Staging according to the TNM-system has important prognostic implications for the development of local recurrence and metastases, affecting overall survival. MDCT is the best exam for diagnosis, staging, and post-operative follow-up, and an optimised protocol is very important. In contrast to the latter, TCC is centred to the excretory system and usually does not distort the renal outline, even in cases such as this, with renal parenchyma invasion.

In addition, renal cell carcinoma is a more frequent tumour which is particularly important to discard. These are typically tumours of older patients, with a male predilection, and usually present with haematuria, or even with renal colic when there is obstruction of the urinary system, which might cause difficulties for its clinical differential diagnosis with renal stones. Transitional cell carcinoma (TCC) accounts for up to 10% of neoplasms of the upper urinary tract and it represents a low percentage of urothelial tumours, which mostly originate from the bladder. In this case, we report a concomitant tumour in the excretory system detected during surgical planning, highlighting the additional benefit of this technique for its ability to reveal urinary abnormalities with great clinical relevance. The use of intravenous contrast is not consensual for treatment planning, but it can be useful for accurate definition of the calyceal anatomy or to clarify anomalous findings in the pre-contrast study. Calculus composition can be obtained either using HU values or more accurately using dual-energy CT technology.

It gives an accurate stone burden estimation using stone size or volume and other morphometric data can be retrieved for staghorn calculi with complex 3D morphology.

This method gives the most information about the calculus and pre-contrast acquisition can be sufficient in many cases. It is a useful tool for surgical planning, particularly since percutaneous nephrolithotomy (NLPC) is now considered the preferred treatment when stone burden is high and/or staghorn morphology is present. Urolithiasis is a frequent urologic disease with high social impact and MDCT is the gold-standard method for diagnosis and follow-up. No further lesions were identified in the excretory system, with normal contrast filling of both ureters and bladder during the excretory phase. A solid mass with heterogeneous contrast-enhancement was identified in the superior calyces and renal pelvis, with focal invasion of the renal cortex and involving the staghorn calculi (Fig. The presence of a right lower pole calyceal diverticulum was noted.

It confirmed bilateral urolithiasis with a staghorn calculus in the right kidney, occupying the renal pelvis and various calyces and showing fragmentation, and density values higher than 1000 Hounsfield units (Fig. 2).ĬT was performed for surgical planning, and a complete uro-CT protocol was acquired for calyceal anatomy definition. A renal ultrasound was performed and detected additional anomalous calyceal anatomy of the right kidney, with a calyceal diverticulum (Fig. An X-ray abdomen and pelvis (KUB) was initially obtained, and showed bilateral renal stones, with fragmented staghorn morphology on the right kidney (Fig.

Staghorn calculus right kidney