CT scanning for diagnosing blunt ureteral and ureteropelvic junction injuries

Springer Science and Business Media LLC - 2008
Sarah Ortega1, Fernado S Netto1, Paul Hamilton2, Peter Chu1, Homer Tien1
1Trauma Program and Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
2Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada

Tóm tắt

Abstract Background Blunt ureteral and ureteropelvic (UPJ) injuries are extremely rare and very difficult to diagnose. Many of these injuries are missed by the initial trauma evaluation. Methods Trauma registry data was used to identify all blunt trauma patients with ureteral or UPJ injuries, from 1 April 2001 to 30 November 2006. Demographics, injury information and outcomes were determined. Chart review was then performed to record initial clinical and all CT findings. Results Eight patients had ureteral or UPJ injuries. Subtle findings such as perinephric stranding and hematomas, and low density retroperitoneal fluid were evident on all initial scans, and prompted delayed excretory scans in 7/8 cases. As a result, ureteral and UPJ injuries were diagnosed immediately for these seven patients. These findings were initially missed in the eighth patient because significant associated visceral findings mandated emergency laparotomy. All ureteral and UPJ injuries have completely healed except for the case with the delay in diagnosis. Conclusion Most blunt ureteral and UPJ injuries can be identified if delayed excretory CT scans are performed based on initial CT findings of perinephric stranding and hematomas, or the finding of low density retroperitoneal fluid.

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