Renal fornix rupture following diagnostic coronarography

Abstract

A 31-year-old man with an uneventful medical history presented at the emergency department with complaints of exercise-related chest pain for 3 weeks. ECG showed ST-elevations in the inferior leads. A diagnostic coronarography was performed and showed multivessel coronary stenosis. During this procedure 200 ml of a nonionic, low-osmolality monomeric contrast agent (Iomeron 350®) and 1250 ml of isotonic saline solution was administered intravenously. After this procedure, the patient suffered from a sudden onset and progressive severe pain in the back and the right lumbar region. A plain CT of the abdomen performed 8 hours post coronarography showed contrast enhanced fluid in the renal sinus and the perinephric/peri-ureteral space (Fig. A (scout view), B (coronal) and C (sagittal) reformatted scans). There was a bladder overdistenstion with a CT-based volumetric estimation of 995 ml. No mechanical cause of upper urinary tract obstruction was present. Subsequent urological work-up included insertion of a bladder catheter (24 hours) and administration of peroral antibiotics. Ultrasound follow-up on the next day revealed no abnormalities and the patient was discharged.