PMC6461058_01
Preoperative stone burden.
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f1
She presented to our outpatient clinic initially in consultation for left-sided abdominal pain, and subsequent CT scan revealed nephrolithiasis with three separate left ureteral stones (Fig. 1), requiring urgent ureteral stent placement.
Poor intraoperative observation.
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f2
During her planned second stage PCNL, initial ureteroscopic observation was very poor because of extensive clot burden in the right renal pelvis and calices (Fig. 2).
Intraoperative CT angiography.
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f3
Ultimately the CTA revealed no evidence of pulmonary thrombus; however, abdominal follow-through was notable for extensive air in the right renal collecting system (Fig. 3).