Spontaneous rupture of the ureter

Case contributed by Mostafa El-Feky


Acute left loin pain. No history of trauma.

Patient Data

Age: 40 years
Gender: Male

CT Urography


Non-contrast CT scan shows left upper third ureteric stone measuring ~0.5 x 0.4 cm. This is associated with a dilated collecting system (grade II hydronephrosis) and proximal hydroureter down to the stone level with associated ureteric mural thickening and permeation of the periureteric fat.

The delayed scans showed extravasation of the excreted contrast around the left ureter creating a non-walled retroperitoneal 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 until it reaches the left side of the pelvis.

Case Discussion

Spontaneous rupture of the ureter is a rare complication of acute ureteric obstruction when there is non-traumatic leakage of the urine from the ureter. The diagnosis is made by contrast studies (CTU or IVU) where there is a contrast leakage around the ureter through the retroperitoneal space and a visible cause of acute distal ureteric obstruction. It is usually secondary to an obstructing ureteric stone. However, it can occur due to other causes of obstruction e.g. tumor. Urine extravasation appears as a fluid collection or stranding on non-contrast images. It is well demonstrated on delayed excretory contrast studies e.g. IVU or CT urography. Extravasation can resolve spontaneously after relieving obstruction or can progress to form a urinoma.

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