title: Rupture of the maternal renal calyx secondary to fetal malpresentation: a case report.
abstract: BACKGROUND
  Rupture of the renal collecting system is a potentially life-threatening condition in pregnancy. Most cases are associated with obstruction from nephrolithiasis or diseased renal parenchyma.
  
  
  METHODS
  A 24-year-old, nulliparous, African American woman at 38 weeks + 3 days' gestation presented with left flank pain refractory to conservative pain management. Computed tomography was negative for a stone but significant for infrarenal fluid and rupture of a left renal calyx. The fetal head was not flexed and appeared to be compressing the left ureter. A face presentation became apparent during her labor course, and she underwent a cesarean delivery when labor did not progress.
  
  
  CONCLUSIONS
  This represents the first reported case of a ruptured renal collecting system secondary to fetal malpresentation. A high index of suspicion is essential to diagnose collecting system rupture, and it may occur in the absence of parenchymal disease or stones.
authors.forename: Samit
authors.initials: S
authors.lastname: Patel
authors.forename: Jason
authors.initials: J
authors.lastname: Pates
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000293:injuries*; D007746:Labor Presentation; D011247:Pregnancy; D011859:Radiography; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology