Spontaneous Rupture of the Renal Pelvis Due to Extrinsic Obstruction by Metastatic Retroperitoneal Lymphadenopathy

Abstract

Spontaneous rupture of the renal pelvis due to metastatic disease is a rare complication. Renal pelvis rupture often goes undiagnosed in cases of non-traumatic origin due to its vague abdominal and flank symptoms. We present a case of an 81-year-old male with primary non-small cell lung cancer who had renal pelvis rupture due to extrinsic compression of the ureter by retroperitoneal lymphadenopathy secondary to metastatic disease.

Keywords: forniceal rupture; renal pelvis; retroperitoneal lymphadenopathy; spontaneous rupture; ureteric obstruction.

Figure 1. Cross-sectional CT imaging

CT cross-sectional imaging in the coronal plane (left panel) of a well-circumscribed peripheral nodularity measuring 4.3 x 3.3 x 4 cm (arrow). Cross-sectional CT imaging in transverse section (right panel) of an enlarged nodularity in left anterior upper abdomen measuring 3.5 x 3.1 cm (arrow).

Figure 2. CT scan of the abdomen and pelvis

CT abdomen and pelvis (CTAP) in transverse plane (left panel) showing extravasation of contrast at the anteromedial aspect of the left renal pelvis (long arrow) with extension along the left iliopsoas muscle (short arrow). Transverse plane CTAP without contrast (middle panel) displaying compression of the left distal ureter by enlarged retroperitoneal lymph nodes measuring 10 x 4 cm (arrow). Coronal plane view of CTAP without contrast (right panel) showing extravasation of retained contrast medial to the renal pelvis outlining the iliopsoas (arrow).