National University Hospital, Singapore, Singapore.
Ng Teng Fong General Hospital, Singapore, Singapore.
BMC Urol. 2020 Jul 13;20(1):98. doi: 10.1186/s12894-020-00669-4.
Atraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction.
A 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted.
Spontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.
无先前存在的肾脏或输尿管疾病的无创伤性肾盂破裂是一种罕见的事件。它发生在急性尿路梗阻的情况下，最常见于输尿管结石。典型症状包括急性腰痛和恶心，类似于肾盂肾炎或其他急性腹痛的原因。双侧无明显尿路梗阻的自发性破裂极其罕见，目前在英文文献中尚未报道。可以从观察到梗阻的破裂病例中推测出可能的病理生理机制。
一名 58 岁女性因无症状性显微镜下血尿接受多期 CT 检查，在对比剂给药后仅在延迟期观察到双侧肾盂破裂，这是在台上发现的。患者没有明显的既往病史。整个研究过程中患者无症状，研究后也无症状，接受了保守治疗。一个月的随访影像学显示尿囊肿消退，无进一步的造影剂外渗。随后未注意到任何并发症或复发。
即使在没有明确尿路梗阻的情况下，静脉内造影剂给药也可能导致罕见的肾盂破裂并发症，而且可能是双侧的。有些病例可能没有症状，但典型症状应提示对肾脏进行评估，特别是在最初的研究中未包括肾脏或未按方案进行延迟期检查时。为了监测和避免感染性后遗症，对尿囊肿和造影剂外渗的缓解进行间隔成像具有临床意义。
