Asymptomatic Urolithiasis Complicated by Nephrocutaneous Fistula
Marion Hamard1, Gael Amzalag2, Christoph D Becker1, Pierre-Alexandre Poletti1
1Department of Imaging and Medical Information Sciences, Service of Radiology, University Hospitals of Geneva, Geneve, 2Department of Medical Imaging, Division of Nuclear Medicine, Neuchatel Hospital - La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland.
Date of Submission: 14-Sep-2016, Date of Acceptance: 22-Dec-2016, Date of Web Publication: 20-Feb-2017.
Asymptomatic spontaneous nephrocutaneous fistula is a rare and severe complication of chronic urolithiasis. We report a case of 56-year-old woman with a nephrocutaneous fistula (NFC) which developed from a superinfected urinoma following calyceal rupture due to an obstructing calculus in the left ureter. The patient was clinically asymptomatic and came to the emergency department for a painless left flank fluctuating mass. This urinoma was superinfected, with a delayed development of renal abscesses and perirenal phlegmon found on contrast-enhanced uro-computed tomography (CT), responsible for left renal vein thrombophlebitis and left psoas abscess.. Thereafter, a 99 mTc dimercaptosuccinic acid (DMSA) scintigraphy revealed a nonfunctional left kidney, leading to the decision of left nephrectomy. Chronic urolithiasis complications are rare and only few cases are reported in medical literature. A systematic medical approach helped selecting the best imaging modality to help diagnosis and treatment. Indeed, uro-CT scan and renal scintigraphy with 99 mTc-DMSA are the most sensitive imaging modalities to investigate morphological and functional urinary tract consequences of NFC, secondary to chronic urolithiasis.
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