Ultrasound-guided percutaneous antegrade pyelography with computed tomography for the diagnosis of spontaneous partial ureteral rupture in a dog

Abstract

A 10-year-old spayed female dalmatian dog developed acute vomiting and abdominal pain. Ultrasound examination of the abdomen showed right hydronephrosis and proximal ureter dilation with mild retroperitoneal free fluid. Computed tomography (CT) of the abdomen confirmed the ultrasonographic findings and revealed, additionally, a right ureteral stone. Spontaneus rupture of the right ureter was confirmed with CT post ultrasound-guided percutaneous antegrade pyelography. Pyeloureteral rupture and the presence of a ureteral stone were confirmed at surgery.

Figure 1

Transverse computed tomographic image of the mid abdomen. A 1.2 cm hyperattenuating (581 HU) calculus is visible at the level of the proximal ureter (arrowhead). Note the presence of free fluid in the retroperitoneal space, which appears as curvilinear hyperattenuating bands of variables thickness in the retroperitoneal fat (arrow). RK — right kidney, LK — left kidney, S — spleen.

Figure 2

Transverse computed tomographic image after intravenous pyelography (15 min delayed acquisition). Note the irregular margins of the right kidney and the heterogeneous contrast enhancement of the right kidney affected by hydronephrosis. RK — right kidney, P — renal pelvis, S — spleen.

Figure 3

Transverse computed tomographic image after percutaneous ultrasound-guided antegrade pyelography. Note the leakage of contrast medium in the retroperitoneal space (arrowhead). RK — right kidney, LK — left kidney, P — renal pelvis.

Figure 4

Dorsal multiplanar reconstruction image after percutaneous ultrasound-guided antegrade pyelography. Contrast medium is visible inside the right ureter distal to the stone, confirming that the obstruction was not complete. Note the point of leakage at the level of the junction between the renal pelvis and the ureter (arrowhead). RK — right kidney, U — ureter, C — calculus, P — renal pelvis.