Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Urinoma is an uncommon condition caused by urine leakage from any part of the urinary tract, often due to trauma, surgery, or obstruction. In this case, a rare presentation of urinoma in a 20‐year‐old female with Fragile X syndrome, who had no prior trauma or surgical history, posed a diagnostic challenge. Initial misinterpretation as a hematoma delayed appropriate treatment. This case highlights the superiority of CT triple phase imaging in accurately diagnosing urinomas and guiding effective management. A 20‐year‐old non‐verbal female with Fragile X syndrome, developmental delay and a history of recurrent urinary tract infections (UTIs) presented with respiratory distress, weight loss and immobility. Initial CT abdomen‐pelvis scans suggested a psoas muscle hematoma and the patient was intubated due to respiratory failure. However, a repeat CT Triple phase with contrast scan identified a left distal ureteric rupture leading to urinoma formation in the retro peritoneal space. This finding followed the discovery of a distal ureteric calculus that had been missed on earlier imaging. The diagnosis was confirmed with CT triple phase imaging, which allowed detailed visualization of the urinary tract and the urine extravasation. Interventional radiology‐guided drainage of the urinoma and subsequent nephrostomy relieved the patient's high intraabdominal pressure, leading to successful extubation. Further management included ureteric stenting, total parenteral nutrition (TPN), and monitoring for complications such as recurrent fever and pleural effusion. The patient made a steady recovery with the resolution of respiratory distress. This case underscores the critical role of CT triple phase imaging in diagnosing and managing urinomas. Compared to other imaging modalities, triple phase CT provides enhanced visualization across three phases (non‐contrast, nephrographic and excretory), enabling better detection of ureteral injuries, urine extravasation and associated complications. In this case, timely use of triple phase CT guided precise interventions, such as nephrostomy and stenting and informed follow‐up care. This case demonstrates the clinical utility of CT triple phase imaging as the definitive diagnostic tool for urinomas, especially in cases where other imaging modalities fail to provide a clear diagnosis. Early and accurate diagnosis using this advanced imaging technique can significantly improve patient outcomes, particularly in rare and complex presentations like this one. Radiology, Urology, General Surgery.
How to cite this article:
Bipin Malkania and Amey Kulkarni. CT Triple Phase Imaging as the Definitive Diagnostic Modality: Unravelling a Misdiagnosed Urinoma in Fragile X Syndrome.
DOI: https://doi.org/10.36478/10.36478/makrjms.2024.11.496.499
URL: https://www.makhillpublications.co/view-article/1815-9346/10.36478/makrjms.2024.11.496.499