Presentation
Postoperative status with persistent complaint.
Patient Data
The right kidney shows dilated pelvicalyceal system with homogeneous layered hyperdense content casting the pelvicalyceal system and extending to the right ureter, in keeping with pelvicalyceal hematomas. Posterior perirenal collection is noted, mostly postoperative sequel.
The left kidney shows mild dilated pelvicalyceal system with double-J catheter seen in place. Lower calyceal hyperdense content, in keeping with calyceal hematoma. There are ureteric stones adjacent to the catheter at the upper and middle thirds.
The urinary bladder shows heterogenous hyperdense intraluminal content, not attached to its wall, in keeping with intraluminal bladder hematoma.
Case Discussion
The patient has a history of recent operation for the right kidney that was done since one week to extract stones and double-J catheter insertion for the left ureter for ureteric stones, which are still seen at the upper and middle third. The patient complained of persistent gross hematuria after the operation. Non-contrast CT shows multiple pelvicalyceal, ureteric and bladder hematomas. They appeared as hyperdense areas on CT with pelvicalyceal dilatation.
Initially hyperdense content can also be due to
General differential diagnoses include:
- urothelial tumors, which can cast pelvicalyceal system, ureters and urinary bladder and can be hyperdense
- pyonephrosis
- milk of calcium in pelvicalyceal system: can also show layering
- delayed contrast excretion due to poor renal functions or obstruction
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