The impacted ureteral stone.

Urinary tract calculi and infections are common causes of presentation to the emergency department. Computed tomography kidney-ureter-bladder is the initial imaging study of choice in patients presenting with symptoms of urinary tract calculi. As clinical evidence of superimposed infection can be atypical or absent, it is crucial to identify subtle imaging findings that suggest this complication. We report here a case of acute ureterolithiasis with missed evidence of superimposed infection on the initial computed tomography kidney-ureter-bladder. The patient subsequently developed urosepsis complicated by critical limb ischemia requiring amputation of all 4 extremities. The case became the topic of a malpractice suit.