PMC5248537_01
Preoperative axial (A) and coronal (B) arterial phase CT images at the level of the kidneys showing partial staghorn calculus in the right collecting system (red arrows). There is heterogeneous enhancement of the right kidney (white arrows) radiographically consistent with pyelonephritis and abnormal proximal right ureteral enhancement (white arrowhead) radiographically consistent with ureteritis.
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The patient underwent effective PCNL (Fig. 1).
Photograph of the infected staghorn calculus. On gross examination, calculus took the form of tan-yellow, bosselated stone with loosely adherent blood clots. Crystallographic analysis (Louis C. Herring and Company) revealed calculus composition of 67% magnesium-ammonium-phosphate-hexahydrate (struvite) and 30% calcium phosphate in carbonate form, calculus culture grew Pseudomonas aeruginosa.
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Stone analysis demonstrated 67% struvite and 30% calcium phosphate carbonate composition (Fig. 2); stone culture grew P. aeruginosa.