"Flapping (thin) Wall Sign" for diverticular stone detection

48 year-old female patient

Right-sided sever flank pain -> local visit.

A total of 11mm-sized diverticular stones were identified and surgery was recommended

Visit the Seoul National University Hospital for 2nd opinion.

Type II (diverticular stone connected to renal pelvis) identified.

Right-sided RIRS was initially performed and combined approach was planned if the RIRS would not be available.

DTPA renal scan showed 12% discrepancy of renal function and right-sided renal functional deterioration.

Diverticular stone detection by "Blue Spritz technique" was not availble and I found 'Flapping (thin) Wall Sign' at the entry into the diverticular space.

You can see the diverticular stones inside after the 'Flappin Thin Wall' was incised.

For removal this kind of diverticular stone, dusting technique is inevitable because frequent basketing is usually not available even though I am an endoluminal endourologist who love basketing technique.