Periureteral extravasation

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Acute left loin pain.

Patient Data

Age: 40
Gender: Male
CT

CT Urography

Left upper third (opposite LV3 mid-body level) ureteric stone is noted, measuring around 0.4 x 0.5 cm. This is associated with dilated collecting system (grade II hydronephrosis) as well as the proximal ureter down to the stone level which showed mural thickening with the permeation of the periureteric fat.

The delayed scans showed extravasation of the excreted contrast (creating a non-walled collection), with feathery irregularities along the ventral surface of the renal pelvis, with tracking of the contrast from the perirenal space, along the anterior border of left psoas muscle along the retroperitoneal space, where it reaches the left side of the pelvis.

Case Discussion

Periureteral extravasation is a complication of high-grade ureteric obstruction and can extend inferiorly in the retroperitoneal space along the ureter, even beyond the level of obstruction. It is usually secondary to an obstructing ureteric stone. However, it can occur due to other cases as obstruction by tumour. 

There are two types of pelvicalyceal rupture: the intrasinusal extravasation probably secondary to fornix rupture where the extravasation is around the fornix and the other type is peri-pelvic and periureteral extravasation which can extend inferiorly in the retroperitoneal space along the ureter. They appear as fluid collection around the ruptured part of the pelvicalyceal system as the fornix, pelvis or the ureter. Extravasation appears as fluid collection or stranding in non-contrast basis. It is well demonstrated in delayed excretory contrast studies as IVU or CT urography. Extravasation can resolve spontaneously after relieving obstruction or can progress to form urinoma.

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Case information

rID: 54919
Case created: 6th Aug 2017
Last edited: 8th Aug 2017
System: Urogenital
Inclusion in quiz mode: Included

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