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previously visited 070206 RENAL PELVIC RUPTURE SECONDARY FROM CONGENITAL UPJ OBSTRUCTION Random Case
Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 1 day old male
History: Prenatal ultrasound: left hydronephrosis. Hematuria (+). Fever (-).
Images:[small]mediumlargeas-submittedimages only

Fig. 1: KUB

Fig. 2: Ultrasound_Day3

Fig. 3: Ultrasound_Day3_animator

Fig. 4: MRU_Day3

Fig. 5: MR_T2_Coronal

Fig. 6: MR_T2_Coronal_1

Fig. 7: MR_T2_Coronal_2

Fig. 8: MR_T2_Coronal_3

Fig. 9: MR_T2_axial_1

Fig. 10: MR_T2_axial_2

Fig. 11: MR_T2_axial_3

Fig. 12: PCND_Day3_1

Fig. 13: PCND_Day3_2

Fig. 14: PCND_Day3_3

Fig. 15: KUB_post PCND

Fig. 16: AP_Day6
Images:[small]mediumlargeas-submittedimages only
Findings: Figure 1 (KUB on day 1 and day 3):
1. Relative increased opacity in left lower abdomen with decreased
   bowel gas,  nature to be determined.

Figure 2,3 (Ultrasound on day 3):
1. Severe left hydronephrosis with a dangling material.
2. Fluid accumulation in left lower abdomen with septations,
   nature to be determined.

Figure 4-11 (MRI on day 3):
1. Marked dilatation of left calyces and renal pelvis with
   rapid tapering at ureteropelvic junction, in favor of
   congenital ureteropelvic junction obstruction.
2. A 1.5cm round soft tissue with stalk fixed to the margin of
   a defect (1.6cm) in anterior wall of left dilated renal pelvis,
   suggesting kidney rupture with a parenchymal fragment
   mixed with hemorrhage.
3. Moderate fluid accumulation in left retroperitoneum with
   some septation, due to urinoma with dissected retroperitoneal
   fascias.

Figure 12-14 (percutaneous nephrostomy drainage, PCND, on day 3):
1. Bloody urine from left renal pelvis.

Figure 15 (KUB, post PCND):
1. Left PCND in place.

Figure 16 (antegrade pyelonephrography, AP, on day 6):
1. Severe stenosis of left ureteropelvic juction, in favor of
   congenital ureteropelvic junction obstruction.
2. No contrast media extravasation, suggesting healed renal pelvis.
Diagnosis: Left renal pelvic rupture associated with congenital ureteropelvic junction obstruction and severe hydronephrosis.
Comments: post a comment

Congenital ureteripelvic junction obstruction is not uncommon.

But the associated kidney rupture is uncommon.

The retroperitoneal fluids always confuse ultrasound operator.

MRI is a good modality to understand the condition.

By Dr. Tsao

--pedrad CSH, 2007-02-15 20:06:25
Additional Details:

Case Number: 8115395Last Updated: 02-19-2007
Rating:

0 ratings
Anatomy: Genitourinary (GU)   Pathology: Congenital
Modality: Conventional Radiograph, Photograph, MR, GU, USAccess Level: Readable by all users
Keywords: upjo, ruptureACR: 813.1452
Case has been viewed 1374 times.

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