Milk of calcium in renal calyces, renal pelvis, and ureter in a person with tetraplegia

Abstract

Milk of calcium is a colloidal suspension of precipitated calcium salts which lies in a dependent manner and imaging reveals a horizontal upper edge. We report a 44-year-old male person with tetraplegia, who had been staying in bed for prolonged periods due to ischial and trochanteric pressure sores. Ultrasound scan of the kidneys revealed numerous variable-sized stones in the left kidney. CT of abdomen showed stones in the left kidney with dense layering of calcific material in a dependent distribution assuming the shape of the renal pelvis and the calyces. CT images in axial and corresponding sagittal views showed milk of calcium exhibiting a fluid level in the renal pelvis and calyces and the ureter. This is the first report of milk of calcium detected in the renal pelvis and calyces as well as in the ureter of a person with spinal cord injury. Following insertion of a ureteric stent, the milk of calcium in the ureter drained partly but the renal milk of calcium persisted. The renal stones were pulverized by ureteroscopy and LASER lithotripsy. Follow-up CT of kidneys performed 6 weeks after surgery showed the milk of calcium in the left ureter had drained, but there was no significant change of the left sizeable branching pelvi-calyceal stone regarding its extension and density.