Ureteral calculus with obstruction and secondary renal pelvis rupture

Case contributed by Dr Jörgen Strömberg

Presentation

Sudden onset of left pelvic pain. Lab tests were normal except for a slightly elevated white blood cell count. The patient was referred to a CT scan to evaluate bowel obstruction, colitis or diverticulitis. This patient had a history of Crohn's disease, and was currently under treatment with steroids.

Patient Data

Age: 70
Gender: Male

In the distal part of the left ureter, a 5-6 mm calculus is present. The ureter and collecting system proximal to the calculus is somewhat ectatic compared to the right side, but there is no marked widening of the ureter, nor is there any hydronephrosis. However, there is stranding of the perirenal fat and findings consistent with small perirenal fluid collections. This raised the suspicion of a rupture of the renal pelvis (urinoma). The patient was therefore called back from the ward for a repeated exam to evaluate if there was any leakage of excreted contrast.

For practical reasons, this exam was carried out about one hour after intravenous contrast injection. The most striking finding is perhaps that of a persisting contrast enhancement of the left kidney parenchyma, indicating impaired left renal function. You will also find that the excreted contrast fills the ureter all the way to the calculus but does not seem to pass distal to it. Excreted contrast is also found in the perirenal fluid collections, thus proving the presence of a rupture of the renal pelvis.

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Case Information

rID: 46100
Case created: 21st Jun 2016
Last edited: 23rd Jun 2016
System: Urogenital
Inclusion in quiz mode: Included

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