHLEBOLITHS PHLEBOLITHS
Bladder Calcifications
 Mixture of calcium oxalate and calcium
phosphate
 Radiopacity reflects their compositions
 Appearance: laminated, faceted, spiculated, or
seedlike
 Stones due to urinary stasis- vesical diverticula
1. “dumbbell” stone
FIG 26. BLADDER CALCULI FIG 27. DUMBBELL STONE
Bladder Calcification
 Calcification w/in the bladder wall- transitional
cell carcinoma
 Tumor calcification- urachal carcinoma
 Mural calcification- schistosomiasis
FIG 28A. TRANSITIONAL FIG 28B. TRANSITIONAL
CELL CARCINOMA CELL CARCINOMA
FIG 29A. URACHAL FIG 29B. URACJAL
CARCINOMA CARCINOMA
Thank You

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Abnormal Calcifications of the

combination of the two

1. disordered excretion of calcium, oxalate, and

1. Monohydrate- small, highly radiopaque

structure, in caliceal diverticulum, or in

1. calcium mixed w/ magnesium, ammonium,

1. Medullary sponge kidney- w/in papillary tips

1. Thin and peripheral

=likelihood of associated malignant disease

TB, amyloid infiltration, tumor

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