Spontaneous Extravasation Research Articles

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Urinoma: Saviour of beleaguered kidney

Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study revealed preserved left renal function; however the right hydroureteronephrotic kidney shrank in size. Conclusion: Spontaneous perinephric urinoma formation due to High pressure chronic retention was a blessing in disguise for the patient. It saved the affected kidney from getting knocked out. The other side hydroureternephrotic kidney suffered anatomical and functional loss.

CENTRAL VENOUS CATHETER BASED PORT FOR MULTI-DOSE CHEMOTHERAPY; TECHNIQUES AND COMPLICATIONS

Background: the utility of percutaneous Chemo port devices in the administration of multi-dose systemic chemotherapy in malignancy patients for long term therapy. It is a small port that is implanted under the skin in subcutaneous tissue to allow easy and repeated access to the bloodstream. To avoid thrombophlebitis and extravasation of drugs
 Objective: To study the utility of percutaneous Chemo port devices in the administration of multi-dose systemic chemotherapy in malignancy patients.
 Methods: this was a prospective study. The study was done in the department of cardiovascular and thoracic surgery SKIMS soura Srinagar Kashmir .from October 2018 to January 2020.We included 50 patients who were advised for Chemotherapy by the Medical Oncology department .The gender distribution being 38 females and 12 males. The mean age group was 43 and 54 years respectively for females and males. A single type of port was used, constructed of titanium and silicone. Puncture was done ultrasound guided. All patients had baseline investigation and dopplar for upper limbs and to rule out central venous stenosis.
 Results: We included total 50 patients, 43 (87%) patients completed their chemotherapy regime including .one (2%) patient who developed ipsilateral pneumothorax which was managed by intercostal tube placement. 2 (4%) patients developed severe wound infection that prompted the instantaneous removal of chemoport device followed by irrigation of the infected pocket and antibiotics. 1 patient developed catheter block which required flushes of heparinised saline. 2 patients required re-orientation of port device for port tilting.One (2%) patient had refractory arrhythmias that did not settle with drugs and hence warranted port removal. None patients had spontaneous extravasation of the port through the skin.
 Exclusion criteria: Pediatric patients age less than 18 years. Patients having Central venous stenosis. Patients having deep venous thrombosis of bilateral upper limbs.
 Conculsion: Central venous based catheter device is a very good means of delivering chemotherapeutic agents in patients of malignancy who have to receive a multi-dose drug therapy.
 Keywords: Chemotherapy, device implantation, utility, complications and management

The role of bradykinin receptor type 2 in spontaneous extravasation in mice skin: implications for non-allergic angio-oedema.

Non-allergic angio-oedema is a life-threatening disease mediated by activation of bradykinin type 2 receptors (B2 receptors). The aim of this study was to investigate whether activation of B2 receptors by endogenous bradykinin contributes to physiological extravasation. This may shed new light on the assumption that treatment with an angiotensin converting enzyme inhibitor (ACEi) results in an alteration in the vascular barrier function predisposing to non-allergic angio-oedema. We generated a new transgenic mouse model characterized by endothelium-specific overexpression of the B2 receptor (B2tg ) and established a non-invasive two-photon laser microscopy approach to measure the kinetics of spontaneous extravasation in vivo. The B2tg mice showed normal morphology and litter size as compared with their transgene-negative littermates (B2n ). Overexpression of B2 receptors was functional in conductance vessels and resistance vessels as evidenced by B2 receptor-mediated aortic dilation to bradykinin in presence of non-specific COX inhibitor diclofenac and by significant hypotension in B2tg respectively. Measurement of dermal extravasation by Miles assay showed that bradykinin induced extravasation was significantly increased in B2tg as compared with B2n . However, neither endothelial overexpression of B2 receptors nor treatment with the ACEi moexipril or B2 antagonist icatibant had any effect on spontaneous extravasation measured by two-photon laser microscopy. Activation of B2 receptors does not appear to be involved in spontaneous extravasation. Therefore, the assumption that treatment with an ACEi results in an alteration in the physiological vascular barrier function predisposing to non-allergic angio-oedema is not supported by our findings.

Overview of Intracerebral Hemorrhage

Stroke is categorized into two major subtypes i.e., ischemic and hemorrhagic and is one of the major causes of morbidity and mortality worldwide. Primary intracerebral hemorrhage (ICH), i.e. spontaneous extravasation of blood into the brain parenchyma, begins very suddenly and is a medical catastrophe. The well-known risk factors for ICH are hypertension, heavy drinking of alcohol, and anticoagulant medication. Risk factors for early death include clinical and radiological severity of the bleeding. Moreover, intraventricular bleeding, use of anticoagulants, and high blood pressure on admission also predict early death after ICH. CT brain imaging is the immediate modality for establishing diagnosis and supplemented with MR imaging depending upon aetiology. Treatment of patients with ICH includes standard supportive care, medical management and surgical intervention.

Vicarious Excretion of Contrast Media in the Gallbladder and Spontaneous Urinary Extravasation into the Perirenal and Retroperitoneal Space Following Coronary Angiography

Vicarious Excretion of Contrast Media in the Gallbladder and Spontaneous Urinary Extravasation into the Perirenal and Retroperitoneal Space Following Coronary Angiography

Neuroimaging in Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is described as spontaneous extravasation of blood into the brain parenchyma. This clinical entity is present in 10% to 15% of all stroke cases1 in the Western population, with reported incidence rates higher in Asia.2–4 It is also associated with a higher mortality rate compared with either ischemic stroke (IS) or subarachnoid hemorrhage.5 ICH is classified according to its primary (80% to 85%) or secondary (15% to 20%) causes. More than 50% of primary ICH events are directly correlated with hypertension as a risk factor, whereas ≈30% are known to be associated with cerebral amyloid angiopathy (CAA). The causes of secondary ICH include hemorrhage conversion of IS, amyloid angiopathy, stimulant drugs, vascular malformations (aneurysms, arterovenous malformations, venous angioma, cavernoma, dural arteriovenous fistula), coagulopathy (hereditary, acquired, induced by anticoagulants or antiplatelets), neoplasms, trauma, vasculitis, Moyamoya disease, or sinus venous thrombosis (Table 1). View this table: Table 1. Intracerebral Hemorrhage (ICH) Classification According to Causes Currently, ICH is classified as either primary or secondary according to only causes. However, this classification does not take into account the inherent differences of underlying vascular pathologies. Hence, a more systematic stratification based on new criteria is currently being developed.1 Specifically, Meretoja et al6 have proposed the SMASH-U classification, based on the underlying diseases of ICH: Structural lesions (cavernomas and arterovenous malformations), Medication (anticoagulation), Amyloid angiopathy, Systemic diseases (liver cirrhosis, thrombocytopenia, and various rare conditions), Hypertension, and Undetermined causes. This classification has proven to be feasible and is also associated with survival prognosis.6 Another classification used in clinical practice distinguishes between deep and lobar ICHs according to location. Deep ICHs are located in the basal ganglia, thalamus, internal capsule, cerebellum, or brain stem and are generally related to hypertension. Whereas, lobar ICHs usually require more extensive diagnostic testing because …

Spontaneous urinary extravasation: detection rate with 64-row multidetector computed tomography in patients presenting with acute abdomen

The aim of this study was to detect the rate of spontaneous urinary extravasation (SUE) with computed tomography (CT) in patients presenting with acute abdomen. Seven hundred thirteen abdominal CT examinations with i.v. contrast media requested mainly from the emergency department and urology clinics for sudden onset abdominal pain, flank pain, nonspecific abdominal pain with nausea and vomiting, and renal colic between September 2007 and August 2011 were retrospectively reviewed. Only adult patients were included in the study. Three patients with SUE were detected. One had a mid-ureteral stone while the etiology for the other two patients was unknown. Two of the patients were treated conservatively; one was treated with stenting with a double-j catheter. SUE should be considered in the differential diagnosis of patients presenting with acute abdomen and perinephric-periureteral fluid collection inconsistent with stone size and who are occasionally stone free. Early and precise diagnosis of SUE plays an important role in the management protocol of patients presenting with acute abdomen.

Spontaneous peripelvic extravasation with nephrocolic caused by ureteral calculus

Spontaneous peripelvic extravasation with nephrocolic caused by ureteral calculus

Glucocorticoid inhibition of vascular abnormalities in a tibia fracture rat model of complex regional pain syndrome type I

Tibia fracture in rats evokes chronic hindpaw warmth, spontaneous extravasation, edema, allodynia, and periarticular bone loss, a syndrome resembling complex regional pain syndrome type I (CRPS I). Glucocorticoids such as methylprednisolone (MP) are probably effective analgesic and anti-edematous agents in patients suffering from CRPS and this study examined the effects of chronic MP treatment in the rat CRPS I model. Bilateral hindpaw thickness, temperature, and nociceptive thresholds were determined, and the hindlimb bone density was measured using dual-energy X-ray absorptiometry (DXA). Spontaneous cutaneous extravasation and substance P infusion evoked extravasation were determined using an Evans blue vascular permeability assay. After baseline testing, the distal tibia was fractured and the hindlimb casted for 4 weeks. At 2 weeks post-fracture MP infusion was started (1 mg/kg/day for 28 days). The rats were retested at 4, 6, and 8 weeks post-fracture. Hindpaw edema and warmth after fracture were reversed by MP infusion and these effects persisted after discontinuing treatment. Furthermore, there was an increase in spontaneous protein extravasation and an enhanced substance P evoked extravasation and edema response in the hindpaw at 4 weeks that was inhibited by MP infusion. Glucocorticoid treatment had no effect on the allodynia, hindpaw unweighting, or the periarticular bone loss observed after tibia fracture. We postulate that post-junctional facilitation of substance P signaling contributes to the hindpaw warmth, edema, and the enhanced spontaneous protein extravasation observed in this CRPS I model, and that the anti-edematous effects of glucocorticoid treatment are due to inhibition of post-junctional neuropeptide signaling.

Scintigraphic Demonstration of Urine Extravasation Secondary to Acute Ureteral Obstruction: A Case Report and Some Considerations about Acute Ureteral Obstruction

Acute ureteral obstruction produces renal damage and complications that are proportional to the severity and length of the obstruction. Anatomic diagnosis of the obstruction may be insufficient to manage the patient. Intravenous urogram (IVU) is the method usually advised by radiologists to obtain functional information, but requires iodinated contrast agents. IVU anatomic information is superior to anatomic information obtained with renal scintigraphy, but normally the physician already has the anatomic information (unenhanced CT or ultrasound). A renal scan offers better physiologic information than the IVU, has neither adverse effects nor complications, is accurate to confirm or discard significant ureteral obstruction, and depicts obstruction complications. This paper presents a patient with spontaneous urine extravasation secondary to acute renal obstruction who is diagnosed with renal scintigraphy. The authors describe the scintigraphic signs of extraperitoneal, diffuse perinephric, urine extravasation and emphasize the role of renal scintigraphy in diagnosis and follow-up of renal colic.

Spontaneous extravasation of urine during emergency intravenous pyelography.

Abstract During intravenous pyelography, spontaneous extravasation of contrast from the pelvicaliceal system into the renal sinus and beyond is rarely seen. The diagnosis in 4 patients with ureteric colic was confirmed by emergency pyelograms, and in each case extravasation of contrast was noted. The most likely explanation of spontaneous ‘pyelosinus back-flow’ is that the sudden increased intrapelvic pressure which occurs during ureteric colic results in minute tears of the caliceal fornix. Spontaneous extravasation of urine could explain the severe loin pain and pyrexia associated with ureteric colic. Complications are rare provided the calculus is passed and no treatment is required. The condition must be clearly distinguished from true rupture of the renal pelvis and ureter which may present as an acute abdomen, requiring urgent exploration and drainage.

Substance P signaling contributes to the vascular and nociceptive abnormalities observed in a tibial fracture rat model of complex regional pain syndrome type I

Wrist and ankle fractures are the most frequent causes of complex regional pain syndrome (CRPS type I). The current study examined the temporal development of vascular, nociceptive and bony changes after distal tibial fracture in rats and compared these changes to those observed after cast immobilization in intact normal rats. After baseline testing the right distal tibial was fractured and the hindlimb casted. A control group was simply casted without fracturing the tibia. After 4 weeks the casts were removed and the rats retested. Subsequent testing was performed at 6, 8, 10, 16, and 20 weeks after onset of treatment. Distal tibial fracture or cast immobilization alone generated chronic hindlimb warmth, edema, spontaneous protein extravasation, allodynia, and periarticular osteoporosis, changes resembling those observed in CRPS. Hindlimb warmth and allodynia resolved much more quickly after cast immobilization than after fracture. Previously we observed that the substance P receptor (NK 1) antagonist LY303870 reversed vascular and nociceptive changes in a sciatic section rat model of CRPS type II. Postulating that facilitated substance P signaling may also contribute to the vascular and nociceptive abnormalities observed after tibial fracture or cast immobilization, we attempted to reverse these changes with LY303870. Hindpaw warmth, spontaneous extravasation, edema, and allodynia were inhibited by LY303870. Collectively, these data support the hypotheses that the distal tibial fracture model simulates CRPS, immobilization alone can generate a syndrome resembling CRPS, and substance P signaling contributes to the vascular and nociceptive changes observed in these models.

A substance P receptor (NK 1) antagonist can reverse vascular and nociceptive abnormalities in a rat model of complex regional pain syndrome type II

Sciatic nerve section in rats evokes chronic hindlimb edema, pain behavior, and hyperalgesia, a syndrome resembling complex regional pain syndrome (CRPS II) in man. Furthermore, there is an increase in spontaneous protein extravasation in the hindpaw skin of rats after sciatic transection, similar to the increased protein extravasation observed in the edematous limbs of CRPS patients. Now we demonstrate that sciatic nerve section also generates chronic hindlimb warmth, distal articular tenderness, allodynia, and periarticular osteoporosis, sequelae of nerve injury resembling those observed in CRPS. We postulated that facilitated substance P signaling may contribute to these vascular and nociceptive abnormalities and attempted to reverse these changes with the long acting substance P receptor (NK 1) antagonist LY303870. Hindpaw spontaneous extravasation was inhibited by LY303870. Systemic administration of LY303870 also reversed hindpaw edema and cutaneous warmth. Intrathecal, but not systemic administration of LY303870 reversed soft tissue and articular mechanical hyperalgesia in the hindpaw. Collectively, these data further support the hypothesis that the sciatic nerve transection model closely resembles CRPS and that substance P contributes to the spontaneous extravasation, edema, warmth, and mechanical hyperalgesia observed in this model.

Newborn Infants With Extravasation In Perirenal Space: Two Cases

Extravasation of the urine in the perirenal space presumably occurs after urine has dissected through the renal sinus and renal hilus. Occasionally urine may directly enter the perirenal space by extravasation from a calyx through the renal parenchyma. We report two cases of extravasation of urine in the perirenal space in the newborn infants. First case was confirmed as posterior urethral valve while no obvious cause was found in second case. To the best of our knowledge, no case of extravasation in the perirenal space secondary to posterior urethral valves reported in the literature. CASE 1 A day old male infant sent for u/s of the kidneys. The antenatal scan two days prior to birth showed dilated small bowel loops and some dilatation of the renal pelvis bilaterally. Postnatal U/S showed gross hydronephrosis on right side and mild hydronephrosis on the left side. Both the ureters were also dilated up to their terminal ends. There was extravasation of the fluid in perirenal space on the left side (Fig 1). The infant had passed meconeum and urine after birth. Abdomen was soft but slightly distended. PFA did not reveal any abnormality. Temperature, respiration, o2 saturation and BP were normal. MSU showed 20 pus cells. K 5.8(Normal value 4.1-5.6 mmol), Creatinine 155(Normal value 28-53 umol), urate 428(Normal value 120-450umol), Na 139(Normal value 135-140mmol), urea, ca, mg, Hb, TLC and platelet counts were normal. MCUG showed grade 5-vesicoureteric reflux on the left side. No vesico ureteric reflux noted on the right side. Dilated posterior urethra consistent with posterior urethral valve noted. Resection of posterior urethral valves carried out with no complications. Repeat sonography of kidneys and MCUG after three months were normal. The perirenal fluid on the left side was absorbed. Figure 1 Figure 1: Fluid in the perirenal space( Arrow). The calyces are dilated. CASE 2 A female infant did not pass urine after birth for three days. On Examination, Abdomen was soft but bladder was full and Newborn Infants With Extravasation In Perirenal Space: Two Cases 2 of 3 distended. She had a sacral dimple. Mild anal stenosis noted. Urea 5mmol,Na 139mmol,K 5.1mmol,Creatinine 89 umol (Normal value 28-53umol), Total bilirubin 133 which came 40 umol/l later. Hb, TLC, Platelet counts were normal. The infant was referred for x-rays of the abdomen, lumbosacral spines and renal sonography to the Radiology department. Abdomen and lumbo-sacral spines x-rays were unremarkable. Sonography of the kidneys showed extravasation of fluid in the left perirenal space with mild changes of hydronephrosis( Fig 2). The left ureter up to the terminal end was dilated. Right kidney was normal. The urinary bladder was grossly distended but otherwise unremarkable. The infant passed urine spontaneously after three hours of sonography. Ultrasonography of the bladder, MCUG and cystoscopy were carried out which were unremarkable. No cause of the obstruction was found. Hypothetically, probably a small calculus was the cause of obstruction, which must have been passed spontaneously. Three months follow up renal sonography was unremarkable. Figure 2 Figure 2: Fluid in the perirenal space marked with arrow. The calyces are mildly dilated. DISCUSSION Extravasation is usually associated with acute obstruction and occurs as the result of increased hydrostatic pressure in the renal sinus. Acute or sub acute obstruction results in increased hydrostatic pressure and dilation of the renal collecting system. Decompression of the obstructed system may occur by rupture of the renal calyx at its fornix. Microruptures or tears occur at the calyceal fornix. The extravasating urine may dissect in the renal sinus1. Usually there is communication between the renal sinus and the perirenal spaces at the renal hilus but anatomic variation are not uncommon2. Once extravasating urine extends from the peripelvic tissues into the perirenal space, it becomes easily visualised by ultrasound as perirenal fluid collection. The ultrasound findings of perirenal fluid are non-specific and can represent extravasted urine, blood, pus, or lymphocele or even pancreatic pseudocyst3. Spontaneous peripelvic extravasation is relatively uncommon. Most of the cases are secondary to urinary calculi, tumours of the ureter or invasion by tumours of the adjacent structures4. The spontaneous extravasation of urine can be diagnosed by Intravenous urography or Ultrasound. The ultrasound appears more sensitive to our knowledge5. In our case no.1, there was bilateral hydronephrosis with perirenal collection on the left side. Once the posterior urethral valves were repaired, no hydronephrosis was evident but absorption of the perirenal fluid on the left side took some time. In case no. 2, no obvious cause of the extravasation in the perirenal space was found. Presumably, there was a tiny stone at the distal end of the left ureter passed spontaneously. CORRESPONDENCE TO Dr. Mahesh Baj Email: Maheshbaj@yahoo.com

Glucocorticoid inhibition of neuropathic limb edema and cutaneous neurogenic extravasation

Sciatic nerve section in rats evokes chronic limb edema, pain behavior, and hindpaw hyperalgesia, a syndrome resembling the complex regional pain syndrome type II (CRPS II or causalgia) in man. Glucocorticoids such as methylprednisolone (MP) have been used as analgesic and anti-edematous agents in patients suffering from CRPS, and interestingly these therapeutic effects appear to persist in some patients after stopping the medication. Similar to the CRPS clinical response to glucocorticoids, we now demonstrate that chronic hindpaw edema in the sciatic transection CRPS model is reversed by a continuous infusion of MP (3 mg/kg/day over 21 days), and this anti-edematous effect persists for at least 1 week after discontinuing MP. Furthermore, there is a chronic increase in spontaneous protein extravasation in the hindpaw skin of rats after sciatic transection, similar to the increased protein extravasation observed in the edematous hands of CRPS patients. A 2-week infusion of MP (3 mg/kg/day) reduced spontaneous protein extravasation in the hindpaw skin by 80%. We postulated that increased spontaneous neurogenic extravasation resulted in development of limb edema in both the animal model and the CRPS patient, and that the anti-edematous effects of MP are due to an inhibition of spontaneous extravasation. Additional experiments examined the inhibitory effects of MP infusion on electrically-evoked neurogenic extravasation in the hindpaw skin of normal rats. MP inhibition was dose- and time-dependent, with an ED 50 of 1.2 mg/kg/day for a 14-day continuous infusion of MP, and a maximum inhibitory effect requiring 17 days of MP infusion (3 mg/kg/day). MP (3 mg/kg/day for 14 days) also blocked both capsaicin- and SP-evoked neurogenic extravasation, indicating a post-junctional inhibitory effect. Our interpretation is that increased spontaneous neurogenic extravasation in this CRPS model contributed to the development and maintenance of hindpaw edema, and that chronic MP administration dose- and time-dependently blocked neurogenic extravasation at a post-junctional level, thus reversing spontaneous extravasation and limb edema in this model.

Spontaneous pyelosinus extravasation in blunt abdominal trauma: Radiographic findings and treatment implications

Spontaneous pyelosinus extravasation (SPE) occurs rarely. It is observed on intravenous urograms performed for the evaluation of “obstructive” processes. SPE is hypothesized to be caused by an acute or subacute increase in renal pelvic pressure secondary to a urinary calculus or other processes that leads to a sudden increase in hydrostatic pressure. Only two cases of SPE secondary to blunt abdominal trauma have been described. We report three additional cases, all of which demonstrated pyelosinus extravasation on their initial intravenous urograms. All patients were followed conservatively without surgical intervention, and each had a benign course without complication. Herein, we present the radiographic findings, pathophysiologic mechanisms, and treatment implications of SPE with the emphasis on expectant management.

Spontaneous plasma extravasation in neutral endopeptidase (NEP) knockout mice is mediated by substance P (SP) and bradykinin (BK)

Spontaneous plasma extravasation in neutral endopeptidase (NEP) knockout mice is mediated by substance P (SP) and bradykinin (BK)

Renal colic associated with spontaneous urinary extravasation and pleural effusion

Renal colic associated with spontaneous urinary extravasation and pleural effusion

Vicarious contrast material excretion in patients with acute unilateral ureteral obstruction.

Radiographs of 45 patients with evidence of acute unilateral ureteral obstruction at intravenous urography, obtained at least 24 hours after injection of contrast material, were retrospectively studied. Vicarious contrast material excretion (VCME) as evidence by gallbladder opacification on delayed radiographs was seen in 19 patients (42%), 10 of whom also showed extravasation of contrast material. A total of 15 of the 45 patients developed spontaneous extravasation; 10 (67%) showed VCME, while only nine of the 30 patients (30%) who did not have spontaneous extravasation of contrast material showed VCME. The creatinine level was elevated (greater than 1.5 mg/dL [133 mumol/L]) in four patients with VCME and in six patients without. This series indicates that VCME is more common than previously appreciated in patients with acute unilateral ureteral obstruction and occurs with greater frequency when obstruction is associated with contrast material extravasation.