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I now have strong textbook material. Let me provide a thorough, plain-language explanation of this CT report.

CT Urogram Report Explained - Mrs. Nagajothi, 38 yrs

Here is a clear, plain-language breakdown of every finding in this report.

What the Scan Is

This is a CT Urogram - a plain (non-contrast) CT scan of the abdomen and pelvis. "Non-contrast" means no dye was injected into the vein. It is specifically designed to look at the kidneys, ureters, and bladder for stones and blockages. This is the gold-standard test for detecting kidney/ureteric stones, as it can pick up both radio-opaque and radiolucent stones.

The Main Finding (Most Important)

"Right proximal ureteric calculus measuring 9.2 x 7.4 mm (HU 650) - causing obstructive uropathy"

Breaking this down:

Right proximal ureteric calculus - A stone (calculus) is sitting in the upper (proximal) part of the right ureter. The ureter is the tube that carries urine from the kidney down to the bladder. "Proximal" means close to the kidney.
9.2 x 7.4 mm - This is the size of the stone - approximately 9 mm x 7 mm. This is a moderately sized stone. Stones under 5 mm often pass on their own; stones above 7-10 mm usually require intervention.
HU 650 - "HU" stands for Hounsfield Units, the density of the stone measured on CT. A value of 650 HU is moderately dense, suggesting a calcium-containing stone (calcium oxalate or calcium phosphate, which make up 70-80% of all stones). Higher HU = harder stone = less likely to break up with shock waves (ESWL).
Obstructive uropathy - This is the key consequence. The stone is blocking the ureter, causing urine to back up into the kidney (hydronephrosis = swollen kidney). This is why the right kidney appears smaller than normal (see below).

This is the primary diagnosis - the main problem causing the patient's symptoms.

Kidney Size Difference

Right kidney: 6.9 x 4.7 cm (smaller than normal)
Left kidney: 10.3 x 4.3 cm (normal size)

The right kidney is smaller because the stone has been obstructing urine outflow for some time, causing the kidney to be under pressure and potentially losing some function. The left kidney is unaffected and appears normal.

Other Findings (Secondary)

1. Bladder mucosa slightly thickened and edematous (cystitis)

The lining of the bladder is mildly inflamed and swollen
This is called cystitis (bladder inflammation), which can accompany a urinary stone or a urinary tract infection (UTI)
Symptoms: burning urination, frequent urge to urinate, lower abdominal discomfort

2. Obesity with excessive fat deposition in chest and abdominal wall

Self-explanatory - the scan noted increased fat deposits around the abdomen and chest wall

3. Minimal mucosal thickening of pyloric antrum - Antral gastritis

The lower part of the stomach (pyloric antrum) shows mild thickening of its lining
This is consistent with gastritis - inflammation of the stomach lining
This could be related to H. pylori infection or chronic NSAID/pain-killer use (often taken for stone pain)
Needs follow-up with the referring doctor (gastroscopy may be considered)

4. No gallstones (GB calculus) or pancreatitis

The gallbladder and pancreas are clear - no stones in the gallbladder, no pancreatic inflammation

5. Fecal loaded large bowel loops

The large intestine (colon) is loaded with stool - constipation is present

6. No intestinal obstruction, no ascites (fluid in abdomen)

The bowel is not blocked; there is no free fluid in the abdominal cavity

7. Liver, Spleen, Pancreas, Adrenals - all normal

No masses, no abnormal lesions in any of these organs

8. No lymphadenopathy

No enlarged lymph nodes detected

9. Bony structures - normal

Spine and bones visible in the scan look normal

What This All Means Clinically

The patient almost certainly presented with:

Severe right-sided flank/loin pain (renal colic) - a classic cramping pain that comes in waves
Possibly blood in urine (hematuria)
Possibly nausea/vomiting
Urinary symptoms (burning, frequency) due to the associated cystitis

The stone (9.2 x 7.4 mm) is large enough that spontaneous passage is unlikely without treatment. The right kidney is already showing signs of stress from obstruction.

What Usually Happens Next (Management)

Your treating doctor/urologist will decide, but typical options include:

Stone Size	Likely Management
< 5 mm	Watch & wait, high fluid intake, pain relief
5-7 mm	Medical expulsive therapy (alpha-blockers like tamsulosin + pain relief)
> 7-10 mm (like this case)	Usually needs urological intervention

For this stone, options likely include:

Ureteroscopy (URS) with laser lithotripsy - A scope is passed up the ureter and the stone is broken with a laser. Most common procedure for proximal ureteric stones of this size.
ESWL (Extracorporeal Shock Wave Lithotripsy) - Shock waves from outside the body break the stone. Less effective for stones > 1 cm or high HU (hard stones).
DJ stent insertion - A plastic tube placed temporarily inside the ureter to relieve the obstruction and let the kidney recover, followed by definitive stone removal.

The referring doctor is Dr. K. Jeyanthi, MD (DGO) - a gynecologist/obstetrician - who referred for this scan. The patient will likely need a urology consultation for definitive management.

Summary Table

Finding	What it Means	Severity
Right proximal ureteric stone 9.2x7.4mm	Blocked right ureter	Urgent - needs treatment
Right kidney smaller (obstructed)	Kidney under pressure from blockage	Significant
Cystitis (bladder inflammation)	Bladder infection/irritation	Mild - needs treatment
Antral gastritis	Stomach lining inflammation	Mild - needs follow-up
Constipation	Loaded bowel	Minor
All other organs normal	No cancer, no other disease	Reassuring

Important note: This explanation is for informational purposes only. Please consult with the treating urologist for a management plan - the stone size and obstructive uropathy require prompt medical attention.

- Barash, Cullen & Stoelting's Clinical Anesthesia 9e, p.4317 (urolithiasis diagnosis and management); Brenner & Rector's The Kidney, 2-Vol Set (nephrolithiasis epidemiology and stone types)

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