Presentation
Severe colicky left sided flank pain associated with two episodes of vomiting and chills.
Patient Data
Abdominal CT before and after contrast injection
A non-contrast Computed Tomography (NECT) of the abdomen was performed which showed two 2–3 mm stones in the pelvic part of the left ureter, near the meatus with free fluid in the left retroperitoneum, suggestive of a perforation of the left collecting system. A delayed scan was performed to achieve a CT urogram (CTU). This confirmed extravasation of contrast medium around the left ureter, the rupture being at the lumbar level of the ureter. Both kidneys contain multiple stones.
Note decreased enhancement of the left kidney, best seen on the nephrographic (parenchymal) phase.
Coronal maximum intensity projection nicely shows the contrast material leak from the ureter at the lumbar level.
Case Discussion
Spontaneous rupture of the ureter often occurs secondary to ureteral lithiasis with urinary tract obstruction and resultant increased intraluminal pressure and subsequent rupture, or can be secondary to a tear of the ureter during passage of the stone. Peritoneal irritation by urine results in presentation with an acute abdomen. Abdominal CT with contrast, including a urographic (excretory) phase, affords the correct diagnosis.
Case courtesy: Dr. Alessandra Guerra
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