SCVIR Annual Meeting Film Panel Session: Diagnosis and Discussion of Case 3

Abstract

A 68-year-old man with transitional cell carcinoma of the bladder presented with generalized weakness and left hip pain and thigh swelling. He reported multiple falls at home. In the evaluation for metastatic disease, a Tc-99m methylene diphosphonate (MDP) whole body bone scan was performed (Fig 1). The bone scan shows marked radiotracer accumulation extending from the region of the left kidney to the anterior left thigh. Findings are suspicious for urine leakage from the left kidney or proximal ureter. Further work-up included a contrast-enhanced computer tomographic (CT) scan of the abdomen and pelvis (Fig 2). This shows bilateral hydronephrosis secondary to a large, locally invasive bladder tumor. Additionally, there is a well-encapsulated fluid collection within the left psoas muscle, extending into the muscles and soft tissues of the left thigh. Delayed CT images (Fig 3) show accumulation of dense contrast material within the previously identified fluid collection. Based on these findings, the patient was referred to the interventional radiology department and a left percutaneous nephrostomy was performed. A nephrostogram from the procedure (Fig 4) demonstrates rapid extravasation of contrast from the proximal left ureter into an amorphous cavity in the left flank, confirming the suspicion of ureteral disruption.