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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

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Published on: November 22, 2019

The impacted ureteral stone.

Leila C Bender¹, Theodore J Dubinsky

¹Department of Radiology, University of Washington, Seattle, WA, USA.

Ultrasound Quarterly

|August 21, 2012

Summary

This summary is machine-generated.

Computed tomography kidney-ureter-bladder is key for diagnosing urinary tract stones. Subtle signs of infection can be missed, leading to severe complications like urosepsis and limb amputation.

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Area of Science:

Radiology
Urology
Infectious Diseases

Background:

Urinary tract calculi and infections are frequent emergency department presentations.
Computed tomography of the kidney, ureter, and bladder (CT KUB) is the primary imaging modality for suspected urinary tract stones.
Identifying superimposed infection in patients with calculi can be challenging due to atypical or absent clinical signs.

Observation:

This case highlights a missed diagnosis of superimposed infection on an initial CT KUB in a patient with acute ureterolithiasis.
The patient subsequently developed severe urosepsis.
The urosepsis led to critical limb ischemia, necessitating quadruple extremity amputation.

Findings:

Subtle CT findings indicative of superimposed infection in ureterolithiasis may be overlooked.
Delayed recognition of infection can result in catastrophic systemic complications.
Missed diagnoses in radiology can have profound patient consequences, including litigation.

Implications:

Radiologists must be vigilant for subtle signs of infection in patients with urinary tract calculi on CT KUB.
Prompt recognition and management of superimposed infection are critical to prevent severe outcomes such as urosepsis and limb ischemia.
This case underscores the importance of accurate interpretation of imaging studies to avoid adverse patient events and potential legal ramifications.