Transureteroureterostomy obstruction mimicking acute tubular necrosis.
A patient receiving nephrotoxic chemotherapy for metastatic cervical cancer was examined for acute renal failure. A Tc-99m MAG3 scan showed symmetric function, bilateral increasing parenchymal activity, and no tracer excretion in either collecting system. The differential diagnosis included cisplatin-induced nephrotoxicity, dose infiltration, and obstruction of the common ureter. Analysis of the scan, an image over the injection site, and a delayed image of the urinary tract indicated obstruction of the common ureter at the anastomotic site of the transureteroureterostomy. In patients with a transureteroureterostomy, symmetric renal dysfunction, and no bladder activity, a delayed image of the urinary tract should be obtained to distinguish obstruction from acute tubular necrosis.
Esteves
Fabio P
FP
Department of Radiology, Emory University, Emory University Hospital, Atlanta, Georgia 30322, USA. fpesteves@hotmail.com
Halkar
Raghuveer K
RK
Taylor
Andrew
A
D058186:Acute Kidney Injury / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging*; D014519:Ureterostomy; D014547:Urinary Diversion / Q000379:methods
D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide