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Rupture of Ureteropelvic Junction-Obstructed Kidney

Adelaide and Meath Hospital Tallaght, Dublin 24, Ireland

We read with interest the excellent trauma case presentation by Smith et al. [1], in which the authors describe a case of rupture of a ureteropelvic junction-obstructed kidney in a 15-year-old male football player. The case is well presented with a useful discussion. The authors correctly indicate the clinical and radiologic features, which may predict the need for urgent surgery by nephrectomy or radiologic intervention by nephrostomy decompression. We would like to add to their discussion, the possible role of urgent radiologic embolization in such cases by means of describing a similar case we recently encountered.

A 20-year-old male soccer player sustained a direct elbow blow to his right flank. He developed acute pain and gross hematuria. CT of his abdomen showed findings suggestive of a right ureteropelvic obstruction with rupture (Fig. 2A). Over the next 12 hr the patient's gross hematuria persisted. He became increasingly hypotensive and had a significant drop in his blood hemoglobin levels. Urgent nephrectomy was considered, but we instead decided to embolize the kidney. The right kidney was selectively embolized using the embolyzing material Embospheres (500-700 µm, BioSphere Medical, Rockland, MA). The patient stabilized immediately after the procedure and made an uneventful recovery. CT performed 3 months after the procedure showed an atrophied right kidney (Fig. 2B). This case supports the role of renal embolization in unstable patients with traumatic rupture of ureteropelvic junction-obstructed kidneys.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —20-year-old male soccer player with acute flank pain. Unenhanced transverse CT scan shows markedly distended pelvis of right kidney, suggesting ureteropelvic obstruction. Note high-attenuation material in pelvis of kidney. Other CT scans (not shown) revealed retroperitoneal and intraperitoneal fluid.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —20-year-old male soccer player with acute flank pain. Transverse CT scan obtained with IV contrast agent 3 months after embolization shows small atrophied right kidney.

References

1. Smith M, Johnston B, Wessells H, Talner L. Rupture of a ureteropelvic junction-obstructed kidney in a 15-year-old football player. AJR 2003;180:504[Free Full Text]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Geoghegan, T. Articles by Torreggiani, W. C. Search for Related Content PubMed PubMed Citation Articles by Geoghegan, T. Articles by Torreggiani, W. C. Social Bookmarking                      What's this?