Figure 1
perinephric soft-tissue stranding
Non enhanced CT scan reveals perinephric soft-tissue stranding
Complications following lithotripsy
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsC. Constantin , P. Schnyder
Connected authors
64 years, male
Clinical History
Patient presented right abdominal pain and macroscopic hematuria 6 hours after extracorporeal shock wave lithotripsy (ESWL) for a right upper uretral calculus
Imaging Findings
Patient presented right abdominal pain and macroscopic hematuria 6 hours after extracorporeal shock wave lithotripsy (ESWL) for a right upper uretral calculus.
A CT examination performed without contrast enhancement, demonstrated a large sub-capsular hematomas (fig 1.), a thickening of perinephric fascia and bridging septa and residual stone fragments in the upper uretera (fig 2.). No obstruction was detected.
The patient was discharged with AINS and antibiotherapy.
An intravenous pyelography performed two months later revealed no abnormality.
Discussion
ESWL is now used for the treatment of about 90% of renal stones. Because of the non-punctual delivery of energy into the stone, some surrounding renal parenchyma is injured.
Several autors dealing with CT scan or MRI obtained after ESWL reported a rate of renal abnormalities in 60 -70%. Most of them (70 %) had evidence of perinephric soft-tissue stranding with thickening of the perirenal fascia of Gerota and renal swelling. Sub-capsular hematomas were found in 15% of treated kidneys and intrarenal hematomas in 4%. Small low-density sub-capsular collections (representing urinomas) were discovered in 6 % cases.
Bleeding complications requiring angiography, embolisation or nephrectomy occurs in less than 1 % of ESWL. Mortality rate post renal ESWL did not exceed 0.02% in a large study of 62'000 patients
Differential Diagnosis List
Sub-capsular hematoma following extracorporeal shock wave lithotripsy
Final Diagnosis
Sub-capsular hematoma following extracorporeal shock wave lithotripsy
References
[1] Rubin JI. Arger PH. Pollack HM. Banner MP. Coleman BG. Mintz MC. VanArsdalen KN. Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation. Radiology 1987. 162 (1):21-4. (PMID: 3786764)
[2] Kaude JV. Williams CM. Millner MR. Scott KN. Finlayson B. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy. AJR. American Journal of Roentgenology 1985. 145(2):305-13. (PMID: 3875231)
[3] Bataille P. Pruna A. Cardon G. Bouzernidj M. el Esper N. Ghazali A. Westeel PF. Achard JM. Fournier A. Renal and hypertensive complications of extracorporeal lithotripsy. Presse Medicale 2000. 29(1):34-8. (PMID: 10682057)
[4] N Papanicolaou, SA Stafford, RC Pfister, AF Althausen, and SP Dretler. Significant renal hemorrhage following extracorporeal shock wave lithotripsy: imaging and clinical features Radiology 1987. 163(3):661-4. (PMID: 3575710)
[5]
Martin TV, Sosa ER
Shock-wave lithotripsy.
In De Meredith F. al.(ed) Campbell's Urology.
W B Saunders Co, seventh edition, pp 2735-2750 (1997).
Case information
| URL: | https://www.eurorad.org/case/717 |
| DOI: | 10.1594/EURORAD/CASE.717 |
| ISSN: | 1563-4086 |
Figure 2
sub-capsular hematoma
Non enhanced CT scan obtained 6 hours after ESWL showing a sub-capsular collection of high attenuation surrounding the right kidney, which attenuation value is markedly lower than that of the left kidney. A stone fragment is detectable within in the collecting system.
perinephric soft-tissue stranding
Non enhanced CT scan reveals perinephric soft-tissue stranding
sub-capsular hematoma
Non enhanced CT scan obtained 6 hours after ESWL showing a sub-capsular collection of high attenuation surrounding the right kidney, which attenuation value is markedly lower than that of the left kidney. A stone fragment is detectable within in the collecting system.