Imaging of bilateral ureteropelvic junction laceration from blunt trauma

Bilateral ureteropelvic junction (UPJ) injury from blunt abdominal trauma is rare, with only seven previously reported cases, all of which were complete avulsions. Early and delayed computed tomography (CT) for visualization of the nephrographic and excretory renal phases, respectively, is essential to distinguish parenchymal from collecting system injury. Once UPJ injury is detected by CT, differentiation between laceration and avulsion is mandatory since laceration is treated nonoperatively, whereas avulsion requires surgical repair. In addition to CT, intravenous pyelography (IVP) or retrograde pyelography may be required for full characterization of the injury. Retrograde pyelography may permit better opacification of the ureters than IVP, enabling the urologist to determine whether stent placement is necessary. We report the first case of bilateral UPJ laceration secondary to blunt abdominal trauma and the imaging studies necessary to make the diagnosis.