Imaging Case of the Week 147 Answer

The x-rays shows a radio-opaque density lateral to the transverse process of L2 on the left side, likely a renal calculus. Patient underwent a CT scan to further characterise the calculus. This turned out to be a stone at the left pelviureteric junction causing moderate left hydronephrosis.

Left PUJ calculus

This patient was treated with intravenous antibiotics and underwent emergency urological surgery to relieve the obstruction and did well.

There is also an incidental finding of a rounded calcified area in the left upper quadrant. CT angiogram of the abdomen identified this to be a partially calcified splenic artery aneurysm measuring 2 cm.

Splenic artery aneurysm
Splenic artery aneurysms are the third most common intra abdominal aneurysms after aortic and iliac artery aneurysms.

Risk factors for splenic artery aneurysm are female gender, multiple pregnancies and portal hypertension.

Early elective repair is recommended for splenic aneurysm in pregnant women or young patients, rapidly enlarging aneurysms, aneurysm in patients with connective tissue disorders and for aneurysms greater than 2 cm.