Purpose
Rupture of the ureter may be post-traumatic or spontaneous.
Spontaneous rupture of the ureter is a rare entity.
The term "spontaneous" implies that the rupture was not induced by recent iatrogenic manupulation,
external trauma,
previous surgery,
degenerative kidney disease or external compression during intravenous Urography.
With these criteria,
spontaneous urinomas usually result from ureteral calculus and are due to transmitted back pressure caused by obstruction.
We report the MDCT findings in 6 cases with spontaneous rupture of the upper ureter secondary to a ureteral calculus,...
Methods and Materials
During the last 3 years,
MDCT was performed in 6 patients with unilateral spontaneous urinoma due to ureteral calculus.
The patients were admitted to our department for investigation of ureteral colic and have increased RBCs and pyosfairia in the general urinalysis.
Patients’ age range was 57-82 years (4M-2F) and the mean age was 68.2 years.
NECT and CECT scans of the abdomen and also delayed scans were performed in 4 patients with normal renal function,
whereas in 2 patients with impaired renal function,
contrast material...
Results
NECT,
as well as CECT in the parenchymal phase,
showed diffuse fluid collection in the perirenal space and around the ureter (figure 1)and also ureteral stone in the precystic portion of the ipsilateral ureter (figure 2)in all patients (thelesions were at the left side in 5 cases and at the right side in 1 case).
In all patients,
the area of rupture was depicted in the proximal portion of the ureter.
Delayed scans 30-45 minutes after contrast material injection in the 4 patients -with normal...
Conclusion
MDCT is the diagnostic examination of choice for the depiction of spontaneous urinomas and also determines their therapeutic approach (usually interventional).
Spontaneous rupture of the ureter from an impacted calculus should be considered in cases of persistent renal colic and atypical presentation.
Any indeterminate fluid collection detected in perirenal,
periureteral,
or perivascular location should be imaged on delayed scans (>20 min) after contrast administration.
Contrast extravasation into the fluid,
confirms the diagnosis of urinary leak.
References
El-Boghdadly SA. Spontaneous rupture of the ureter proximal to ureteric stone.
J R Soc Med 1985;78:255-257.
Leuthardt R,
Bernhardt E,
Gasser T,
Kummer M. Spontaneous perforation of the ureter: A rare complication of urolithiasis.
Eur J Pediatr Surg 1994;4(4):205-206.
Alexander ES,
Colley DP,
Clark RA.
Computed tomography of retroperitoneal fluid collections.
Semin Roentgenol 1981;16:268-276.
Berrocal A,
Quezada F,
Cruces de Abia F,
et al.
Spontaneous rupture of the ureter caused by an impacted stone.
Arch Esp Urol 1989;42(6):587-591.
Paajanen H,
Kettunen J,
Tainio H,
Jauhiainen...
Personal Information
Theodosia Kontaki,
MD
Department of Radiology,
"Mamatseio" General Hospital,
Kozani,
Greece
E-mail:
[email protected]