Describe the most common mechanisms of injury and the various clinical presentations of ureteral injury after trauma. Identify key and characteristic findings of ureteral injury on multidetector CT. Discuss cases of ureteral injury. Review common misses and misinterpretations of ureteral injury on imaging that represent the highest morbidity and mortality if left untreated. Discuss the implication of imaging findings on clinical management and surgical intervention.

Computed tomography is a frontrunner in diagnosing genitourinary injuries after trauma. Certain findings and conditions must not be missed by Radiologists. We will discuss the most common mechanisms of injury and the clinical presentations of ureteral injury after trauma, as well as the key imaging findings on multidetector CT scan through sample cases from our Institution.

Clinical presentation The clinical presentation of ureteral injury is varied. Patients may present with fever, hematuria, dysuria, anuria, flank pain, flank ecchymosis, lower back pain, peritonitis with or without leukocytosis, incontinence, vaginal urinary leak, or they may even asymptomatic. [6] Lack of hematuria does not exclude ureteric injury. If there is any sign of hematuria, further imaging or exploration should be performed. [2] Laboratories may show increased serum creatinine and blood urea nitrogen levels, although these signs and symptoms are neither sensitive nor specific. A...

Ureteral injuries are severe events which should not be missed by Radiologists since delayed in diagnosis results in serious complications and increases morbidity and mortality. The ureters are small structures with a long course along important abdominal and pelvic structures, rendering them extremely vulnerable to iatrogenic injury. In the setting of trauma, they are often associated to other serious injuries. A high index of suspicion is vital when evaluating for ureteric injuries and low threshold for further imaging or exploration, to avoid delayed diagnosis and...

Amanda P. Marrero-González, MD PGY3 Diagnostic Radiology Resident [email protected] Department of Diagnostic Radiology - University of Puerto Rico - School of Medicine PO Box 365067 San Juan, PR 00936-5067 787-758-2525 (ext. 2482)

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