0:00

So the frequency of renal stones is so high, and

0:03

we see tons of renal stones every day in the

0:05

ER, that this is definitely a subject matter

0:08

which is worth your attention and worth knowing

0:11

a lot about, especially if you live in this.

0:13

Have you ever heard of the stone belt

0:15

that is in the southern parts of America?

0:16

I guess that's where patients

0:18

become more dehydrated and form

0:20

renal stones.

0:21

In this case, it's just kind of a higher-level case

0:24

demonstrating a lot of urine around the kidney.

0:27

In this case, we actually got the delayed images

0:29

consistent where we saw extravasation of contrast from

0:32

this little forniceal region that's considered the weakest

0:35

link in the urinary collecting system and is the most

0:38

likely location to pop and have urine extravasate.

0:42

In general, though, you may not always

0:43

have delayed images here. I would use

0:45

if you had contrast-enhanced images.

0:48

The fact that we have ill disequilibration of the

0:51

contrast between the two kidneys, that's an

0:53

indication that the pressure has been released here.

0:55

That large volume of fluid around the kidneys.

0:57

I think you should raise the possibility

0:59

of forniceal rupture and urinoma, uh, whenever

1:02

you see this large of a volume of.

1:04

Urine or fluid around the kidney, it can be

1:07

an indication to upscale the patient from a

1:10

watch-and-see fluid situation to a ureteric

1:13

stent because you would need to bypass and

1:16

decompress this injured urinary collecting system.

1:19

So renal stones are very important.

1:21

They're a really common cause for patients

1:22

to come to the emergency room, knowing where

1:25

they would obstruct, always imaging them.

1:28

Measuring them on axial bone windows and realizing

1:30

that if you have a large volume of perinephric fluid,

1:33

you may have a urinoma and highlighting that possibility.

1:36

If you have the opportunity to get a

1:38

delay, it's always gorgeous, but you

1:40

may not actually need to, uh, show it.

1:42

With imaging, though, I have to

1:43

tell you, your urology colleagues.

1:45

Just like everything, seeing is believing.

1:48

So if you are, um, given that opportunity,

1:50

it's always nice to have a delay.

1:52

If you're ever looking at ureteric

1:54

injuries from other entities, always do

1:56

five- to seven-minute delay to imaging.

Forniceal Rupture

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video