Iatrogenic Urinomas Identified by 99mTc DTPA Renal Scintigraphy

Padma Subramanyam

doi:10.4172/2329-9088.1000131

Abstract

Urine leaks can occur from the kidney, ureter, bladder, and urethra, and is usually attributed to an iatrogenic cause. Urinomas are collection of extravasated urine that may be initially occult and may lead to complications such as abscess formation and electrolyte imbalances if not promptly diagnosed and appropriately managed. It is important not only to diagnose urine leaks but also to determine their cause and extent, thus imaging specialists play a key role. We present two iatrogenic cases of urinomas, one from the ureter and the other from the kidney that were diagnosed by 99mTechnetium Diethylene triamine penta acetic acid (99mTc DTPA) renogram. Initially contrast enhanced computed tomography reported the first case to be a large ovarian cyst, while the other case was reported to be a pyogenic abscess. 99mTc DTPA renogram is a highly reliable, non invasive investigation with a physiological basis. It can be used not only for diagnosing urine leaks but also for assessing individual renal function as there may be an underlying renal disarrangement in such patients.

Highlights

Urine leaks and urinomas result from disruption of the urinary tract, potentially occurring at any level from the renal calyx to the urethra [1]
We present two iatrogenic cases of urinomas, one from the ureter and the other from the kidney that were diagnosed by 99mTc DTPA renogram
Urine leaks and urinoma usually result from blunt or penetrating renal trauma that may occur as a disruption of the calyces, infundibulum or renal pelvis

Summary

Introduction

Urine leaks and urinomas result from disruption of the urinary tract, potentially occurring at any level from the renal calyx to the urethra [1]. We present two iatrogenic cases of urinomas, one from the ureter and the other from the kidney that were diagnosed by 99mTc DTPA renogram She is a 43 years old patient under evaluation for primary infertility. Magnetic Resonance Imaging (MRI) of pelvis (Figure 1b) showed a large pelvic multiloculated cystic lesion exerting mass effect over the rectum and bladder with moderate right hydroureteronephrosis. GFR is defined as the volume of fluid filtered from the kidney i.e glomerular capillaries into the Bowman's capsule per unit time This abnormal pelvic collection of tracer was found to communicate with the right ureter suggesting a significant urine leak. Anterior and posterior dynamic images revealed a urine leak from right ureter, apparently from the anastomotic site, leading to a urinoma (progressive accumulation in dynamic DTPA images) corresponding to the CT detected pelvic cystic mass (better seen in anterior images and marked by an arrow). Patient underwent surgical re exploration and postoperative DTPA renogram (Figure 2c) showed complete resolution of the right urinoma

Discussion

Conclusion