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Urinomas caused by ureteral injuries: CT appearance
1Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer 52621, Israel.
Abdominal Imaging
|December 12, 2001
Summary
Computed tomography (CT) can identify urinomas from ureteral injuries, which are often missed clinically. Delayed CT scanning is crucial for diagnosing these injuries, especially after surgery or trauma.
Area of Science:
- Radiology
- Urology
- Surgical Complications
Background:
- Ureteral injuries frequently lead to urinomas and are often not clinically suspected, resulting in diagnostic delays.
- Delayed diagnosis of ureteral injuries can complicate patient management and outcomes.
Purpose of the Study:
- To describe the computed tomographic (CT) features of urinomas resulting from ureteral injuries.
- To highlight the utility of delayed CT scanning in diagnosing ureteral injuries.
Main Methods:
- Retrospective review of CT scans from 12 patients with ureteral injuries (iatrogenic or traumatic).
- CT imaging included pre- and post-contrast administration, with delayed scanning in 11 cases.
- Analysis of urinoma appearance, location of injury, and associated findings like hydronephrosis.
Main Results:
- Urinomas presented as confined fluid collections, free fluid (ascites), or both.
- Contrast extravasation was visible on early scans in 6 patients and on delayed scans in the other 6.
- Ipsilateral hydronephrosis was observed in 7 patients; injuries were treated conservatively in 8 and surgically in 4.
Conclusions:
- Ureteral injuries, particularly after iatrogenic causes or trauma, are often diagnosed late.
- The presence of ascites or fluid collections in symptomatic patients warrants consideration of ureteral injury.
- Delayed CT scanning should be prompted by clinical suspicion of ureteral injury in relevant patient populations.