Radiological Case: Spontaneous Ureteral Injury

Kristy L. Ratkowski, MD; Michael Lin, MD; Sanjeev Bhalla, MD


Appl Radiol. 2018;47(7):38-39. 

In This Article

Case Summary

An 18-year-old gravida 3 woman was transferred from an outside hospital to our facility for worsening abdominal pain, tachycardia, and mild hypotension following a reportedly uncomplicated vaginal delivery. The outside hospital CT scan demonstrated a large amount of free fluid measuring simple fluid attenuation within the right pelvis. Upon arrival, the patient's symptoms worsened and another CT scan was obtained with a split bolus technique[1] to capture the nephrographic and excretory phases in combination, which demonstrated right ureteral injury with extravasation of urine within the pelvis. The patient was then taken to urgent cystoscopy for retrograde ureteral stent placement, which was unsuccessful. Interventional radiology subsequently placed a percutaneous nephroureteral stent past the point of injury and into the bladder, which was successfully internalized to a double J ureteral catheter 2 weeks later.