Visualizing the "Pop-Off": Point-of-Care Ultrasound Diagnosis of Spontaneous Ureteral Rupture

Area of Science:

• Urology
• Radiology
• Emergency Medicine

Background:

• Spontaneous ureteral rupture (SUR) is a rare complication of obstructive uropathy.
• It can present atypically, mimicking other acute abdominal conditions.
• Normal urinalysis can be misleading in these cases.

Purpose of the Study:

• To report a case of spontaneous ureteral rupture.
• To highlight the diagnostic utility of point-of-care ultrasound (POCUS) in identifying ureteral rupture and associated collections.
• To emphasize the role of advanced imaging in confirming the diagnosis.

Main Methods:

• Case report of a 66-year-old male with acute flank pain.
• Initial evaluation with point-of-care ultrasound (POCUS).
• Diagnostic confirmation with contrast-enhanced computed tomography (CT).

Main Results:

• POCUS identified hydronephrosis and a significant perinephric fluid collection, revealing ureteral discontinuity.
• CT confirmed spontaneous ureteral rupture secondary to a distal ureteral calculus with extensive urinoma.
• The patient successfully underwent urinary diversion and stenting.

Conclusions:

• POCUS can expedite the diagnosis of spontaneous ureteral rupture by visualizing extrarenal fluid collections and the rupture site.
• Delayed-phase CT is crucial for definitive diagnosis, especially with non-contributory urinalysis.
• Early diagnosis and intervention lead to full recovery.