KUB Hall of Fame

You are at handover. The day shift registrar stumbles towards the weary tunnel of egress and casually relates the story of your next patient…

“Finally, there is a 64 year old lady who presented with left sided abdominal pain and haematuria. I have placed an IV line, taken bloods and given some analgesia. Her pain is now under control. Just check the abdominal XR before sending her home…”

Your review of the abdominal XR takes a little longer than you had suspected…can you determine her past medical history and current pathology?

KUB iatrogenic artefacts

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Case submitted by Dr Rahul Goswami, Changi General Hospital


1. CABG sternotomy wires
2. Prosthetic heart valve – old notes say aortic valve replacement. It is seen from its side – therefore it looks like a linear thin rectangle.
3. Right nephrostomy tube (J coil)
4. Stoma bag
5. Left renal calculus
6. IVC filter
7. Surgical thumb tacks in the sacral region during hysterectomy

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  1. RP says

    There is a colostomy bag in place on the right side alongwith a drain. Cant figure out what the pins are doing there.

  2. says

    Cardiac surgery for heart valve replacement. she may have anticoagulant therapy too
    Inferior vena cava filter
    Vertebral arthrosis
    Right side catheter of ureterostomy ? nephrostomy but seems a little too low ?
    strange objects in lower abcomen : foreign bodies in sigmoid such as drawing pins ? but would have perforated the bowel before irritating and infecting urinary tract, and I don’t see pneumoperitoneum (localised ?) or even opacity of pelvic haematoma.
    or osteosynthesis material for old sacral fracture and it has irritated even perforated the left urinary tract explaining fever and haematuria

  3. says

    I concur with thoracotomie’s findings.
    Cardiac valve replacement.
    IVC filter.
    Right nephrostomy.
    Metallic foreign bodies -- tack pins -- overlying the left ala of sacrum. Most likely to be ingested foreign bodies. But as thoracotomie says, it’s surprising that the sharp pins have not caused a bowel perforation.
    In addition, I think there are multiple left renal calculi.

  4. Mathan.K says

    Colostomy bag on right,with a ? drain (or is it a PCN) , IVC filter , Sternotomy sutures (Old CABG) , those pins looks out of place must be artefacts , lot of phleboliths too.

  5. says

    In addition to the above metallica… isn’t this Rigler’s sign (double wall sign)? Looks like some air around the gallbladder too.

    I would do an urgent MRI.*

    *only kidding

  6. says

    malingerer! multiple complaints / self harm over time resulting in serial diagnostic and therapeutic diseases.

    or, well-insured medicare recipient getting routine care my proceduralists in fee-for-service US hospital