Oukassem Siham, Debbi Salma, Abourak Chaima, Messouad Ola, El Aoufir Omar, Jroundi Laila, Miko Ali Mohammed, Diouri Mamoun, Bouhnib Ayoub, Ibrahimi Ahmed
Emergency Radiology Department CHU Ibn Sina, Mohamed V University Rabat, Morocco.
Urology Department CHU Ibn Sina, Mohamed V University Rabat, Morocco.
Radiol Case Rep. 2024 Dec 21;20(3):1486-1491. doi: 10.1016/j.radcr.2024.11.067. eCollection 2025 Mar.
A 50-year-old patient with a prior history of chronic smoking presented to the emergency department with diffuse abdominal pain, primarily localized to the right hypochondrium and epigastric region, along with nausea, but without fever, vomiting, or urinary symptoms. Laboratory tests were largely unremarkable except for isolated hematuria and a mildly elevated CRP. Given the atypical clinical presentation, a 3-phase abdominal CT scan (without contrast, portal, and delayed phases) was conducted, revealing a horseshoe kidney with an obstructing 4 mm stone at the right ureteral meatus. This obstruction led to dilation of the right ureter and renal calyces. In the delayed phase, a rupture of the right calyx was observed with contrast extravasation into the perirenal space. The patient was managed with conservative intervention, including the placement of a JJ stent, analgesics, and antibiotics. The obstructing stone was expelled during stent placement, and the patient showed a favorable clinical course thereafter. Spontaneous rupture of the renal calyx in a horseshoe kidney due to ureteral obstruction by a small calculus is a rare but significant event. Prompt diagnosis with CT imaging and conservative management, including stent placement, can lead to positive outcomes in complex anatomical presentations such as horseshoe kidneys.
一名有长期慢性吸烟史的50岁患者因弥漫性腹痛就诊于急诊科，疼痛主要局限于右季肋区和上腹部，伴有恶心，但无发热、呕吐或泌尿系统症状。实验室检查除孤立性血尿和轻度升高的CRP外，大多无异常。鉴于临床表现不典型，进行了腹部三期CT扫描（平扫、门静脉期和延迟期），结果显示马蹄肾，右侧输尿管口有一枚4毫米的梗阻性结石。该梗阻导致右侧输尿管和肾盏扩张。在延迟期，观察到右肾盏破裂，造影剂外渗至肾周间隙。患者接受了保守治疗，包括放置双J支架、使用镇痛药和抗生素。在放置支架过程中，梗阻性结石排出，此后患者临床病程良好。马蹄肾因小结石导致输尿管梗阻而引起肾盏自发性破裂是一种罕见但严重的事件。通过CT成像及时诊断并采取包括放置支架在内的保守治疗，对于马蹄肾等复杂解剖结构的病例可取得良好效果。
