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Spontaneous rupture of the renal calyx secondary to a vesicoureteral junction calculus

Published:December 24, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.10.021

      Highlights

      • Renal calyceal rupture occurs secondary to a relatively large obstructing ureteral calculus.
      • High index of suspicion for calyceal rupture should be present even in the scenario of a small urolithiasis.
      • Contrast enhanced CT scan is vital for the diagnosis.
      • Management by a double–J ureter stent insertion can yield good clinical outcome.

      Abstract

      Background

      Spontaneous urinary collecting system rupture is caused by increased ureteral intraluminal pressure secondary to an obstruction. Rarely, a small stone exerts high intraureteral pressure especially if it is located distally. Many management modalities with good outcomes have been implicated.

      Purpose

      Herein, we present a case of nontraumatic rupture of the renal calyx due to a 4 mm obstructing stone at the vesicoureteral junction.

      Basic procedures

      CT scan of abdomen and pelvis without contrast, CT scan of the abdomen and pelvis with intravenous contrast, Cystoscopy, Double–J ureter stent, Urinary Foley catheter.

      Main findings

      The diagnosis was confirmed by CT imaging. Non-contrast enhanced CT scan of abdomen and pelvis showed obstructive calculi measuring 4 mm in the right vesicoureteral junction. Contrast-enhanced CT scan revealed leakage of contrast in the perinephric space at the right major calyx with intact bilateral ureters, suggestive of calyceal rupture. The treatment involved antibiotics and double-J stenting.

      Principal conclusions

      This case demonstrates that spontaneous calyceal rupture should be suspected in urolothiasis patients presenting for a severe pain even if the calculus is small (less than 5 mm) and the laboratory markers are normal. An immediate management is required to relief symptoms and prevent further complications.

      Keywords

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