In the first image, you can see bilateral severe hydronephrosis as evidenced by the dilated collecting system filled with anechoic (black) urine exerting pressure on the renal parenchyma. Second image shows bladder ultrasound with echogenic debris and a stone appearing as hyperechoic curved structure with a shadow. The echogenic material could be a blood clot also. Usually but not always, debris moves with moving the patient while clot remains adherent to the bladder wall. On color Doppler, Stones demonstrate twinkling, which is a rapidly alternating focus of intense color signals resembling turbulent flow that is more pronounced with rougher stones. Don’t forget to scan urinary bladder in any patient with hydronephrosis, even if they have a Foley catheter.
