Pediatric Ureteral Trauma

  • Etiology: Blunt abdominal trauma
  • Imaging CT:
    — Spectrum is contusion to laceration to transection with extravasation of contrast
    — Extravasation of urine with urinoma on delayed images
  • DDX:
  • Complications: Ureteral obstruction
  • Treatment: Ureteral stent
  • Clinical:

Radiology Cases of Ureteral Trauma

Radiology Cases of Ureteral Transection

CT of renal trauma / renal laceration and ureteral trauma / ureteral transection and splenic trauma / splenic laceration
Axial and coronal CT with contrast of the abdomen immediate phase (above) shows low density in the superior and inferior poles of the left kidney and fluid in the left perirenal and pararenal spaces. There is also a large area of low density in the spleen. Delayed phase CT images (below) show extravasation of urine out of the ureter into the left pararenal space.

Radiology Cases of False Positive Ureteral Transection

CT of renal laceration and suspected ureter transection
Axial CT with contrast of the abdomen (above left) shows an extensive laceration of the left kidney with an associated low density retroperitoneal hematoma surrounding the left kidney. Delayed lower axial image from the same CT exam (below left) shows extravasation of high density IV contrast around the left psoas muscle. 3D CT urogram performed the next day (right) again shows massive extravasation of IV contrast medial to the left kidney with non-visualization of the left ureter suggesting ureteral transection. The right kidney and ureter are normal. However, a retrograde urogram performed the next day showed the left ureter was not transected which allowed placement of a left ureteral stent.