Presentation
Flank pain with dysuria, frequency and haematuria. History of chronic ketamine abuse.
Patient Data
Average size kidneys with moderate dilatation of the pelvicalyceal systems. Both ureters are also mild to moderately dilated and traceable throughout their course. Mild mural thickening and increased mucosal enhancement in bilateral ureters and renal pelves and mild periureteric fat stranding. Shrunken urinary bladder with diffuse mural thickening and increased mucosal enhancement. No radiopaque urinary tract calculi or perinephric fat stranding/collection is seen.
Case Discussion
Cystoscopy was performed which showed a small capacity bladder with hyperaemic/congested mucosa. Urine analysis was negative for any infection. In view of the history of chronic ketamine use, these CT scan features (shrunken bladder, mural thickening, and increased mucosal enhancement of the bladder and ureters) are consistent with ketamine bladder.
Ketamine has a smooth muscle relaxing property and its chronic abuse damages the urinary bladder, causing ulcers, cystitis, and fibrosis leading to urinary incontinence, haematuria, bladder overactivity, shrinkage, and hydroureteronephrosis in the later stages 1. Ketamine abuse also may cause epigastric pain, gastritis, and impairment of liver function due to irregularity and non-obstructive biliary dilatation. Lastly, ketamine abuse can also cause pneumomediastinum, subcutaneous emphysema, and pneumorrhachis which is thought to be caused by the barotrauma due to the sudden increase in the interalveolar pressure following passive apnoea and/or cough during the insufflations of Ketamine 1.
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