Fistulazing urinoma following radio-frequency ablation of transplanted kidney for renocellular carcinoma
Presentation
Radio-frequency ablation (RFA) to transplant kidney for renocellular carcinoma. Subsequently experienced urine leak from percutaneous site. Short ureteric stent in situ. Now leaking pus from percutaneous site.
Patient Data
Transverse image (linear probe) proves the presence of a turbid fluid collection with a fistula to the subcutaneous soft tissues and the skin surface.
Longitudinal image (convex probe) demonstrates a funnel-like narrow stalk likely connecting the transplant kidney and the collection.
Overall the collection is very likely to be a urinoma secondary to the previous intervention.
CT study was performed to check if the contrast appears in the collection on excretory phase.
Pararenal collection, communicating with the collecting system, and demonstrating a fistula to the skin:
There is a 4.5 cm, peripherally-enhancing collection, located at the caudal aspect of the transplant kidney in the left lower quadrant (related to the RFA site). This collection shows fistulous communication with the overlying skin in the left lower quadrant. On the delayed phase images, there is contrast collecting within the extrarenal collection.
There is a double J stent in the collecting system of the transplant kidney. The upper pole calyces of the transplant kidney are dilated, and contrast pools within them on delayed phase images, suggesting that there is infundibular obstruction.
Case Discussion
The communication between the collecting system and the fluid collection (urinoma) was the information that only CT provided. The fistula to the skin surface and the turbid content of the collection is better visualized on ultrasound.
The urinoma was drained through he fistula.
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