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Click Axial images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. A Foley catheter with an inflated balloon in the proximal left ureter was seen. Air locules in the dilated ureter and collecting system were also present and suggested ureteral rupture. Pancolitis, anasarca, bilateral pleural effusions, ascites, and scoliosis were also seen (but not directly relevant to the acute diagnosis). The CT was performed on a GE? 64-slice CT scanner. All images are from the patient's initial abdomen/pelvis CT scan performed about 60 seconds following administration of 70cc of Ultravist? 300 nonionic intravenous contrast (for arterial phase evaluation). The patient had ingested about 1 liter of oral barium contrast about 90 minutes prior to scanning. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 140 kVp and variable mAs, which ranged from 218 mAs to 387 mAs for the provided axial images.

Click Coronal images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. A Foley catheter with an inflated balloon in the proximal left ureter was seen. Air locules in the dilated ureter and collecting system were also present and suggested ureteral rupture. Pancolitis, anasarca, bilateral pleural effusions, ascites, and scoliosis were also seen (but not directly relevant to the acute diagnosis). The CT was performed on a GE? 64-slice CT scanner. All images are from the patient's initial abdomen/pelvis CT scan performed about 60 seconds following administration of 70cc of Ultravist? 300 nonionic intravenous contrast (for arterial phase evaluation). The patient had ingested about 1 liter of oral barium contrast about 90 minutes prior to scanning. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 140 kVp and variable mAs, which ranged from 218 mAs to 387 mAs.

Click Sagittal images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. A Foley catheter with an inflated balloon in the proximal left ureter was seen. Air locules in the dilated ureter and collecting system were also present and suggested ureteral rupture. Pancolitis, anasarca, bilateral pleural effusions, ascites, and scoliosis were also seen (but not directly relevant to the acute diagnosis). The CT was performed on a GE? 64-slice CT scanner. All images are from the patient's initial abdomen/pelvis CT scan performed about 60 seconds following administration of 70cc of Ultravist? 300 nonionic intravenous contrast (for arterial phase evaluation). The patient had ingested about 1 liter of oral barium contrast about 90 minutes prior to scanning. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 140 kVp and variable mAs, which ranged from 218 mAs to 387 mAs.

Click Axial images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. The delayed abdomen/pelvis CT scan showed left ureteral contrast extravasation with formation of a contained collection at the site of ureteral rupture. Air and filling defects (likely blood/clot) were seen in the left collecting system. Some contrast was seen passing through the more distal left ureter into the bladder, which indicated that some of the ruptured ureter was intact. Contrast was also seen in the right renal collecting system. There was marked interval improvement of left renal collecting system dilatation following removal of the malpositioned Foley catheter. A Foley balloon was now seen properly positioned in the bladder. Pancolitis, left pleural effusion, cholelithiasis, scoliosis, anasarca, and ascites were again seen without change. The CT was performed on a GE? 64-slice CT scanner. The abdomen/pelvis CT scan was performed about 5 hours after the patient's original CT without further intravenous/oral contrast administration. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 202 mAs to 385 mAs.

Click Coronal images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. Coronal images from the delayed abdomen/pelvis CT scan again showed left ureteral contrast extravasation with formation of a contained collection at the site of ureteral rupture. Air and filling defects (likely blood/clot) were seen in the left collecting system. Some contrast was seen passing through the more distal left ureter into the bladder, which indicated that some of the ruptured ureter was intact. Contrast was also seen in the right renal collecting system. There was marked interval improvement of left renal collecting system dilatation following removal of the malpositioned Foley catheter. A Foley balloon was now seen properly positioned in the bladder. Pancolitis, left pleural effusion, cholelithiasis, scoliosis, anasarca, and ascites were again seen without change. The CT was performed on a GE? 64-slice CT scanner. The abdomen/pelvis CT scan was performed about 5 hours after the patient's original CT without further intravenous/oral contrast administration. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 202 mAs to 385 mAs.

Click Sagittal images from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. Sagittal images from the delayed abdomen/pelvis CT scan again showed left ureteral contrast extravasation with formation of a contained collection at the site of ureteral rupture. Air and filling defects (likely blood/clot) were seen in the left collecting system. Some contrast was seen passing through the more distal left ureter into the bladder, which indicated that some of the ruptured ureter was intact. Contrast was also seen in the right renal collecting system. There was marked interval improvement of left renal collecting system dilatation following removal of the malpositioned Foley catheter. A Foley balloon was now seen properly positioned in the bladder. Pancolitis, left pleural effusion, cholelithiasis, scoliosis, anasarca, and ascites were again seen without change. The CT was performed on a GE? 64-slice CT scanner. The abdomen/pelvis CT scan was performed about 5 hours after the patient's original CT without further intravenous/oral contrast administration. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 202 mAs to 385 mAs.

Click The fluoroscopic stack images are from a 59 year old female with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. The fluoroscopic images showed needle access of a left upper pole calyx with subsequent collecting system contrast distension. The known contrast collection from proximal ureteral rupture was again seen. A guidewire was then passed down the ureter, where it repeatedly exited the ureter at its site of rupture and passed into the contained contrast collection. After several attempts, a Berenstein catheter was advanced over a guidewire and successfully passed through the intact portion of the left ureter and into the bladder. A nephroureteral stent was then passed over the guidewire and into the bladder, where its distal end was pigtailed. A post-procedure contrast bolus confirmed successful bypass of the ureteral rupture. The proximal catheter end was secured and connected to gravity drainage to promote ureteral healing. The flouroscopy was performed about 90 minutes following acquisition of a followup CT scan. All images were acquired by a GE? fluoroscopy machine. Various penetration settings were automatically adopted by the flourscopy machinery, with kV ranging from 65.5 to 70.0 and mAs ranging from 95.0 to 154.0. About 30cc of Ultravist? 300 nonionic intravenous contrast were used during the procedure. All images obtained during the procedure have been provided.

Click Axial images from a prior CT (by 2 months) of a 59 year old female who presented with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. This prior study was obtained for evaluation of retroperitoneal hemorrhage. No retroperitoneal hematoma or hemorrhage was seen. Decubitus ulcers of the sacrum, right ischial tuberosity, and right buttock with underlying gas locules and bone sclerosis/irregularity were noted which raised concern for osteomyelitis. A cirrhotic liver with ascites, anasarca, and cholelithiasis was also seen. A chronic Foley catheter balloon was present in the bladder. Bilateral pleural effusions were incompletely imaged. The CT was performed on a GE? 64-slice CT scanner. No intravenous contrast was administered. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 345 mAs to 442 mAs for the provided axial images.

Click Coronal images from a prior CT (by 2 months) of a 59 year old female who presented with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. This prior study was obtained for evaluation of retroperitoneal hemorrhage. No retroperitoneal hematoma or hemorrhage was seen. Decubitus ulcers of the sacrum, right ischial tuberosity, and right buttock with underlying gas locules and bone sclerosis/irregularity were noted which raised concern for osteomyelitis. A cirrhotic liver with ascites, anasarca, and cholelithiasis was also seen. A chronic Foley catheter balloon was present in the bladder. Bilateral pleural effusions were incompletely imaged. The CT was performed on a GE? 64-slice CT scanner. No intravenous contrast was administered. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 345 mAs to 442 mAs for the provided axial images.

Click Sagittal images from a prior CT (by 2 months) of a 59 year old female who presented with ureteral rupture following inflation of an incorrectly placed Foley catheter balloon. This prior study was obtained for evaluation of retroperitoneal hemorrhage. No retroperitoneal hematoma or hemorrhage was seen. Decubitus ulcers of the sacrum, right ischial tuberosity, and right buttock with underlying gas locules and bone sclerosis/irregularity were noted which raised concern for osteomyelitis. A cirrhotic liver with ascites, anasarca, and cholelithiasis was also seen. A chronic Foley catheter balloon was present in the bladder. Bilateral pleural effusions were incompletely imaged. The CT was performed on a GE? 64-slice CT scanner. No intravenous contrast was administered. Standard soft tissue windows were used (width = 350, center = 50). 5mm axial slices were acquired, using 120 kVp and variable mAs, which ranged from 345 mAs to 442 mAs for the provided axial images.