Radiol Oncol 2002; 36(2): 87-90. 

case report 


Incomplete spontaneous ureteral disruption 

Zdravko Borković1, Dubravka Srdoč1, Goran Bedalov2 

1Department of Radiology, 2Department of Urology, Clinical Hospital “Dubrava”, Zagreb, Croatia 

Background. The aim of the authors was to present the case of spontaneous partial ureteral rupture during 
a renal colic, caused by an anorganic concrement in the proximal part of the left ureter, at the level of the 
transverse processus of L3. 
Case report. On the excretory urography imaging, the dilatation of the canal system, cups, necks and 
pyelon, was observed. At the level of the pyeloureteric passage, the contrast medium was leaking. The leakage 
was found to be extending along the psoas muscle to the pelvis. On the transversal CT imaging scans, 
the contrast medium was seen along the medial and dorsal part of the perirenal space, and in the distal part, 
along the psoas muscle to the pelvis. The ureter was imaged from the pyeloureterical rupture to the site of 
the concrement. No signs of the damage of the renal parenchyma or perirenal bleeding were detected. During 
surgery, the site of the rupture was found and also a lot of the perirenal and periureteral liquid. After the extraction 
of the concrement, the suture of the rupture was made. Postoperative urography and CT showed a 
normal ureteral image. 
Conclusions. At the spontaneous partial disruption of the ureter, the contrast medium is still seen in the 
ureter, distally from the site of the rupture and as extravasation along the psoas muscle. 

Key words: ureter; rupture; tomography, X-ray computed 

Received 18 January 2002 
Accepted 2 March 2002 

Correspondence to: Zdravko Borković MD, Department 
of Radiology, Clinical Hospital “Dubrava”, Av.

G. Šuška 6, 10000 Zagreb, Croatia; Phone: +385 1 
2902860; Fax: +385 1 263 695; E-mail: 
z_borkovic@net.hr 
Introduction 

Partial or complete ureteral disruption is often 
caused by trauma, but can also be a consequence 
of surgical or other diagnostic procedures. 
The spontaneous rupture of the 
ureter is a rare condition, but the most frequent 
cause is a concrement in the pyelon or 
ureter. Typical signs for this condition are the 
absence of renal parenchymal damage, 
perirenal collection of the urine and absence 
of haematoma that are always detected in 
dorsal or medial perirenal space in case of 


Borković Z et al. / Spontaneous ureteral disruption 

trauma.1-3 After administration of contrast 
medium, the leakage and extravasation of 
contrast is always present. In case of the complete 
disruption, the contrast material is never 
seen distally from the site of the rupture, in 
contrast to the partial disruption where the 
contrast medium is always seen distally.3-5 

For the differentiation of the disruption 
type, it is important to make also excretory 
urography and CT examination with contrast 
medium in addition to anamnestic or clinical 
data. We thus have more data on contrast position, 
haematoma or renal parenchyma 
damage. The disruption caused by trauma always 
presents the damage of renal parenchyma 
and the perirenal haematoma. CT examination 
is also important in following the 
position of the contrast and that of the urino


ma.6-8 

Case report 

R. N., a 40-year-old woman, was hospitalised 
because of pain attacks, starting 2 weeks earlier, 
presenting as a renal colic. The day before 
hospitalisation, the pain was very strong, 
with colic characteristic in the area of the left 
hemiabdomen. Later on, the attack suddenly 
stopped. Clinical examination detected 
painful areas at the level of the left kidney 
and in the left hemiabdomen. 
Laboratory examinations were normal, except 
for a great number of fresh erythrocytes 
in the urine. 

Conventional radiological examination of 
urotract showed an anorganic concrement 
with the size of 8 × 4 mm large, at the level of 
the transversal processus of the L3 on the left 
(Figure 1). 

Excretory urography was made with contrast 
medium (Telebrix 380, 60 ml). The right 
kidney was normal, but in the left one, the dilatation 
of the canal system, including the 
cups with necks and pyelon, was found. The 
leakage of the contrast medium from pye-

Figure 1. X-ray of abdomen at the level of the trans-
versal processus of L3 on the left, an anorganic con-
crement, with the size of 8 × 4 mm. 


Figure 2. I.v. urography demonstrates the dilatation of 
the canal system at the left kidney and extravasation 
of the contrast from the ureter into the periureteral 
space along the psoas muscle to the level of the pelvis. 


Radiol Oncol 2002; 36(2): 87-90. 


Borković Z et al. / Spontaneous ureteral disruption 

loureteric passage in the distal direction 
along the psoas muscle to the pelvis was also 
present on the left side. The renal parenchyma 
on the left was intact (Figure 2). 

A conventional CT examination of the abdomen 
showed the dilatation of the canal system 
of the left kidney with the extravasation 
of the contrast medium into the medial and 
dorsal part of the left perirenal space, and also 
into the medial and partially ventral part of 
the peripyelic space. After the introduction of 
contrast medium, the left ureter shows opacification 
(Figures 3a,b,c,d). On the distally 
transverse scans, the contrast medium was 
seen along the psoas muscle to the pelvis. The 
findings in the right kidney were normal. 

During surgical exploration, a large 
amount of liquid was found in a perirenal 
space and along the left ureter and psoas 
muscle. The site of spontaneous rupture was 
found at the level of the pyeloureteric junction; 
the ureter, though, was not completely 
disconnected from the pyelon. The concrement 
was extracted through this part of the 
ureter and surgical suture was made. 

All control laboratory examinations were 
normal. At the control excretory urography 
performed 5 days after surgical treatment, the 
dilatation at the middle of the canal system of 
the kidney was seen, but there was no more 
signs of the leakage of the contrast. 


Figure 3. CT finding: (a) dilatation of the canal system of the left kidney, with the contrast leaking into the medial 
and dorsal perirenal space, without any sign of the trauma of the kidney or perirenal haematoma; (b) and (c) the 
contrast found in the medial part of the kidney and pyelon; d) the contrast in the ureter dispersed distally along 
the psoas muscle and also in the periuretral space. 

Radiol Oncol 2002; 36(2): 87-90. 


Borković Z et al. / Spontaneous ureteral disruption 

Discussion 
References 

Partial spontaneous rupture of the ureter is 
an extremely rare condition, mostly caused 
by ureteral stone. The rupture of the ureter 
and the pyelon with or without the rupture of 
the kidney can sometime occur as a result of 
blunt trauma. Such condition can be caused 
also by surgical or diagnostic ureteral procedures. 


The CT image of blunt renal trauma 
showed the presence of extravasation, laceration 
and haematoma of renal tissue with 
perirenal haematoma. Contrary to traumatic 
disruptions, partial spontaneous and complete 
disruptions of the ureter have a characteristic 
CT image after contrast medium applications. 
This image shows an intact renal 
parenchyma, the absence of the perirenal 
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of the ureter oriented distally from the 
rupture were not observed, whereas those 
oriented distally along the psoas muscle is 
present. 

In partial spontaneous disruption of the 
ureter, the contrast medium in the ureter is 
seen distally from the site of the rupture and 
as extravasation along the psoas muscle. 

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