URETEROPELVIC JUNCTION DISRUPTION SECONDARY TO BLUNT TRAUMA - EXCRETORY PHASE IMAGING (DELAYED FILMS) SHOULD HELP PREVENT A MISSED DIAGNOSIS

Purpose: Ureteropelvic junction disruption is a rare condition which i s often diagnosed after some delay, The aim of this study is to examin e the current status of this entity and to determine if improvements c ould be made in the diagnosis. Materials and Methods: We evaluated 5 c onsecutive adult cases of ureteropelvic junction disruption secondary to blunt trauma and compared the findings to those reported in literat ure. Results: The diagnosis was delayed by at least 24 hours in 4 of t he 5 cases (80%). Compared to the literature, in which most delays in diagnosis were the result of genitourinary tract imaging being omitted , most of our delays (3 cases) were a result of the initial contrast e nhanced spiral (helical) computerized tomography (CT) failing to provi de the diagnosis. This failure occurred because of either absence of c ontrast extravasation (2 cases) or only subtle extravasation (1 case), which was not recognized by the radiologist, The delay in diagnosis r esulted in added morbidity in all circumstances. Conclusions: Ureterop elvic junction disruption continues to be diagnosed late in a large pr oportion of cases. Absence of gross contrast extravasation on nephrogr am phase scanning using spiral CT may not exclude a major injury of th e ureteropelvic junction. Addition of delayed CT of the kidney 5 to 8 minutes or longer after contrast material injection (during the excret ory phase) may increase the probability of extravasation being demonst rated and, thus, reduce the possibility of missing a ureteropelvic jun ction disruption.