Radiological Case: Spontaneous Ureteral Injury

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

Disclosures

Appl Radiol. 2018;47(7):38-39. 

In This Article

Imaging Findings

Initial CT scan from the outside hospital demonstrated a dilated, enhancing right ureter terminating in a large amount of simple fluid within the pelvis (Figure 1), with a fleck of gas adjacent to the distal ureter. A Foley catheter and gas were also seen in the bladder lumen. Subsequent CT at our institution was performed with a split bolus technique to allow for opacification of the collecting systems. This study demonstrated contrast extravasation from the injured distal right ureter (Figure 2). Fluoroscopic images from placement of a percutaneous nephroureteral stent confirmed the ureteral injury, with free contrast accumulating adjacent to the wire during placement and the successful placement of a percutaneous nephroureteral stent crossing the site of injury to terminate in the bladder (Figure 3).

Figure 1.

Initial contrast-enhanced coronal CT demonstrates a dilated, enhancing right ureter (arrow) terminating in a large amount of simple fluid within the pelvis with a fleck of gas (arrowhead) adjacent to the distal ureter.

Figure 2.

Subsequent oblique coronal maximum intensity projection CT with split bolus contrast shows extravasation from the injured distal right ureter (arrow).

Figure 3.

Fluoroscopic images from placement of a percutaneous nephroureteral stent confirm the ureteral injury with free contrast (arrow) accumulating adjacent to the wire during placement and the successful placement of a percutaneous nephroureteral stent crossing the site of injury to terminate in the bladder (arrowhead).

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