A 90-year-old woman presented to her primary care physician with non-specific generalised lower abdominal pain, mild dysuria, and urinary frequency. She had been treated with empirical antibiotics for presumed urinary tract infections with varying improvements in her symptoms. Her past medical history included a previous stroke with no significant residual deficits and anxiety. She had a brief smoking history in her youth and no significant exposure to industrial carcinogens. To further investigate her symptoms, she underwent a computed tomography intravenous pyelogram (CT IVP).
The CT IVP demonstrated the development of a right perinephric collection between the nephrogenic (
Figure 1A) and pyelographic phases (
Figure 1B). Peri-nephric hyperdense material and contrast indicated the development of a mixed haematoma and urinoma. This was suggestive of a spontaneous calyceal rupture and associated haemorrhage leak. The patient remained stable throughout the scan, with no flank pain or haematuria. The remainder of the scan did not reveal any significant cause of her abdominal pain, and there were no significant findings along the genito-urinary tract.
Three urine cytology samples were negative for malignant urothelial cells. Her kidney function also remained stable, with a creatinine level of 76 μmol/L and an estimated glomerular filtration rate of 61 mL/min/1.73 m
2. A non-contrast CT was repeated in two weeks, showing complete resolution of the perinephric collection with conservative management (
Figure 2). Her imaging did not show any evidence of malignancy, and there was no explanation for the spontaneous calyceal rupture and haemorrhage during the two phases of the CT scan.
The imaging was also reviewed in a uro-radiology multi-disciplinary meeting. Although a rigid cystoscopy and bilateral retrograde pyelogram were offered, the patient opted for non-operative conservative management. This case demonstrates an interesting case of a spontaneous calyceal rupture and associated haemorrhage during a routine CT IVP which was successfully conservatively managed.
Author Contributions
B.R.: Conceptualization, data curation, writing—original draft preparation, writing—review and editing; D.C.-C.: writing—original draft preparation, writing—review and editing; D.S.: writing—original draft preparation, writing—review and editing; E.L.: supervision, writing—review and editing. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Ethical review and approval were not required for this study as anonymity is assured and there are no associated risks.
Informed Consent Statement
Informed consent was obtained from the patient involved in the study.
Data Availability Statement
The original contributions presented in the study are included in the article. Further inquires can be directed to the corresponding author.
Conflicts of Interest
The authors declare no conflicts of interest.
| Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
