Computed tomography of ureteral disruption

Area of Science:

• Radiology
• Urology
• Trauma Imaging

Background:

• Blunt trauma can cause significant injury to the urinary tract, including the ureteropelvic junction.
• Accurate and timely diagnosis of ureteropelvic disruption is crucial for appropriate patient management.
• Distinguishing ureteral injury from renal parenchymal injury on imaging can be challenging.

Purpose of the Study:

• To compare computed tomography (CT) findings in patients with urine extravasation due to ureteropelvic disruption versus renal parenchymal injury.
• To identify specific CT characteristics indicative of ureteropelvic disruption secondary to blunt trauma.
• To assess the diagnostic utility of CT in differentiating ureteral injury from renal parenchymal injury.

Main Methods:

• Retrospective review of computed tomography (CT) scans from four cases of ureteropelvic disruption and 15 cases of renal parenchymal injury following blunt trauma.
• Analysis of contrast medium excretion, presence of perirenal hematoma, and location of contrast extravasation.
• Evaluation of ureteral opacification patterns on CT.

Main Results:

• In three cases of isolated ureteropelvic disruption, renal parenchyma was intact, contrast excretion was normal, and no perirenal hematoma was observed.
• Contrast medium extravasation was predominantly noted in the medial perirenal space in ureteropelvic disruption cases.
• The ipsilateral ureter was not opacified in three out of four ureteropelvic disruption cases, a finding distinct from renal parenchymal injury.

Conclusions:

• Specific CT findings, including medial perirenal contrast extravasation and lack of ureteral opacification, are distinct indicators of ureteropelvic disruption.
• CT can confidently diagnose ureteral disruption when these characteristic findings are present in trauma patients.
• Combined renal parenchymal injury and ureteropelvic disruption can occur, necessitating thorough evaluation.